Abstract
BackgroundThe World Health Organisation and the Joint United Nations Programme in 2006 reaffirmed the earlier recommendation of 2000 that all HIV-exposed infants in resource-poor countries should commence cotrimoxazole (CTX) prophylaxis at 6-weeks of life. CTX prophylaxis should be continued until the child is confirmed HIV-uninfected and there is no further exposure to breastmilk transmission. We determined CTX coverage and explored factors associated with CTX administration in HIV-exposed infants at a primary health clinic in South Africa.MethodsIn a cross-sectional study of HIV-exposed infants 6–18 months of age attending a child immunisation clinic, data from the current visit and previous visits related to CTX prophylaxis, feeding practice and infant HIV testing were extracted from the child's immunisation record. Further information related to the administration of CTX prophylaxis was obtained from an interview with the child's mother.ResultsOne-third (33.0%) HIV-exposed infants had not initiated CTX at all and breastfed infants were more likely to have commenced CTX prophylaxis as compared to their non-breastfed counterparts (78.7% vs 63.4%) (p = 0.008). Availability of infant's HIV status was strongly associated with continuation or discontinuation of CTX after 6 months of age or after breastfeeding cessation. Maternal self-reports indicated that only 52.5% (95%CI 47.5–57.5) understood the reason for CTX prophylaxis, 126 (47%) did not dose during weekends; 55 (21%) dosed their infants 3 times a day and 70 (26%) dosed their infants twice daily.ConclusionA third of HIV-exposed children attending a primary health care facility in this South African setting did not receive CTX prophylaxis. Not commencing CTX prophylaxis was strongly associated with infants not breastfeeding and unnecessary continued exposure to CTX in this paediatric population was due to limited availability of early infant diagnosis. Attendance at immunization clinics can be seen as missed opportunities for early infant diagnosis of HIV and related care.
Highlights
Cotrimoxazole (CTX) prophylaxis has been known for its protective effect against opportunistic infections in adults and its benefits have been demonstrated in HIV infected children [1,2]
The World Health Organisation (WHO)/United Nations Programme on HIV/ AIDS (UNAIDS) recommendations for universal CTX prophylaxis in all HIV exposed infants and HIV infected children were made when mother-to-child transmission (MTCT) rates were reportedly much higher in the absence of interventions to reduce the risk of MTCT
Considering the lower MTCT rate achieved in recent years, less than 5% of HIV exposed children would essentially benefit from CTX prophylaxis 95% would require it until breastfeeding cessation and confirmation of their negative HIV status
Summary
Cotrimoxazole (CTX) prophylaxis has been known for its protective effect against opportunistic infections in adults and its benefits have been demonstrated in HIV infected children [1,2]. The recommendation of the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/ AIDS (UNAIDS) in 2004, that all HIV exposed infants should receive CTX from 4–6 weeks of age until infants are confirmed HIV uninfected and no longer exposed to HIV through breastfeeding. The WHO/UNAIDS recommendations for universal CTX prophylaxis in all HIV exposed infants and HIV infected children were made when mother-to-child transmission (MTCT) rates were reportedly much higher in the absence of interventions to reduce the risk of MTCT. The World Health Organisation and the Joint United Nations Programme in 2006 reaffirmed the earlier recommendation of 2000 that all HIV-exposed infants in resource-poor countries should commence cotrimoxazole (CTX) prophylaxis at 6-weeks of life.
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