Abstract
Background:The success of any prevention of mother-to-child transmission (PMTCT) program is assessed by the proportion of HIV-exposed infants that sero-convert at the end of all risk exposures. Although adopting the best feeding option for HIV-exposed infants is one of the factors that impact PMTCT outcomes, there is limited data on the assessment of PMTCT success rates based on antiretroviral interventions and feeding options. This study assesses the success rate of PMTCT service based on antiretroviral interventions and feeding options.Methods:Eighty-five HIV-infected mothers previously in care were enrolled in a prospective cohort study. Folders and structured questionnaires were used to extract data on mother-infant pair and the first CD4, count of infected mothers on enrolment at PMTCT clinic. Dry blood spot samples were obtained from exposed infants for early infant diagnosis. Results were analyzed using the SPSS software.Results:The mean age of enrolled mothers was 31.3 ± 4.4 years, and an average CD4+ T-lymphocyte count of 368.6 ± 216.2 cells/µl. Seven (8.2%) of the HIV-exposed infants were positive for HIV-1 based on early infant diagnosis results. Overall PMTCT success rate (PMTCTSR) was 91.8%. HIV-1 prevalence of 5.0%, 0% and 21.1% was found among infants of patients who opted for breastfeeding, replacement feeding, and mixed feeding respectively thus yielding PMTCT success rates of 95%, 100% and 78.9%. Pediatric antiretroviral interventions success rates in HIV-exposed infants was 95.8%, 80.0% and 66.7% based on age groups ≤ 6 months, > 6 ≤ 12 months, and > 12 ≤ 18 months respectively.Conclusion and Global Health Implications:Quality PMTCT service is vital for successful prevention of mother-to-child transmission of HIV. Implementation of more dynamic approaches such as adherence to option B+ guidelines in PMTCT service in our settings can further reduce mother-to-child transmission of HIV and improve outcomes.
Highlights
1.1 Background of the studyMother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a major public health problem and its prevention is vital in curtailing HIV acquisition among children.[1]
The objective of this study was to assess the prevention of mother-to-child transmission (PMTCT) services success rate at this facility, the only federal tertiary health institution in rural area of Ekiti state that offers anti-retroviral therapy (ART)/ PMTCT service, to determine the extent to which the facility met its set goal of achieving less than 5% mother-to-child transmission of HIV
The study: 1) assessed if certain social demographic characteristics affect PMTCT outcomes; 2) assessed the impact of the mean CD4 counts of enrolled mothers categorized based on infants HIV-status and feeding options on PMTCT outcomes; 3) assessed PMTCT success rates among enrolled mothers based on antiretroviral therapy interventions period and feeding options; 4) determined the prevalence of mother-to-child transmission of HIV-1 among exposed infants; and 5) determined the pediatric antiretroviral success rates among HIV-1 exposed infants.We hypothesised that Antireroviral interventions and feeding options will influence PMTCT outcomes in this population
Summary
Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a major public health problem and its prevention is vital in curtailing HIV acquisition among children.[1] Mother-to-ChildTransmission of HIV accounts for over 90% of HIV infections in children,[2, 3] and Nigeria has the highest number of new HIV infections among children.Motherto-child transmission accounts for up to 14% of new HIV infections globally.[4,5] The risk of transmission in the absence of any intervention by an infected mother is estimated to be 15-25%, which increases significantly to 20-45% when infants are breastfed.[6] Prevention of mother-to-child transmission (PMTCT) interventions reduces the risk of transmission to less than 5% if strategies are adhered to during pregnancy, labor, delivery and breastfeeding.[7] These interventions involve holistic approaches that range from administration of antiretroviral therapy for the mother, a short course of antiretroviral drugs for the baby, adoption of measures to prevent HIV acquisition in the pregnancy and right choice of feeding options. Adopting the best feeding option for HIV-exposed infants is one of the factors that impact PMTCT outcomes, there is limited data on the assessment of PMTCT success rates based on antiretroviral interventions and feeding options.This study assesses the success rate of PMTCT service based on antiretroviral interventions and feeding options
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