Mother-to-child Transmission Of Human Immunodeficiency Virus Research Articles

Effect of Dolutegravir-Based First-Line Antiretroviral Therapy on Mother-to-Child Transmission of HIV Among HIV-Exposed Infants in Ethiopia: a Before-and-After Study.

Currently, Dolutegravir (DTG)-based regimens are administered to women on Option B plus to prevent mother-to-child transmission (MTCT) of the virus. However, its effect on reducing MTCT of human immunodeficiency virus (HIV) among HIV-exposed infants over the previously used Efavirenz (EFV)-based regimen is unknown. This study aimed to compare the effects of DTG-based and EFV-based regimens on the MTCT of HIV among HIV-exposed infants in Ethiopia. An uncontrolled before-and-after study design was conducted among 958 mother-infant pairs (479 on EFV-based and 479 on DTG-based regimens) enrolled in the prevention of mother-to-child transmission (PMTCT) care from September 2015 to February 2023. The outcome variable was the HIV infection status among the exposed infants. A log-binomial model was employed, and the proportion was computed to compare the incidence of MTCT of HIV in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess the predictor variables. Mothers on DTG-based regimens were approximately 44% (adjusted risk ratio (aRR): 0.56; 95% CI: 0.44, 0.70) less likely to transmit HIV to their infants than those on EFV-based regimens. In addition, poor or fair adherence to antiretroviral therapy (ART) (aRR: 5.82; 95% CI: 3.41, 9.93), home delivery (aRR: 3.61; 95% CI: 2.32, 5.62), mixed feeding practice (aRR: 1.83; 95% CI: 1.45, 2.3) and not receiving antiretroviral prophylaxis (aRR: 3.26; 95% CI: 1.6, 6.64) were found to increase the risk of MTCT of HIV infection, whereas older maternal age (aRR: 0.93; 95% CI: 0.9, 0.96) was a protective factor. Mother-to-child transmission of HIV was less frequently observed in mother-infant pairs exposed to the DTG-based regimens as compared to those exposed to the EFV-based regimens. Thus, DTG-based first-line ART regimens supplementation should be sustained to achieve global and national targets for zero new infections in HIV-exposed infants.

Factors associated with knowledge of mother-to-child transmission of HIV among reproductive-age women in Indonesia: a multilevel analysis

BackgroundMaternal transmission of human immunodeficiency virus (HIV) commonly occurs from mother to child during pregnancy, delivery, and breastfeeding which accounts for almost all the new HIV infections among children aged 0–14 years. Despite major efforts and progress in controlling and preventing HIV, it continues to pose a great public health threat, especially in Indonesia. This study assessed the factors associated with the knowledge of mother-to-child transmission (MTCT) of HIV among reproductive-age women in Indonesia.MethodsThis study used data from the 2017 Indonesian Demographic and Health Survey (IDHS). We sampled 39,735 reproductive-age women (15–49 years) for analysis. Using Stata version 16.0, multilevel logistic regression models were fitted, and the results were presented as adjusted odds ratios (aORs) with their confidence intervals (CIs).ResultsThe study found that 72% of women had knowledge of MTCT of HIV. Women who were aged between 45 and 49 years (aOR = 1.65, 95%CI = 1.46–1.88) had higher odds of knowledge of MTCT of HIV than those aged 15–19 years. Women who attained higher education (aOR = 2.92, 95%CI = 2.06–4.15) had increased odds of knowledge of MTCT of HIV than those with no formal education. Women who had four children (aOR = 1.19, 95% CI = 1.05–1.35) had higher odds of knowledge of MTCT of HIV than nulliparous women. Women who frequently read newspapers/magazines (aOR = 1.14, 95%CI = 1.06–1.25) and frequently used the internet almost every day (aOR = 1.28, 95%CI = 1.19–1.38) had higher odds of knowledge of MTCT of HIV than those who did not read newspapers/magazines and non-users of internet, respectively. Women within the richer (aOR = 1.11, 95%CI = 1.02–1.20) and the richest (aOR = 1.14, 95%CI = 1.04–1.25) wealth quintile higher odds of knowledge of MTCT of HIV than those in the poorest wealth quantile. Women who resided in rural areas were less likely to have knowledge of MTCT of HIV (aOR = 0.79, 95% CI = 0.74–0.86) than those in urban settlements.ConclusionsKnowledge of MTCT of HIV was slightly above average. The study findings on the factors associated with knowledge of MTCT of HIV provide evidence for policymakers and clinicians to utilize in the quest to eliminate MTCT of HIV among children. We recommend that awareness programs should consider the key findings from this study when delivering public education or when developing interventions to improve women’s knowledge on MTCT of HIV.

