Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambi
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Date
2012
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Background: Mother-to-child transmission of HIV (MTCT) remains the most prevalent source of pediatric HIV infection. Most
PMTCT (prevention of mother-to-child transmission of HIV) programs have concentrated monitoring and evaluation efforts
on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV positive mothers to estimate MTCT rates.
Method: This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age
from five Zambian provinces between September 2007 and July 2010.
Results: The majority of children (58.6%) had a PCR test conducted between age six weeks and six months. Exclusive
breastfeeding (56.8%) was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and
93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP),
30.9% received highly active antiretroviral treatment (HAART), 19.6% received sdNVP only and 12.9% received no ARVs.
Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were
5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP,
sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV
exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1) both mother and
infant receiving prophylaxis, 2) children never breastfed and 3) mother being 30 years old or greater. Overall between
September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then
between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant
difference.
Conclusion: The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non-chemoprophylactic factors
also play a significant role in HIV transmission. The overall change in the proportions of positive PCR results over time is
more likely an indication of better PMTCT implementation. Determination of the outcomes of PMTCT in program settings is
feasible but requires accurate documentation and analysis.
Description
Research Article
Keywords
HIV, Perinatal HIV Transmission, Mother-to-child transmission of HIV (MTCT)
Citation
Citation: Torpey K, Mandala J, Kasonde P, Bryan-Mofya G, Bweupe M, et al. (2012) Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambia. PLoS ONE 7(8): e42859. doi:10.1371/journal.pone.0042859