PMTCT Intervention Research Articles

Incidence of mother-to-child transmission of HIV and predictors of positivity among HIV exposed infants in South Gondar public hospitals, Northwest Ethiopia: competing risk regression model

BackgroundThe principal route of HIV infection in children is vertical transmission. Thus, this study aimed to assess the incidence of mother-to-child transmission of HIV and predictors of positivity among HIV-exposed infants.MethodInstitutions-based retrospective follow-up study was conducted in South Gondar Public hospitals, Northwest Ethiopia from December 2019 to November 2021. The data were taken from PMTCT logbooks and patient medical records, with death being the competing event. Data were entered in to Epi info version 7 and exported to STATA version 14 for final analysis. Both bivariable and multiple variable proportional subdistribution hazard analysis were conducted to identify predictors. P-value < 0.05 was level of significance.ResultA total of 469 exposed infant mother pairs records were included. The cumulative incidence rate at the end of the study period was 5.2 per 1000 person months (5.2; 95% CI: 3.4-8.0).Infants’ absence of ARV prophylaxis at birth (aSHR = 3.7; 95% CI: 1.33–10.48), Mothers with no PMTCT intervention (aSHR = 5.1; 95% CI: 1.83–14.03), home delivery (aSHR = 4.1; 95%CI: 1.46–11.63) and maternal disclosure of HIV status to partner/families (aSHR = 2.9; 95% CI: 1.06–7.78) were predictors of HIV positivity.ConclusionThe study found that Infants’ absence of ARV prophylaxis at birth, mothers without PMTCT intervention, home delivery and mothers who were not disclosing their HIV status to families were predictors of HIV positivity.

Acceptability of mentor mother peer support for women living with HIV in North-Central Nigeria: a qualitative study

BackgroundMentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria.MethodsWe conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected.ResultsMost participants were female (n = 78, 67%), and married (n = 110, 94%). All participant groups found mentor mothers acceptable as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers’ services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers.ConclusionsMentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention.Trial registrationClinicaltrials.gov registration number (NCT 01936753), registered on September 3, 2013 (retrospectively registered).

Retention-in-care in the PMTCT cascade: definitions matter! Analyses from the INSPIRE projects in Malawi, Nigeria and Zimbabwe.

IntroductionDefinitions of retention‐in‐care in Prevention of Mother‐to‐Child Transmission of HIV (PMTCT) vary substantially between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidence‐based interventions for improving retention‐in‐care. In this paper, we estimated retention‐in‐care rates according to different definitions, and we quantified and visualized the degree of agreement between definitions.MethodsWe calculated retention in care rates using nine definitions in the six INSPIRE PMTCT intervention studies, conducted in three sub‐Saharan African countries between 2013 and 2017. With data from one of the studies (E4E), we estimated the agreement between definitions using Gwet’s agreement coefficient (AC1) and concordance. We calculated positive predictive values (PPV) and negative predictive values (NPV) for all definitions considering successively each definition as the reference standard. Finally, we used a Multiple Correspondence Analysis (MCA) to examine clustering of the way different definitions handle retention‐in‐care.ResultsRetention‐in‐care rates among 5107 women ranged from 30% to 76% in the complete dataset with Gwet’s AC1 being 0.56 [0.53; 0.59] indicating a moderate agreement between all definitions together. Two pairs of definitions with high inner concordance and agreement had either very high PPV or very high NPV, and appeared distinct from the other five definitions on the MCA figures. These pairs of definitions were also the ones resulting in the lowest and highest estimates of retention‐in‐care. The simplest definition, that only required a final clinic visit to classify women as retained in care, and classified 55% of women as retained in care, had a PPV ranging from 0.7 to 1 and a NPV ranging from 0.69 to 0.98 when excluding the two pairs afore‐mentioned; it resulted in a moderate to substantial agreement and a 70% to 90% concordance with all other definitions.ConclusionsOur study highlights the variability of definitions in estimating retention‐in‐care. Some definitions are very stringent which may be required in some instances. A simple indicator such as attendance at a single time point may be sufficient for programme planning and evaluation.

Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data.

Background: Mother to child transmission of HIV (MTCT) is a global challenge affecting many countries especially in sub-Saharan Africa. In 2009 about 370,000 infants were infected with HIV mainly through MTCT and most of them in sub-Saharan Africa. We aimed to determine the effectiveness of Option B+ compared to other options in reducing rates of early MTCT of HIV infections in Zambia.Methods: This was a retrospective cohort study based on routinely collected data using SmartCare in Zambia. Survival analysis with Cox Proportional Hazard regression was used to determine association between MTCT and regimen type of mothers. Kaplan-Meier (K-M) curves were used to compare MTCT for infants born to mothers option B+ to those on other options, and Wilcoxon (Breslow) test was used to establish statistical significance.Results: Overall (n = 1,444), mother-baby pairs with complete data were included in the analysis, with the median age of mothers being 33 (28–38) years; and 57% of these women were on Option B+. MTCT rate was estimated at 5% (73/1,444) [P = 0.025]. A Kaplan-Meier estimate showed that HIV Exposed Infants (HEI) of mothers on Option B+ had lower MTCT rate than those who were on other MTCT prevention interventions [Wilcoxon test; chi2 = 4.97; P = 0.025]. Furthermore, The Nelson Aalen cumulative hazard estimates indicated similar evidence of option B+ being more effective than other options with some statistical significance [HR = 0.63, P = 0.068]. HEI of option B+ mothers had 50% reduced risk of having HIV infection compared to option A/B [adjusted HR = 0.4; 95% CI = 0.28–0.84; P = 0.010]. HEI to women who were married had an increased risk 50% of getting infected compared to those not married [adjusted HR = 1.5; 95% CI = 3.43–6.30; P < 0.001]. Exposed infants whose mothers had assisted delivery had 3 times increased risk of getting infected compared to those born through normal vaginal delivery [Adjusted HR = 3.2; 95% CI = 0.98–10.21; P = 0.050].Conclusions: The use of Option B+ as PMTCT intervention was found to be more effective in reducing MTCT of HIV compared to other options. Scaling up access to life-long ART and improving retention for women on treatment can potentially reduce further vertical transmission.

HIV prevalence and risk factors in infants born to HIV positive mothers, measured by dried blood spot real-time PCR assay in Tigray, Northern Ethiopia

BackgroundInfants infected during pregnancy or while breastfeeding requires early HIV diagnosis at 6 weeks after birth to identify HIV infection and timely treatment. The objective of this work was to determine the prevalence and associated risk factors of HIV among HIV exposed infants in the Tigray regional state, Northern Ethiopia.MethodsA cross-sectional study was conducted on 350 exposed infants born to HIV seropositive mothers from September 01 to December 30, 2016. Convenient consecutive sampling technique was employed to enroll HIV exposed infants from age 6 weeks to 18 months attending prevention of mother to child transmission (PMCT) clinic at Anti Retroviral Therapy (ART) site facility in Tigray, Ethiopia. Sociodemographic data and associated risk factors were collected using a structured questionnaire. Dried Blood Spot (DBS) samples were collected from each infant and transported by post to Tigray Health Research Institute to detect HIV infection using real-time Polymerase Chain Reaction (PCR). Data were entered into EPI Info version 7, exported and analyzed using Statistical Package for Social Sciences (SPSS) version 22. p-value less than 0.05 was deemed to be statistically significant by Fisher’s exact test.ResultsThree hundred forty infants (175 males, 165 females) met the criteria for selection during the completion of the study and the overall HIV prevalence was found to be 2.1% (n = 7). The majority of infants were from urban areas (n = 246, 72.4%). 45.5% (5/11, p = 0.001) infants were without ARV prophylaxis, 60% (3/5, p = 0.001) infants born to mothers who did not take maternal PMTCT intervention, 43% (3/7, p = 0.001) infants born to mothers who were not enrolled to ART care, and 6.1% (4/66, p = 0.029) infants of unmarried mothers showed statistically significant difference.ConclusionsThe overall prevalence of HIV among exposed infants was high but lower than the Millennium Development Goal targets. In order to eliminate the mother to child HIV transmission (MTCT) ARV prophylaxis in infants must be strengthened, and enrollment of HIV positive pregnant women to PMTCT and ART care and treatment is needed.