Follow-up for 3 years of a pediatric population diagnosed in 2018 with mother-to-child transmission of HIV in 8 Latin American countries in the PLANTAIDS cohort

IntroductionThe frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis.MethodologyRetrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development).ResultsThe study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8–5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection.ConclusionsIt is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children.

Knowledge of prevention of mother-to-child transmission of HIV among reproductive age women in high HIV/AIDS prevalent countries: A multilevel analysis of recent Demographic and Health Surveys.

A lack of enough knowledge about the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) among reproductive-age women is thought to be a key contributor to new pediatric HIV infections worldwide, and rising HIV-related infant mortality, particularly in resource-limited countries. Knowledge of MTCT of HIV is key to halt the progression of HIV/AIDS. Therefore, this study aimed to assess knowledge of MTCT of HIV and its associated factors among reproductive-age women in high HIV/AIDS prevalent countries. A secondary data analysis was performed using 8 HIV/AIDS prevalent countries' Demographic and Health Surveys. A total weighted sample of 97,130 respondents was included in this study. Stata 17 was used for data extraction, coding, and analysis. A multilevel binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to determine the factors of good knowledge of MTCT of HIV among reproductive-age women. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. The prevalence of good knowledge of MTCT HIV was 57.89% (95% CI: 57.67,58.29). Mothers aged 25-34 (AOR = 1.37, 95% CI = 1.32, 1.42), 35 and above(AOR = 2.46,95% CI = 1.41, 1.52), mothers' primary education (AOR = 1.32, 95% CI = 1.26, 1.38),), secondary education (AOR = 1.65,95% CI = 1.56, 1.74), higher education (AOR = 1.72,95% CI = 1.58,1.86), exposed to mass media (AOR = 1.12, 95% CI = 1.08,1.16) rich wealth status (AOR = 1.11 (95% CI = 1.06,1.15), talked about MTCT (AOR = 1.70,95% CI = 1.64, 1.76), visited by field worker (AOR = 1.09, 95% CI = 1.03,1.14), health facility visit (AOR = 1.15, 95% CI = 1.11, 1.18), urban dwellers (AOR = 1.09, 95% CI = 1.04,1.14), ever tested for HIV(AOR = 2.18 (95% CI = 2.10,2.27), currently working status (AOR = 1.15, 95% CI = 1.12,1.19) were factors associated with good knowledge of MTCT of HIV/AIDS among reproductive age women. Overall, the prevalence of good knowledge of MTCT was low in high HIV/AIDS prevalent countries. Maternal age, primary education and above, exposed to media, having higher wealth status, talked about MTCT during ANC visits, being visited by a field worker, visited a health facility, currently working, living in the urban area, and ever been tested for HIV were positively associated with knowledge of MTCT. Health policy and programs should focus on educating mothers, encouraging women to contact health facilities and a well-targeted communications program is required to enhance knowledge of MTCT of HIV.

Evaluation of prevention of mother to child transmission programme at a tertiary healthcare facility in Southwestern Nigeria.

