Abstract
The human immunodeficiency virus (HIV) remains a leading cause of maternal morbidity and mortality in Sub-Saharan Africa. Prevention of mother-to-child transmission (PMTCT) has proven an effective strategy to end paediatric infections and ensure HIV-infected mothers access treatment. Based on cross-sectional data collected from June 2008 to May 2013, we assessed changes in HIV prevalence, risk factors for HIV, provision of PMTCT antiretroviral treatment (ART), and the association between HIV infection, birth outcomes and maternal characteristics at the Simão Mendes National Hospital, Guinea-Bissau’s largest maternity ward. Among 24,107 women, the HIV prevalence was 3.3% for HIV-1, 0.8% for HIV-2 and 0.9% for HIV-1/2. A significant decline in HIV-1, HIV-2, and HIV-1/2 prevalence was observed over time. HIV infection was associated with age and ethnicity. A total of 85% of HIV-infected women received ART as part of PMTCT, yet overall treatment coverage during labour and delivery declined significantly for both mothers and infants. Twenty-two percent of infants did not receive treatment, and 67% of HIV-2-infected mothers and 77% of their infants received ineffective non-nucleoside reverse transcriptase inhibitors for PMTCT. Maternal HIV was associated with low birth weight but not stillbirth. Inadequate continuity of care and ART coverage present challenges to optimal PMTCT in Guinea-Bissau.
Highlights
Despite remarkable progress over the past decade, Sub-Saharan Africa (SSA) continues to have the highest global prevalence of human immunodeficiency virus (HIV)
According to the joint United Nations programme on HIV/AIDS (UNAIDS), 3.4% of the population in Guinea-Bissau is infected with HIV (UNAIDS, 2018c), yet the true number may be notably higher considering that HIV prevalence in the country’s capital is 6.7%7
Assessing birth outcomes for HIV-1, HIV-2 and HIV-1/2 dually infected women compared with HIV negative women, we found that maternal HIV-1 and HIV-1/2 co-infection were associated with low birthweight (LBW), AOR 1.25 and AOR 1.73, respectively (Table 3)
Summary
Despite remarkable progress over the past decade, Sub-Saharan Africa (SSA) continues to have the highest global prevalence of HIV. In 2017, an estimated 1.3 million pregnant women were living with HIV, and 130,000 infants were infected with HIV in S SA3. PMTCT has yielded remarkable results, with an estimated 93% of pregnant women in eastern and southern Africa living with HIV receiving antiretroviral prophylaxis, resulting in mother-to-child transmission rates of less than 10%. High rates of early mortality and loss to follow-up have recently been described among HIV-infected children (< 15 years of age) in Guinea-Bissau. Based on a study of 525 HIV-infected children, 11% died and 39% were lost to follow-up within the first year of follow-up, highlighting continuous challenges with implementing sustainable PMTCT services[15].
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