Abstract
BackgroundAntiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007–2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa.ResultsData for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07–1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31–20.15, p = 0.019).ConclusionsAmong the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.
Highlights
Antiretroviral therapy (ART) has proved effective in reducing rates of mother-to child transmission (MTCT) of Human Immunodeficiency Virus (HIV) to very low levels in resource-rich countries and in some resource-limited contexts [1,2,3,4,5]
When implementing a prevention of mother-to-child transmission (PMTCT) program, local hospitals may adhere to World Health Organization (WHO) guidelines [6], endorse local guidelines issued by national authorities, or follow protocols from clinical trials
In order to explore such issues, we retrospectively evaluated the records of a perinatal hospital service in Luanda, Angola, to evaluate the main outcomes among women and infants accessing a local program for prevention of HIV mother-to-child transmission
Summary
Antiretroviral therapy (ART) has proved effective in reducing rates of mother-to child transmission (MTCT) of Human Immunodeficiency Virus (HIV) to very low levels in resource-rich countries and in some resource-limited contexts [1,2,3,4,5]. It is only partially known to which extent such favourable results may be obtained by local PMTCT programs, that several countries and municipalities have implemented In such programs, care is usually provided at a hospital level, and usually depends on local resources, with no or limited external support from international agencies or other sources. In order to explore such issues, we retrospectively evaluated the records of a perinatal hospital service in Luanda, Angola, to evaluate the main outcomes among women and infants accessing a local program for prevention of HIV mother-to-child transmission. Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa
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