In 2002, more than 280,000 HIV-exposed babies were born in South Africa. According to international PMTCT guidelines, these children require follow-up to 12 months of age. Worldwide, the high loss to follow-up rates experienced by PMTCT programs precludes them from identifying and managing HIV-infected children. Socio-economic factors have been identified as potential contributors to poor follow-up. A small descriptive study to examine socio-economic circumstances of women attending the Coronation Women and Children's Hospital PMTCT program was undertaken. Cross-sectional data from 176 women, interviewed at their infants' 12-month visit, was collected using a semi-structured questionnaire. Socio-economic factors such as poverty, geographical relocation and a lack of paternal support may affect the capacity of families to comply with the PMTCT follow-up program. Fifty-seven percent of mothers were unemployed, 25% of fathers did not support their children and only 58% of children remained resident in Johannesburg at the 12-month visit. The lack of follow-up of HIV-infected children denies them access to adequate medical care. Understanding the socio-economic factors that affect the ability of communities to comply with PMTCT programs will assist resource-poor countries in devising strategies to achieve follow-up of HIV-exposed infants.
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"HIV prevalence is generally higher among low socioeconomic status . The higher incidence among children of lower socioeconomic background has been attributed to a lower access to prevention of mother to child transmission services due to associated illiteracy, lower awareness, and poverty . The observation in this study that HIV infected children had lower nutritional indices than the HIV negative controls (Table 1) has been reported in other studies [38, 39] which attributed the finding partially to poor food intake and the catabolic effects of the opportunistic infections. "
[Show abstract][Hide abstract] ABSTRACT: Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population.
AIDS research and treatment 08/2014; 2014:351043. DOI:10.1155/2014/351043
"The study underlines the need of establishing systematic referral mechanisms to ensure that HIV infected infants are enrolled in ART programs. Such significant LTFU of HIV exposed infants has been noted by other programs in sub-Saharan Africa [13,15,17,19]. "
[Show abstract][Hide abstract] ABSTRACT: By the end of 2009 an estimated 2.5 million children worldwide were living with HIV-1, mostly as a consequence of vertical transmission, and more than 90% of these children live in sub-Saharan Africa. In 2008 the World Health Organization (WHO), recommended early initiation of Highly Active Antiretroviral Therapy (HAART) to all HIV infected infants diagnosed within the first year of life, and since 2010, within the first two years of life, irrespective of CD4 count or WHO clinical stage. The study aims were to describe implementation of EID programs in three Tanzanian regions with differences in HIV prevalences and logistical set-up with regard to HIV DNA testing.
Data were obtained by review of the prevention from mother to child transmission of HIV (PMTCT) registers from 2009--2011 at the Reproductive and Child Health Clinics (RCH) and from the databases from the Care and Treatment Clinics (CTC) in all the three regions; Kilimanjaro, Mbeya and Tanga. Statistical tests used were Poisson regression model and rank sum test.
During the period of 2009 -- 2011 a total of 4,860 exposed infants were registered from the reviewed sites, of whom 4,292 (88.3%) were screened for HIV infection. Overall proportion of tested infants in the three regions increased from 77.2% in 2009 to 97.8% in 2011. A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test). The prevalence of HIV infection among infants was higher in Mbeya when compared to Kilimanjaro region RR = 1.872 (95% CI = 1.408 -- 2.543) p < 0.001. However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p < 0,001. A substantial of loss to follow-up (LTFU) was evident at all stages of EID services in the period of 2009 to 2011. Among the infants who were receiving treatment, 61% were found to be LFTU during the review period.
The study showed an increase in testing of HIV exposed infants within the three years, there is large variations of HIV prevalence among the regions. Challenges like; sample turnaround time and LTFU must be overcome before this can translate into the intended goal of early initiation of lifelong lifesaving antiretroviral therapy for the infants.
BMC Public Health 10/2013; 13(1):910. DOI:10.1186/1471-2458-13-910 · 2.26 Impact Factor
"Hence, understanding the determinants of retention is important. In a public-funded urban hospital in Johannesburg, South Africa, almost half of infants born to HIV-infected mothers in a routine PMTCT service were lost to follow-up (LTFU) by two weeks of age . At the time this study was conducted, the national guidelines in South Africa did not include routine HIV testing for infants at six weeks and recommended testing for infants at 12 months of age . "
[Show abstract][Hide abstract] ABSTRACT: Follow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa.
We conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants' LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death.
Of 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (≥ 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044).
This urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.