Most children acquire HIV infection as a result of mother to child transmission (MTCT). The risk of MTCT of HIV is generally estimated at between 15 and 40% without prophylaxis. MTCT was responsible for approximately 370,000 infant HIV infections worldwide with Nigeria accounting for 30%. The study evaluated the effectiveness of prevention of MTCT of HIV infection programme by determining the rate of MTCT of HIV in babies who underwent the programme by review of health records of mother- infant pairs at Olabisi Onabanjo University Teaching Hospital. This was a cross-sectional analytical conducted over twelve years period with medical records of 545 mother-infant pairs analysed. The rate of MTCT of HIV infection was 2.9% compared to 7.1% earlier reported in the centre. The rate of MTCT of HIV was lowest among mother-infant pairs who both received prophylaxis. Ages at recruitment are strong determinant of the risk of infection. Late usage of MTCT prevention service is a risk for HIV infection among exposed infants.

Edukasi Pencegahan HIV-AIDS dan Mother to Child Transmission of HIV Pada Wanita Usia Subur Dalam Mendukung Indonesia Bebas AIDS 2030

Acquired Immunodeficiency Syndrome (AIDS) is a type of infection caused by the Human Immunodeficiency Virus (HIV) which attacks the immune system and causes susceptibility to a disease. HIV/AIDS cases are like an iceberg phenomenon because fewer people are checking their health status than actually happened. There are still high rates of HIV/AIDS and Mother to Child Transmission (MTCT) of HIV in the world and in Indonesia and even in Papua.So it is necessary to educate various lines of society. The purpose of this community service is to increase the knowledge of women of childbearing age about HIV/AIDS prevention and MTCT of HIV. The educational methods used were (1) Pre-test (2) Dissemination of material and leaflet (3) Evaluation of the results of educational activities with a post-test. The result of this community service was an increase in knowledge about HIV/AIDS and accompanied by MTCT of HIV. This proves that there is a positive increase after the educational intervention given.

The association between mother-to-child HIV transmission knowledge and antenatal care utilisation in Cameroon.

While the health benefits of antenatal care (ANC) utilisation for mothers and their infants have been well documented, very few studies have explored the association between mother-to-child transmission (MTCT) knowledge of human immunodeficiency virus (HIV) and mothers' utilisation of ANC in HIV endemic regions such as Cameroon. To address this void in the literature, we use the 2018 Cameroon Demographic and Health Survey to examine the association between mother's knowledge of MTCT of HIV and the three strands of ANC utilisation (i.e., number of ANC visits, timing to first ANC visit, and place of delivery). We found that women with adequate MTCT knowledge were more likely to have four to seven ANC visits (relative risk ratio [RRR]=1.39, p<0.001) and more than eight ANC visits (RRR=1.43, p<0.05), compared to their counterparts with inadequate knowledge. Similarly, women with adequate MTCT knowledge were more likely to attend ANC within the first trimester (odds ratio [OR]=1.16, p<0.05) and to give birth in a health facility (OR=1.37, p<0.001) than their counterparts with inadequate MTCT of HIV knowledge. These results remained robust after controlling for theoretically relevant variables. Based on these findings, we discussed several implications for policymakers and recommendations for future research.

Coinfection Dynamics of HBV-HIV/AIDS with Mother-to-Child Transmission and Medical Interventions

In this study, we analyzed the effect of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) on the transmission dynamics of their coinfection to make a recommendation based on reasons to public health sector, policy makers, and programme implementers. We proved that the solutions of the sub and full models are positive and bounded. The effective reproduction numbers of the models are derived using the next generation matrix method. The disease-free and endemic equilibria of the submodels and the coinfection model are computed, and the stability of those equilibria is analyzed using Routh-Hurwitz criteria after computing the associated effective reproduction numbers. We performed a sensitivity analysis to show the influence of different parameters on the effective reproduction number of HBV-HIV/AIDS coinfection model, and we identified the most sensitive parameters are τ 2 and α 1 , which are the rate of MTCT of HIV and treatment rate for HBV infected class, respectively. The numerical simulation of the model is done using MATLAB and the findings from the simulations are discussed. From the results of numerical simulations, we observed that an increase in the rates of MTCT of HBV and HIV exacerbated HBV-HIV/AIDS coinfection, while a decrease in the rates of MTCT of these infections would decline the number of cases, minimize the spread, and help to eliminate HBV-HIV/AIDS coinfection from the society gradually.

