Abstract
Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.
Highlights
With a population of 23.3 million and a national HIV prevalence of 4.5%, Cameroon is one of the countries most affected by the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic in West and Central Africa [1] [2]
As per Option B+ recommendations, clients were initiated on antiretroviral therapy (ART) immediately after HIV diagnosis, and blood was drawn for baseline laboratory tests of CD4 cell count, full blood count, liver function test, serum creatinine, and fasting blood sugar
All 669 participants who initiated Option B+ were enrolled in the study
Summary
With a population of 23.3 million and a national HIV prevalence of 4.5%, Cameroon is one of the countries most affected by the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic in West and Central Africa [1] [2]. National data from 2011 showed that while 81% of pregnant women seen in health facilities received HIV testing during antenatal care (ANC), labor and delivery (L & D), and the postpartum period combined (8.4% tested HIV-positive), only 67% of these HIV-positive women received antiretroviral therapy (ART) for PMTCT [3] [4]. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within
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