Reducing Pediatric HIV Infection: Estimating Mother-to-Child Transmission Rates in a Program Setting in Zambia
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Date
2010
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Journal of acquired immune deficiency syndromes and human retrovirology
Abstract
Background: Vertical transmission of HIV remains the main
source of pediatric HIV infection in Africa with transmission rates as
high as 25%–45% without intervention. Even though effective
interventions to reduce vertical transmission of HIVare now available
and remarkable progress has been made in scaling up prevention of
mother-to-child transmission (PMTCT) services, the effectiveness of
PMTCT interventions is unknown in Zambia. In this study, we
estimate HIV vertical transmission rates at different age bands among
perinatally exposed children.
Methods: The study analyzed program data of DNA polymerase
chain reaction results and selected client information on dried blood
spot samples from perinatally exposed children aged 0–12 months
sent to the polymerase chain reaction laboratory from 5 provinces
between September 2007 and January 2009.
Results: Samples of 8237 babies between 0 and 12 months were
analyzed, with 84% of the mothers having ever breastfed their
children. The observed transmission rate was 6.5% (5.1%, 7.8%)
among infants aged 0–6 weeks when both mother and infant received
interventions compared with 20.9% (12.3%, 29.5%) where no
intervention was given to either mother or baby. Observed HIV
transmission with single-dose nevirapine (sdNVP) was 8.5% (5.9%,
11.0%) among infants aged 0–6 weeks, whereas zidovudine with
sdNVP (zidovudine + NVP) and highly active antiretroviral therapy
were associated with observed transmission rates of 6.8% (4.5%,
9.1%) and 5.0% (3.0%, 7.0%), respectively; whereas these estimates
were not significantly different from one another, they were all
significantly lower than no intervention for which the estimated rate
was 20.9%. Regardless of the intervention, the observed transmission
rates were higher among infants aged 6–12 months.
Conclusions: PMTCT interventions, including sdNVP, are working
in program settings. However, postnatal transmission especially after
6 months through suboptimal feeding practises remains an important
challenge to further reduce pediatric HIV
Description
Research Article
Keywords
effectiveness, PMTCT, PCR, transmission rate