Spatial variability of mother-to-child human immunodeficiency virus transmission in a province in the Brazilian Rainforest: An ecological study.

The mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a serious public health problem in the Brazilian Rainforest. This study aimed to spatially analyze this type of infection between 2007 and 2018 in Pará, which is the second-largest Brazilian state in the Brazilian Rainforest and also has the highest MTCT of HIV in Brazil. We analyzed the incidence rates of HIV (including the acquired immunodeficiency syndrome (AIDS) by MTCT as the main route of infection in children younger than 13 years old and whose mothers live in Pará. We employed spatial autocorrelation, spatial scanning, and geographic-weighted spatial regression techniques. In the period of this study, 389 new HIV/AIDS were noted, with territorial expansion of the incidence rates in the municipalities in northern and southern Pará having the highest rates. São Francisco do Pará had high spatial risk and high-spatiotemporal risk clusters comprising municipalities in western and south-western Pará between 2013 and 2016. The spatial variability of HIV/AIDS incidence rates was found to be common in the number of men and women with formal jobs; unemployed ≥18 years old people; elementary school pupils; and families enrolled in the "Single Registry for Social Programs". The social equity approach in Pará guarantee pregnant women access to preventive, diagnostic and treatment health services and their children should be supported to eliminate the MTCT of HIV in Pará.

Clinical and Biological Risk Factors Associated with Increased Mother-to-Child Transmission of HIV in Two South-East HIV-AIDS Regional Centers in Romania.

Background and Objectives: The occurrence of human immunodeficiency virus (HIV) infection in children in Romania has been reported since 1989. This retrospective study was aimed at assessing clinical and biological risk factors for mother-to-child transmission (MTCT) of HIV in two HIV-acquired immune deficiency syndrome (AIDS) Regional Centers (RCs), Constanta and Craiova in Romania. Materials and Methods: During the study period (2008–2019), 408 HIV-positive pregnant women, 244 from Constanta RC and 164 from Craiova RC who attended antenatal visits, were included. All HIV-positive pregnant women were under combined antiretroviral therapy (cART) during pregnancy and childbirth, being followedup with their infants up to 18 months after delivery. We investigated the clinical as well as biological risk factorsassociated with increased MTCT of HIV. Results: Comparing different variables of HIV-positive pregnant women from the two HIV-AIDS CRs, we find that there are significant differences between the mean value of hemoglobin, CD4 level, environmental area, marital and amniotic membranes status, and HIV patient stage in the last trimester of pregnancy (p < 0.05), but without any differences in mother’s mean age, education level, type of delivery, breastfeeding, the duration of cART administration, HIV viral load, and survival rate. Conclusions: In 408 HIV-positive pregnant women followed up at two HIV-AIDS RCs in Romania, the most important clinical and biological risk factors associated with increased MTCT of HIV are represented by anemia, CD4 level, and HIV patient stage.

Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Among Pregnant Women with Dual or Triplex Infections of HIV, HBV and HCV in Nigeria: A Systematic Review

