Abstract
Background:Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing.Methods:At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data.Results:Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV.Conclusion and Global Health Implications:We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era.
Highlights
IntroductionThe demonstrated efficacy of prevention of mother-to-child transmission of HIV (PMTCT) remains dependent on both maternal and infant adherence to PMTCT activities.A wealth of research has described adherence to HIV medications in many populations across multiple settings, but less evidence exists regarding adherence to post-natal PMTCT activities such as antiretroviral therapy (ART) prophylaxis and infant testing for infants born to HIV-positive women.[3,4,5,6,7,8,9]
There was a lag between initial WM recruitment (June 2015) and Wise Infant Study (WIN) enrollment (January 2016), during which time, WM women continued to be lost to follow-up (LTFU), there was no significant difference in mean number of days between WM and WIN enrollment time with respect to WM randomization status (control = 199 days (SD 64 days), intervention = 196 days (SD 61 days), p = 0.86); this held for both study sites
This study is the first to our knowledge to report on infant access to the post-natal NVP prophylaxis components of prevention of mother-to-child transmission of HIV (PMTCT) and completion of six-week early infant diagnosis (EID) HIV testing within the setting of a maternal antiretroviral therapy (ART) adherence intervention, and is one of a limited number of studies that have followed a cohort of infants through the PMTCT-cascade under Option B+ conditions.While this study did not demonstrate a difference in NVP receipt for infant prophylaxis and time to EID testing with respect to the maternal electronic drug monitoring (EDM) adherence intervention, it does illuminate trends of special concern within the infant PMTCT cascade
Summary
The demonstrated efficacy of PMTCT remains dependent on both maternal and infant adherence to PMTCT activities.A wealth of research has described adherence to HIV medications in many populations across multiple settings, but less evidence exists regarding adherence to post-natal PMTCT activities such as antiretroviral therapy (ART) prophylaxis and infant testing for infants born to HIV-positive women.[3,4,5,6,7,8,9]. Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions.We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
