Determinants of mother-to-child transmission of HIV despite PMTCT interventions in Enugu, Nigeria

Abstract

Background. The burden of paediatric HIV is unacceptably high in Nigeria. Prevention of mother-to-child transmission (PMTCT) of HIV represents a critical opportunity for reducing the burden of paediatric HIV. Objectives. To determine risk factors of MTCT of HIV following PMTCT interventions. Methods. This was a prospective study over a 12-month period, involving HIV-positive pregnant mothers in their third trimester. A structured, interviewer-administered questionnaire was used to obtain relevant information about mothers and their babies. Maternal HIV RNA levels (viral load) and CD4 counts were also obtained. DNA polymerase chain reaction (PCR) testing was done for all the infants. Data analysis was with SPSS version 15 (Chicago, USA). Results. There was a total of 210 infants, comprising 198 singletons and 6 sets of twins. Two infants had a positive DNA PCR, giving an MTCT rate of 1%. There was significant association between MTCT of HIV and maternal HIV RNA levels ( p =0.009) and mixed feeding ( p <0.001). None of the other risk factors studied, namely maternal CD4 count, mode of delivery and duration of rupture of fetal membrane before delivery, had any influence on MTCT. Conclusion. The rate of MTCT can be reduced markedly if there is strict adherence to PMTCT strategies. It is therefore recommended that there be increased access to PMTCT programmes and full participation of mothers in Nigeria.