A Review and Analysis of Outcomes from Prevention of Mother-to-Child Transmission of HIV Infant Follow-up Services at a Pediatric Infectious Diseases Unit of a Major Tertiary Hospital in Nigeria: 2007-2020.

Ebelechuku Francesca Ugochukwu,Chinyere Ukamaka Onubogu,Emeka Stephen Edokwe,Uchenna Ekwochi,Stanley Kenechi Onah,Esther Ngozi Umeadi,Kenneth Nchekwube Okeke

doi:10.21106/ijma.510

Abstract

Background and Objective:Above 90% of childhood HIV infections result from mother-to-child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria.Methods:This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client’s folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status.Results:Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never-breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative.Conclusion and Global Health Implications:Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.

Highlights

According to the National Agency for the Control of AIDS (NACA), Nigeria accounted for 37,000 of the world’s 160,000 new cases of babies born with Human Immunodeficiency Virus (HIV) in 2016.2 A high burden of infection in women naturally translates to an increase in that of infants and young children as vertical or mother-to-child transmission (MTCT) accounts for upwards of 90% of infections
Infants who did not receive any form of ARVs for post-exposure prophylaxis (PEP) were significantly more likely to have MTCT of HIV
The determining factor for being HIV-negative hinged on mother-infant pairs receiving ARVs and not necessarily the breastfeeding status

Summary

Introduction

Without any interventions during these stages, MTCT rates range between 15% and 45%, increasing with the duration of breastfeeding.[3] ,the risk of MTCT can be reduced to less than 2% with a package of evidence-based interventions which constitute prevention of mother-to-child transmission (PMTCT) strategies.[3] PMTCT services are offered to women of childbearing age living with or at risk of HIV to maintain their health and prevent their infants from acquiring HIV These services include preventing unwanted pregnancies among women living with HIV; safe childbirth practices; lifelong antiretroviral (ARV) drug therapy to mothers once their status is ascertained, irrespective of CD4 cell counts; ARV prophylaxis to infants from birth; infant feeding counseling and appropriate choices; early infant virologic diagnosis of HIV post-partum and during the breastfeeding period.[3]. 90% of childhood HIV infections result from mother-to-child transmission (MTCT).This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria

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Discussion

Conclusion