Background: There is no previous systemic review on mother-to-child transmission (MTCT) rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among pregnant women with dual or triplex infections of HIV, HBV and HCV. The aim of this study was to systematically review the literature and identify MTCT rates and factors associated with MTCT of HIV, HBV and HCV among pregnant women and their infant pairs with dual or triplex infections of HIV, HBV and HCV in Nigeria. Methods: A systematic review was done using PRISMA guidelines. Searches were conducted on 19th February 2021 in PubMed, Google Scholar and CINAHL to identify studies published from 1st February 2001 until 31st January 2021 using keywords including ‘MTCT,’ ‘co-infection,’ ‘dual infection,’ ‘triplex infection,’ ‘HIV,’ ‘HBV,’ and ‘HCV’. Studies that reported MTCT rate of at least any of HIV, HBV and HCV and/or its associated factors with them among pregnant women and their infant pairs with dual and triplex infections of HIV, HBV and HCV in Nigeria irrespective of publication status or language were eligible. If there was no eligible study, studies on mono-infection (HIV or HBV or HCV) population were eligible for narrative synthesis only. Studies were excluded if they were abstracts only or published prior to February 2001. The data from these studies were extracted independently by two authors with disagreements resolved by a third author and consensus reached. The protocol was prospectively registered in the PROSPERO database, ID: CRD42020202070. Findings: The search identified 891 reports. After screening titles and abstracts, 25 full-text articles were assessed for eligibility and none of the studies was included for quantitative synthesis in the systematic review. We identified one relevant large national ongoing study. We have included a comprehensive narrative account of 18 studies where we identified a MTCT rate analysis of HIV (median MTCT rate at birth: 2.18%; range: 0.0% to 9.6%; 5,863 participants; 15 studies) and HBV (median MTCT rate at birth: 51.6%; range: 42.86% to 72.0%; 433 participants; three studies) among mother-infant pairs with mono-infection of HIV and HBV respectively, as this forms the only evidence base in this area. Interpretation: Currently, we found no reliable evidence to inform decisions on the rate of MTCT transmission of HIV, HBV and HCV among mother-infant pairs with dual or triplex infection of HIV, HBV and HCV in Nigeria since the only present study is ongoing. This important topic has been addressed in few studies involving an entirely mono-infection population for HIV or HBV but not HCV. Future research needs to focus on the MTCT rates among mother-infant pairs with dual or triplex infections of HIV, HBV and HCV. Funding: TETFund National Research Fund 2019 (Grant number TETFund/DR&D/CE/NRF/STI/33). Declaration of Interest: We declare no competing interests.

Preventing mother to child transmission of HIV: lessons learned from China

BackgroundThe program for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) was launched in 2003 in China, but few studies have been conducted to describe the panorama of PMTCT. We investigated the rate and associated factors of mother-to-child transmission (MTCT) in China from 2004 to 2018.MethodsHIV-infected pregnant women from two areas in China between 2004 and 2018 were enrolled. Antiretrovirals (ARVs) were provided to the mothers and their babies, and the children were followed and tested for HIV.ResultsIn total, 857 mothers and their 899 children were enrolled, and the overall MTCT rate was 6.6% (95% CI 5.0–8.2). The MTCT rates of nonintervention, only formula feeding (FF), infant prophylaxis (IP) + FF, single dosage antiretrovirals (sdARVs) + IP + FF, zidovudine (AZT) alone+IP + FF and prenatal combination antiretroviral therapy (cART) + IP + FF were 36.4, 9.4, 10.0, 5.7, 3.8 and 0.3%, respectively. The MTCT rate declined over time. No ARVs, CD4 count < 200/μL, low birth weight, and breastfeeding were associated with MTCT of HIV. For different ARVs, a higher MTCT rate was observed for AZT alone, sdARVs, and no ARVs compared to cART for pregnant women.ConclusionsAlthough the overall MTCT rate remains relatively high, the real-world effect of prenatal cART+IP + FF in China has exerted the same protective effects in high-income countries. With the extension of prenatal cART for pregnant women with HIV, the MTCT rate of HIV has gradually declined in China. However, the coverage of prenatal cART for pregnant women should be further improved. The effect of only post-exposure prophylaxis for infants was limited.

Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review.

BackgroundChildhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV.MethodsA realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome.ResultsThree CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make ‘male friendly’ adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV.ConclusionsThe CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a ‘male friendly space’ and where there are high levels of community education programs around MTCT.

Prevention of Mother-to-Child Transmission of HIV: Data Analysis Based on Pregnant Women Population from 2012 to 2018, in Nantong City, China.

