Abstract
In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.
Highlights
HIV mother-to-child transmission (MTCT) continues to threaten child survival worldwide
The use of highly active antiretroviral therapy ([Highly active antiretroviral therapy (HAART)], defined as a regimen of three or more antiretrovirals from two or more classes), which is essential for elimination of MTCT and contributes to maternal health, has been shown to be cost effective compared to single-dose nevirapine in several low- and middle-income (LMI) countries, including the Dominican Republic (DR) [6,7,8], but few data exist on the scalability of these measures or the current obstacles to eliminating MTCT in these countries [9,10,11,12,13]
After publication of the national guidelines recommending HAART for prevention of mother-to-child transmission (pMTCT) (2009–2011), the proportion diagnosed during labor and delivery rose and the proportions diagnosed within 72 hours of birth and at other or unknown times declined significantly
Summary
HIV mother-to-child transmission (MTCT) continues to threaten child survival worldwide. Over two million children are infected with HIV, the vast majority infected by MTCT in low- and middle-income (LMI) countries [1, 2]. Virtual elimination of HIV MTCT has been achieved in most industrialized countries, with declines of over 80%–90% in the number of cases of perinatally acquired HIV infection, and MTCT rates of under 2%-3% [3,4,5]. To assess progress towards MTCT elimination in this MI country, we analyzed data recorded at the time of collection of samples for virologic testing performed to determine whether perinatally exposed infants and young children had acquired HIV infection
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