Abstract
BackgroundTo improve the care and treatment of HIV-exposed children, early infant diagnosis (EID) using dried blood spot (DBS) sampling has been performed in Senegal since 2007, making molecular diagnosis accessible for patients living in decentralized settings. This study aimed to determine the evolution of the HIV transmission rate in children from 2008 to 2015 and to analyze associated factors, particularly the mother’s treatment status and/or child’s prophylaxis status and the feeding mode.MethodsThe data were analyzed using EID reports from the reference laboratory. Information related to sociodemographic characteristics, HIV profiles, the mother’s treatment status, the child’s prophylaxis status, and the feeding mode was included. Descriptive statistics were calculated, and bivariate and multivariate logistic regression analyses were performed.ResultsDuring the study period, a total of 5418 samples (5020 DBS and 398 buffy coat) from 168 primary prevention of HIV mother-to-child transmission (PMTCT) intervention sites in Senegal were tested. The samples were collected from 4443 children with a median age of 8 weeks (1–140 weeks) and a sex ratio (M/F) of 1.1 (2309/2095). One-third (35.2%; N = 1564) of the children were tested before 6 weeks of age. Twenty percent (N = 885) underwent molecular diagnostic testing more than once. An increased number of mothers receiving treatment (57.4%; N = 2550) and children receiving prophylaxis (52.1%; N = 2315) for protection against HIV infection during breastfeeding was found over the study period. The transmission rate decreased from 14.8% (95% confidence interval (CI): 11.4–18.3) in 2008 to 4.1% (95% CI: 2.5–7.5) in 2015 (p < 0.001). However, multivariate logistic regression analysis revealed that independent predictors of HIV mother-to-child transmission included lack of mother’s treatment (adjusted odd ratio (aOR) = 3.8, 95% CI: 1.9–7.7; p˂0.001), lack of child’s prophylaxis (aOR = 7.8, 95% CI: 1.7–35.7; p = 0.009), infant age at diagnosis (aOR = 2.2, 95% CI: 1.1–4.3 for ≤6 weeks versus 12–24 weeks; p = 0.025) and protective effect of breastfeeding on ART against formula feeding (aOR = 0.4, 95% CI: 0.2, 0.7; p = 0.005).ConclusionThis study demonstrates the effectiveness of PMTCT interventions in Senegal but indicates also that increased efforts should be continued to reduce the MTCT rate to less than 2%.
Highlights
Pediatric HIV infection remains a significant public health issue; 2.6 million children, 2.3 million of whom were in sub-Saharan Africa (SSA), were infected worldwide in 2014 [1]
One-third (35.2%; N = 1564) of the children were tested before 6 weeks of age
This study demonstrates the effectiveness of prevention of HIV mother-to-child transmission (PMTCT) interventions in Senegal but indicates that increased efforts should be continued to reduce the mother-to-child transmission (MTCT) rate to less than 2%
Summary
Pediatric HIV infection remains a significant public health issue; 2.6 million children, 2.3 million of whom were in sub-Saharan Africa (SSA), were infected worldwide in 2014 [1]. In alignment with the WHO guidelines, Option A was adopted in Senegal in 2010; in this regimen, AZT treatment is begun at the 14th week of gestation, a single dose of nevirapine (sdNVP) is provided during labor, daily doses of zidovudine/lamivudine (AZT/3TC) are given for 7 days postpartum, and daily doses of NVP are given from birth to up to 4–6 weeks postpartum. By the end of 2011, Option B was adopted; this option consists of a three-drug regimen provided to the mother from the 14th week of gestation to delivery and continuing during the entire breastfeeding period. At the end of 2012, Senegal adopted Option B+, which provides lifelong ART to all HIV-infected pregnant and breastfeeding women irrespective of CD4 count or clinical stage [2,3,4]. This study aimed to determine the evolution of the HIV transmission rate in children from 2008 to 2015 and to analyze associated factors, the mother’s treatment status and/or child’s prophylaxis status and the feeding mode
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