China has implemented a nation-wide policy to control mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) since 2011, yet the efficacy of the control policy is less studied. The aim of the present study was to report the data in the prevention of MTCT of HIV in Nantong city, China. The screening and prevalence of HIV in pregnant women and the efficacy of prophylaxis in Nantong city, China, January 2012 through December 2018, were analyzed. Among a total population of 410,044 pregnant women, anti-HIV was tested prenatally in 393,658 (96.0%) women and in 16,287 (3.97%) women at delivery. In total, 51 women were confirmed with HIV infection. After the exclusion of repeat pregnancies, the overall prevalence of HIV infection was 1.20/10 000 (48/400,377). The prevalence (6.75/10,000) in women tested at delivery was >5-fold higher than that (1.02/10,000) in prenatally screened women. Of 48 HIV-infected women, 12 terminated their pregnancies and 36 others delivered 36 neonates, of whom 35 were followed up. No HIV infection occurred in 24 children born to mothers with antiretroviral therapy (ART) during pregnancy along with other preventive measures. Among 11 children born to mothers who did not receive ART during pregnancy because of the absence of a prenatal anti-HIV test, none of the 6 children who were delivered by cesarean section and timely administered neonatal antiretroviral prophylaxis was infected, but 2 (40%) of 5 children who were spontaneously delivered and administered delayed antiretroviral prophylaxis were infected. Prenatal identification of HIV infection and timely administration of all preventive measures can completely block MTCT of HIV. The data indicate that more efforts must be taken to ensure that all pregnant women are tested for anti-HIV during pregnancy. For pregnant women who missed the prenatal screening, a positive result in rapid anti-HIV test at delivery should be sufficient to take preventive measures to prevent MTCT of HIV.

Impact of antiretroviral regimen on viral suppression among pregnant women living with HIV in Brazil.

Human immunodeficiency virus (HIV) viral load (VL) during pregnancy is a critical determinant of the risk of HIV mother-to-child transmission (MTCT). Prior studies suggest that VL suppression is influenced by antiretroviral regimen. In this study, using secondary real-life data from the Ministry of Health of Brazil, we compared VL suppression at 60-180 days after the first antiretroviral therapy (ART) prescription during pregnancy and time to undetectable VL among pregnant women under treatment with double nucleoside/nucleotide regimens combined with efavirenz, boosted lopinavir, boosted atazanavir, or raltegravir, with adjustment for potential confounders in multivariable models. A total of 18,997 pregnant women living with HIV were included in the study. Compared to regimens containing lopinavir, we found that atazanavir-, efavirenz-, and raltegravir-based regimens were superior in achieving both outcomes after adjustment for age, social vulnerability index, time under ART, baseline CD4+ cell count, and baseline HIV VL. Raltegravir-containing regimens had the highest adjusted odds/rates of VL suppression compared to patients with other regimens. Elimination of HIV MTCT is still a critical public health issue in many countries. Our findings suggest that raltegravir-based regimens were superior when compared to efavirenz-, lopinavir-, and atazanavir-based antiretroviral regimens in achieving suppression of HIV VL.

Knowledge, attitudes, and practices regarding exclusive breastfeeding among HIV-positive mothers in Uganda: A qualitative study.

In Uganda, the prevalence of human immunodeficiency virus (HIV) in pregnant women was estimated at 6.1% in 2009, and in 2011, mother-to-child transmission (MTCT) of HIV resulted in 20 600 new paediatric HIV infections. A total of 50% of MTCT of HIV in Uganda occurs after birth, and this is partially attributable to poor adherence to infant feeding (IF) guidelines. Poor IF practices contribute to approximately 1.4 million deaths in children aged younger than five. In 2011, Uganda's rate of exclusive breastfeeding (EBF) was 62% for infants aged 0 to 5 months. Identifying barriers provides information on how to improve support for HIV-positive mothers' adherence to EBF, which may take the form of targeted interventions. This study explores the knowledge, attitudes, and practices of HIV-positive mothers in Kampala, Uganda, regarding EBF of infants aged younger than 6 months. Five focus group discussions, each consisting of five HIV-positive mothers, were carried out at Kawempe Home Care using a semi-structured guide. Thematic content analysis was used to analyse the data. The study findings showed that the main barriers to HIV-positive mothers practising EBF include a lack of IF counselling, fear of HIV transmission through breast milk, returning to work, and breastfeeding difficulties. The main factors influencing HIV-positive mothers' decisions regarding IF are IF counselling and partners' and families' recommendations. This study recommends increasing access to couples-based HIV testing at antenatal clinics and couples-based IF counselling, while ensuring that it addresses breastfeeding difficulties.