A systematic review and meta-analysis of vertical transmission route of HIV in Ethiopia

BackgroundThe burden of mother-to-child transmission rate of HIV is high and risk factors are common in Ethiopia. This systematic review and meta-analysis intended to provide the pooled estimation of mother-to-child transmission rate and its risk factors in Ethiopia.MethodsWe searched PubMed, Google Scholar, EMBASE and Web of Science electronic databases for all available references. We included observational studies including case-control, cohort, and cross-sectional studies. The search was further limited to studies conducted in Ethiopia and publish in English. Heterogeneity was checked using the I2 statistic. Egger’s test and the funnel plot were used to assess publication bias. A meta-analysis using a weighted inverse variance random-effects model was performed.ResultsA total of 18 studies with 6253 individuals were included in this systematic review and meta-analysis. Of these, 14 studies with 4624 individuals were used to estimate the prevalence. The estimated pooled prevalence of mother-to-child transmission of HIV was 11.4% (95% CI = 9.1–13.7). The pooled adjusted odds ratio (AOR) of mother-to-child transmission of HIV for the infants from rural area was 3.8 (95% CI = 1.4 to 6.3), infants delivered at home was 3.2 (95% CI = 1.2 to 5.2), infant didn’t take antiretroviral prophylaxis was 5.8 (95% CI = 1.5 to 10.3), mother didn’t take antiretroviral prophylaxis was 6.1 (95% CI = 2.5 to 9.6), mothers didn’t receive PMTCT intervention was 5.1 (95% CI = 1.6, 8.6), and on mixed feeding was 4.3 (95% CI = 1.8 to 6.7).ConclusionsThis systematic review and meta-analysis showed that mother-to-child transmission rate of HIV was high in Ethiopia. Being from the rural residence, home delivery, not taking antiretroviral prophylaxis, the absence of PMTCT intervention, and mixed infant feeding practices increased the risk of HIV transmission.Trial registrationIt is registered in the Prospero database: (PROSPERO 2017: CRD42017078232).

Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis

BackgroundMother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living with HIV are found. Previous studies in Ethiopia present inconsistent and inconclusive findings on the prevalence and associated factors of MTCT of HIV. Therefore, this study was conducted to determine the pooled prevalence of MTCT of HIV and its associated factors in Ethiopia.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. All published studies were retrieved using relevant search terms in MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to critically appraise articles. STATA version 14 software was used to perform the Meta-analysis. The I2 statistics was used to test heterogeneity and publication bias was assessed using Begg’s and Egger’s tests. Odds ratio (OR) with 95% confidence interval (CI) was presented using forest plots.ResultsA total of nine studies, 3688 mother-baby pairs, were included in this meta-analysis. The pooled prevalence of MTCT of HIV in Ethiopia was 9.93% (95% CI: 7.29, 12.56). The subgroup analysis showed a higher prevalence of MTCT of HIV in Dire Dawa City Administration (15.7%) and lowest in Southern Nations, Nationality and Peoples Region (SNNPR) (4.16%). Associated factors with MTCT of HIV include: mixed feeding, OR = 7.46 (95%CI: 4.71, 11.81), absence of infant ARV prophylaxis, OR = 7.89 (95%CI: 4.32, 14.42), home delivery, OR = 5.08 (95%CI: 2.32, 11.15), and absence of maternal PMTCT intervention, OR = 7.13 (95% CI: 3.31, 15.35).ConclusionsAlmost one in ten HIV exposed infants become HIV positive in Ethiopia. Factors like: mixed feeding, the absence of infant ARV prophylaxis, home delivery and absence of mother’s PMTCT intervention were significantly associated with MTCT of HIV. Therefore, the governmental and non-governmental organizations need to focus on the identified factors and work towards improving the prevention of mother to child transmission of HIV (PMTCT) program.

