Abstract
BackgroundThe Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery. We evaluated the impact of antiretroviral (ARV) regimen and maternal CD4+ count on HIV transmission within the Tingathe program in Lilongwe, Malawi.MethodsWe reviewed clinical records of 1088 mother-infant pairs enrolled from March 2009 to March 2011 who completed follow-up to first DNA PCR. Eligibility for antiretroviral treatment (ART) was determined by CD4+ cell count (CD4+) for women not yet on ART. ART-eligible women initiated stavudine-lamivudine-nevirapine. Early ART was defined as ART for ≥14 weeks prior to delivery. For women ineligible for ART, optimal ARV prophylaxis was maternal AZT ≥6 weeks+sdNVP, and infant sdNVP+AZT for 1 week. HIV transmission rates were determined for ARV regimens, and factors associated with vertical transmission were identified using bivariate logistic regression.ResultsTransmission rate at first PCR was 4.1%. Pairs receiving suboptimal ARV prophylaxis were more likely to transmit HIV (10.3%, 95% CI, 5.5–18.1%). ART was associated with reduced transmission (1.4%, 95% CI, 0.6–3.0%), with early ART associated with decreased transmission (no transmission), compared to all other treatment groups (p = 0.001). No association was detected between transmission and CD4+ categories (p = 0.337), trimester of pregnancy at enrollment (p = 0.100), or maternal age (p = 0.164).ConclusionLow rates of MTCT of HIV are possible in resource-constrained settings under routine programmatic conditions. No transmissions were observed among women on ART for more than 14 weeks prior to delivery.
Highlights
The Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery
In resource-limited settings, studies have demonstrated the efficacy or effectiveness of various PMTCT interventions, including singledose nevirapine, combination prophylaxis, maternal antiretroviral treatment (ART), and extended infant prophylaxis [3,4,5,6]. These studies have informed the development of World Health Organization (WHO) guidelines with simple and effective interventions that can result in transmission rates of less than 5% feasible, even in breastfeeding populations [7,8]
An estimated 330,000 new infections occur in children every year, the vast majority attributed to vertical transmission [9]
Summary
The Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery. In resource-limited settings, studies have demonstrated the efficacy or effectiveness of various PMTCT interventions, including singledose nevirapine (sdNVP), combination prophylaxis, maternal antiretroviral treatment (ART), and extended infant prophylaxis [3,4,5,6]. These studies have informed the development of World Health Organization (WHO) guidelines with simple and effective interventions that can result in transmission rates of less than 5% feasible, even in breastfeeding populations [7,8]. Outside the unique environment of controlled research studies, few reports [12,13,14] have documented the realworld effectiveness of PMTCT interventions when properly administered within routine programmatic settings
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