Mother to Child Transmission of HIV and Associated Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, Ethiopia.

BackgroundVertical transmission of Human Immunodeficiency Virus (HIV) is the primary route of infection among children. Ethiopia is among the top ten countries in the world with the highest burden of HIV infections among children. Therefore we aimed to assess mother to child transmission (MTCT) of HIV and associated factors among HIV exposed infants (HEIs).MethodsA cross-sectional study was conducted using retrospective data collected from HEIs paired with their mothers who had received the services in prevention of mother to child transmission (PMTCT) programs from January 2014 to December 2017 in public health facilities in Dessie town. Data of a total of 313 HEIs paired with their mothers were obtained by using semi-structured data extraction proforma from their medical records. The data were processed in Epi-info version 7.1.2.0 and analyzed using SPSS version 22. Crude and adjusted odds ratios with their 95% confidence intervals and p-value were used to identify significant factors.ResultsThe prevalence of HIV among exposed infants was 3.8%. Absence of maternal antenatal care visit (AOR = 4.6, 95% CI: 1.17–17.99), home delivery (AOR = 4.2, 95% CI: 1.04 −16.76), absence of antiretroviral intervention to the mother (AOR= 5.7, 95% CI: 1.10–29.36), and failure to initiate nevirapine prophylaxis for the infant (AOR = 5.3, 95% CI: 1.11 −25.44) were significant factors of MTCT of HIV.ConclusionPrevalence of MTCT of HIV was low (3.8%) in Dessie town public health facilities. Having ANC visit, delivery at health facility, maternal ARV drug intake, and infant ARV prophylaxis were the significant protective factors against MTCT of HIV. Promoting ANC service utilization among pregnant women and providing counseling as well as setting up linkage with PMTCT and giving ARV intervention to all HIV positive pregnant women and timely initiation of NVP prophylaxis to all HEIs should be recommended by the minister of health and health facilities.

Phagocytosis of a Model Human Immunodeficiency Virus Target by Human Breast Milk Leukocytes Is Predominantly Granulocyte-Driven When Elicited by Specific Antibody.

Studies demonstrate a protective effect of antibodies (Abs) in breast milk (BM) against mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Contribution of the BM cellular component has been overlooked. The only clinical HIV vaccine trial to demonstrate efficacy, RV144, correlated protection with Abs mediating functions through the constant immunoglobulin region-the crystallizable fragment (Fc). These data support induction of vaccine Abs triggering antiviral activities by leukocytes through Fc receptors (FcRs). To measure Ab-dependent cellular phagocytosis (ADCP), an essential Fc-mediated response, by BM phagocytes. Cells were isolated from five human BM samples obtained at 7-183 days postpartum and analyzed for ADCP. Fluorescent beads coated with HIV envelope (Env) epitopes were used as targets. Sixty-seven to 100 mL of milk was utilized. Total cell concentrations per milliliter were 16,083-222,857, with 1.6-12.3% being CD45+ leukocytes. ADCP activity was measurable using the HIV-specific Ab 830A. Use of the actin inhibitor cytochalasin D and FcR blocker indicated that ADCP was actin dependent and required FcR engagement. ADCP scores were variable, but largely consistent, across the samples studied, exhibiting <4-fold difference from lowest to highest activity for CD45+ cells. Of the CD45+ ADCP, significantly more activity was granulocyte derived (72-95%), while the remaining activity was monocyte driven. The data indicate that BM phagocytes can manifest antiviral activities in the presence of specific Abs and therefore may contribute to reduction of MTCT of HIV.