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years.

ObjectiveTo describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.DesignCross-sectional analysis of national early infant diagnosis (EID) database.Methods365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.Results11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.ConclusionDespite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

BackgroundIn 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia.MethodsRetrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association.ResultThree hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%–7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn’t get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096).ConclusionsThere is significant progress on the reduction of the rate of HIV transmission from mother to child in Ethiopia. Age of the mother, status of the mother at an entry to PMTCT program and presence of PMTCT interventions were significant factors associated with HIV transmission. Hence, the above factors should be given due emphasis on controlling HIV transmission from mother to child.

Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8years retrospective analysis.

BackgroundOver the last decade, Ethiopia adopted different strategies of prevention of mother to child transmission of HIV (PMTCT). Prior to implementation of Option A in 2011, there was no provision of prophylaxis for PMTCT. With ‘Option A’, PMTCT interventions relied on maternal CD4 count. In early 2013, ‘‘Option B+’’ has been started; with this option, antiretroviral therapy is started and continued for life to any HIV positive pregnant mother irrespective of CD4 count with an enhanced treatment for the baby. Though there are a number of studies which evaluated the effectiveness of PMTCT interventions, the current study assessed the real-world effectiveness of PMTCT options in a setting where there is limitation of resources.ObjectiveThis study tried to address three questions: what proportion of babies tested by DNA-PCR are HIV infected in the first 2 months of life? How does the type of PMTCT intervention affect presence of HIV infection at this age? What are the factors affecting HIV transmission, after controlling for type of PMCT-HIV intervention?MethodsWe assessed records of 624 registered HIV exposed infants and 412 mothers who were delivered at Bishoftu Hospital from May 2006 to August 2014. Presence of HIV infection at 6–8 weeks of age was assessed from the records. Maternal and infant risk factors for infection at this age were analyzed. Data were collected using standard data abstraction format and were analyzed using SPSS version 20.ResultsAmong all the infants who were delivered at the hospital during the study period, 624/936 (66.7 %) had undergone early infant diagnosis at 6–8 weeks. Twenty-seven (4.3 %) were positive for HIV DNA PCR at the age of 6–8 weeks. None of the infants who received ‘‘Option B+’’ had a positive HIV DNA PCR result. HIV infection rate was highest among those who took either no prophylaxis or single dose Nevirapine (11.5 and 11.1 % respectively). Those who took single dose Nevirapine and Zidovudine had HIV positivity rate of 3.9 %. Many of the covariates which were shown to be predictors on bivariate analysis were found not to be independent predictors on multivariate analysis.ConclusionPMTCT ‘’Option B+’’ resulted in zero HIV infection rates among the included infants. There was a high loss to follow up rate at 6–8 weeks of age. The authors recommend that a better strategy of linkage to care and treatment should be devised for HIV exposed infants.

Saving the third generation from HIV; first case report in Sri Lanka

A 20-year-old unmarried HIV positive female patient presented to the HIV clinic, Colombo with oral candidiasis, generalized pruritic papular eruptions (PPE), weight loss and intermittent fever for 6 months’ duration. Her CD4 count was 50 cells/μl. This patient was first found to be HIV antibody positive at the age of 8 years, when she was screened due to her mother’s HIV positive status. Following the presentation, patient was started on ART in December 2010 and continued for 3 years. After that the patient defaulted for about 3 months and re-attended the clinic. At that visit she was pregnant with 20 weeks of gestation. Her partner was HIV negative. Later the patient gave birth to an HIV negative boy with the support of the national programme on Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Sri Lanka. Mother of the index patient and the index patient represent the 1st and 2nd generation while the third generation infection was prevented with PMTCT intervention. Sri Lanka Journal of Sexual Health and HIV Medicine Vol.1 2015: 33-36

