Abstract
Introductionthe HIV-free survival rate is the gold-standard measure of the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting. However, data on HIV-free survival among the HIV-exposed infants followed up in most low-resource settings are lacking. We determined the HIV-free survival among breastfed infants in two tertiary facilities in a resource-poor setting in northern Uganda.Methodswe conducted a retrospective cohort study in May 2019 and retrospectively reviewed records of HIV-exposed infants registered in 2014 through 2016 at two tertiary facilities in northern Uganda. We analyzed data using SPSS v16 software package. The chi-square and Student t-tests were used to compare factors among infant groups. Multivariate logistic regression analysis was used to determine factors independently associated with HIV-free survival. P-value <0.05 was considered for statistical significance.Resultsmajority of the infants were males 55.6% (203/365) and 98.6% (360/365) received nevirapine prophylaxis. A total of 345 (94.5%) infants were exclusively breastfed, only 100/345 (29.0%) of whom were exclusively breastfed for at least 6 months, while the breastfeeding status of 44/345 (12.8 %) infants could not be ascertained. The overall HIV-free survival rate was 93.7% (342/365), while 2.7% (10/365) were HIV-infected and 3.6% (13/365) died. Infants´ age at enrolment in care (aOR 5.20, p=0.008) and treatment facility (aOR 3.76, p=0.027) were the independent determinants of HIV-free survival.Conclusionthe HIV-free survival rate among the breastfed infants in the study setting marginally falls short of the recommended standard, thus calling for more efforts to improve survival.
Highlights
Even though the incidence of paediatric HIV is falling as a result of an increase in effective methods to prevent mother-to-child transmission of HIV, an estimated 180,000 (110,000-260,000) new paediatric HIV-1 infections occurred in 2017, primarily through mother-to-child transmission, mainly in sub-Saharan Africa [1]
Our study estimates that the HIV-free survival rate in the study setting for breastfed infants enrolled by 2 months of age was 94.6%, below the World Health Organization (WHO) goal of >95% HIV-free rate in breastfeeding population for virtual elimination of HIV
A further prospective study would be necessary to assess a more accurate HIV-free survival rate given the limitations of retrospective data
Summary
Even though the incidence of paediatric HIV is falling as a result of an increase in effective methods to prevent mother-to-child transmission of HIV, an estimated 180,000 (110,000-260,000) new paediatric HIV-1 infections occurred in 2017, primarily through mother-to-child transmission, mainly in sub-Saharan Africa [1]. Uganda rolled out nationwide implementation of PMTCT option B+ approach in 2013, a policy whereby all HIVinfected pregnant and breastfeeding women were started on combination ART (with lamivudine/tenofovir disoproxil fumarate/efavirenz [3TC/TDF/EFV] as the preferred regimen) for life, regardless of their WHO clinical stage and/or CD4 cell count, following the World Health Organization (WHO) guidance [6] This was later expanded in a 2016 update of the national guidelines [7] following the release of new WHO guidelines in 2015 [8], with the recommendation for lifelong ART for all HIV-positive individuals, including pregnant and breastfeeding women, regardless of clinical stage and CD4 count. We carried out a study to determine the HIV-free survival among breastfed infants enrolled by 2 months of age in a resource-poor setting
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