Determinants of comprehensive knowledge of mother to child transmission (MTCT) of HIV and its prevention among Zimbabwean women: Analysis of 2015 Zimbabwe Demographic and Health Survey

ABSTRACTIntroduction: The global burden of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome has significantly decreased; however, new HIV infections decline slowly; this poses challenges to achieve Sustainable Development Goal 3.3. Mother-to-child transmission (MTCT) of HIV contributes to about 6.4% of all new pediatric HIV infections in Zimbabwe. Women’s comprehensive knowledge of MTCT of HIV and its prevention is associated with poor utilization of MTCT services and therefore new pediatric HIV infections. We use Demographic and Health Survey (DHS) of 2015 to measure determinants of correct comprehensive knowledge of MTCT and prevention of mother-to-child transmission (PMTCT)of HIV in Zimbabwe.Methods: We conducted a secondary analysis of 2015 DHS among 9955 women at reproductive age. Correct comprehensive knowledge of MTCT and PMTCT was measured as a composite score of five questions. We used weighing factors to account for the two-stage cluster sampling technique. Frequencies and relative frequencies were used to measure sociodemographic factors of women; we employed bivariate and multivariate logistic regression analysis to examine determinants of correct comprehensive knowledge of MTCT and PMTCT.Results: About 70.5% of women have correct comprehensive knowledge of MTCT and PMTCT. In multivariate logistic regression analysis, factors strongly associated with correct comprehensive knowledge were age of women (where 15–19 years have lower adjusted odds ratio [AOR] than other age groups), residing in Mashonaland central, Masvingo, Harare, and Bulawayo provinces (p < 0.005), and receiving posttest counseling after HIV test (AOR = 1.49, 95% confidence interval [CI] = 1.12–1.98, p = 0.007). However, Christian women were less likely to have such knowledge (AOR = 0.57, 95% CI = 0.37–0.88, p = 0.012).Discussion: 30% of women at reproductive age in Zimbabwe lack correct comprehensive knowledge of MTCT and its prevention. Such knowledge is associated with demographic factors such as age, religion, provinces, and receiving posttest counseling. The fact that MTCT of HIV still poses a challenge in the country, interventions toward the elimination of new newborn HIV infections should consider these factors.

Status of Prevention of Mother-to-Child Transmission (PMTCT) Services Utilization and Factors Affecting PMTCT Service Uptake by Pregnant Women Attending Antenatal Care Clinic in Selected Health Facilities of Afar Regional State, Ethiopia

Mother-to-child transmission (MTCT) is the predominant way for children to acquire human immunodeficiency virus (HIV) infection worldwide including Ethiopia. Thus, objective of this study was to determine the status of prevention of mother-to-child transmission (PMTCT) services utilization and factors affecting PMTCT utilization in health facilities of Afar region, Ethiopia. A cross-sectional study was conducted from December 2014 to April 2015 taking 347 pregnant women and 22 health care providers. Data were collected using a questioner prepared separately for pregnant women and health care providers involved in PMTCT service delivery. Data were analyzed using SPSS considering P value <0.05 statistical significant. The study indicated that the PMTCT service utilization was 67.7%. The study also showed that there is statistically significant association in using PMTCT service with women education level, monthly income, and residence around PMTCT site. Though not statistically significant, excess waiting time, limited physical access to PMTCT sites, and transportation problem were identified as barriers for PMTCT service utilization by pregnant women. Though knowledge of mothers on MTCT of HIV and PMTCT service utilization in agropostural community of Afar region was promising, there were also different barriers identified hindering PMTCT utilization. Thus, we recommend “Wored” and zonal health office to create awareness on significance of PMTCT service in the community, enhance accessibility of PMTCT sites, provide up-to-date trainings for health care providers, and ensure constant supply for PMTCT service.