HIV infection: Prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital, Makurdi, Nigeria

Background: Human immunodeficiency virus (HIV) testing of pregnant women and their partners is an important step in access to prevention of mother-to-child transmission (MTCT) services; pregnant women are at a high risk of seroconversion, which is associated with a high rate of MTCT. Repeat HIV testing in late pregnancy or in labor is worthwhile in areas with high HIV prevalence. This study aimed at determining HIV prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital.Patients and Methods: This was a prospective cross-sectional study involving 432 cohorts of antenatal attendees. The HIV status of these women were determined at booking using rapid HIV kits: Determine ½, Stat-Pak, and Unigold Recombigen. Repeat testing was performed during labor among women who were HIV negative at booking to determine the seroconversion rate.Results: Overall HIV prevalence among this cohort of women was 8.6%. The seroconversion rate during labor was 2.5% among women who were seronegative at booking. Majority of the participants were young (modal age = 26–29 years, 36%), belonged to middle class (60.9%) and upper class (17.6%), and had secondary (50.0%) or tertiary education (38.0%).Conclusion: HIV prevalence and seroconversion rates are rather high. There is need for more aggressive PMTCT awareness advocacy and intervention to reduce the incidence of pediatric acquired immunodeficiency syndrome in our setting. Further studies to differentiate seroconversion from new infections in pregnancy are worthwhile PMTCT strategies.

Engaging mentor mothers in a PMTCT intervention program in rural North-Central Nigeria

Engaging mentor mothers in a PMTCT intervention program in rural North-Central Nigeria

Incidences and Predictors of HIV Positivity among Infants who Born from HIV Positive Mother who Have Follow Up at Two Hospitals of Southern Ethiopia, 2014

Introduction: Despite a dramatic progress in improvements regarding infant mortality due to HIV/AIDS in the past decades, HIV/AIDS is causing a devastating impact on the world’s children. Mother-to-child transmission (MTCT) is by far the largest source of HIV infection in children under the age of 15, with 90% of the cases infected during pregnancy, birth, and major share is after birth.Therefore, this study follows infants after the first test (Deoxyribonucleic acid (DNA) Polymerase Chain Reaction (PCR) testing) is negative, until the occurrences of HIV positivity and predictors associated with it in the two hospital of Southern Ethiopia. Objective: The aim was to assess the incidence, Survival experiences and predictors of HIV positivity among infants born from HIV positive mothers in two hospital of Southern Ethiopia, 2014. Methodology: Institution-Based Retrospective follow up study was conducted at Hawassa Referral and Yirgalem General Hospital from September 2000 to August 2005 E.C. Data was collected by trained BSc nurses from medical registration book of 485 exposed infants . It was entered in to EPI Info 3.5.1 and exported to SPSS version 20 for further analysis. Both Bivariate and Multiple variable Cox regression analysis were conducted to identify predictors. P-value< 0.05 was considered as level of significance. Results: Among 457 participants included under analysis contributed for 4249.4 Person Months of follow up. Cumulative and overall incidence rate of HIV positivity among infants were 19(4.16%) and 4.47/1000 PM (95% CI: 4.02-4.92) respectively. Mean HIV free survival time difference between Exclusive breast feeding 20.2 (95 % CI, 19.6, 20.8)), mixed feeding (17.5 (95% CI, 15.5-19.5)) and exclusive formula feeding 16.8 (95% CI, 16.3, 18.4) were significant. Mixed breast feeding (AHR: 8.23(1.98, 34.2)), ARV prophylaxis (yes) (AHR: 0.19(95% CI, 0.04-0.89)), Maternal HAART (AHR: 0.16(95% CI, .041, 0.59) and SdNVP + AZT+ 3TC (AHR: 0.113(95% CI: 0.02, 0.61)) intervention were independent predictors of HIV positivity among exposed infants. Conclusion: The risk of mother to child transmission of HIV is high for HIV exposed infants. All mothers should start PMTCT intervention as a guideline and it is better to discourage mixed infant feeding to prevent the upcoming infants from the HIV infection.

A retrospective analysis among male and female infants EID results in Cross River State, Nigeria

Methods A retrospective study was conducted in July, 2011 among male and female infants receiving PMTCT intervention for Early Infant Diagnosis in PHC’s at four different LGA’s of Cross River namely: Akamkpa, Calabar South, Odukpani and Biase respectively. Relevant data of the HIV infection status to male and female infants, whose samples were collected and diagnosed using PCR, was obtained from the National PMTCT-EID register. The data was analyzed using Cross-tabulation.

Improved Detection of Incident HIV Infection and Uptake of PMTCT Services in Labor and Delivery in a High HIV Prevalence Setting

To maximize prevention of mother-to-child transmission of HIV (PMTCT) effectiveness and increase identification of HIV status in maternity units in Swaziland. With a quasi-experimental design, 3 maternity units were randomly assigned to the training intervention and 3 units were controls. Targeted on-site training was provided to nurse-midwives in intervention sites. HIV status was recorded with testing offered to women presenting with unknown and distant negative status. Cord blood was obtained and tested for HIV antibodies and presence of nevirapine as a marker of PMTCT intervention coverage. Contingency tables and χ² tests were used to test for associations between frequencies of events. Of the 2444 enrolled women, 215 (9%) arrived in maternity with unknown status and 1398 (58%) had tested HIV negative in antenatal clinic. Significantly more HIV-negative women (45%) and women with unknown status (96%) in intervention sites were tested compared with similar women in control sites, 14% and 65%, respectively (P < 0.0001 for both). Nevirapine coverage in HIV-positive cord blood was significantly higher in intervention sites (80%) than in control sites (69%, P < 0.0001). Cumulative HIV incidence was 4% with an incidence rate of 16.8 per 100 person-years. Antiretroviral prophylaxis coverage in seroconverters was significantly higher in intervention sites 54% (13 of 24) than the control group [26% (9 of 34), P = 0.03]. In high HIV prevalence settings, such as Swaziland, the incidence of HIV during pregnancy is high. An on-site training intervention for maternity nurses significantly increases the identification of HIV infection and maximizes the provision of PMTCT interventions.

Effects of in Utero Antiretroviral Exposure on Longitudinal Growth of HIV-Exposed Uninfected Infants in Botswana

The impact of in utero exposure to highly active antiretroviral therapy (HAART) on longitudinal growth of HIV-uninfected infants is unknown. The Mashi and Mma Bana PMTCT intervention trials enrolled HIV-infected pregnant women at four sites in Botswana. Breast-fed (BF), HIV-uninfected infants born at 37 weeks or greater were included in this analysis. Weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z-scores were calculated using World Health Organization Child Growth Standards. Mean z-scores were compared between in utero antiretroviral exposure groups using Student t test, response profiles analysis, and general linear mixed effects modeling. Growth of 619 HAART-exposed and 440 zidovudine-exposed, HIV-uninfected infants was evaluated. Mean birth weights were 3.01 kg for HAART and 3.15 kg for zidovudine-exposed infants (P < 0.001) with lower mean birth WAZ, length-for-age (LAZ), and weight-for-length (WLZ) among HAART-exposed infants (all P < 0.001). HAART-exposed infants had greater improvement in WAZ and weight-for-length (WLZ) from birth through 2 months (P = 0.03, P < 0.001, respectively). The WAZ did not differ between groups from 3 through 6 months (P = 0.26). Length-for-age (LAZ) remained lower in HAART-exposed infants but the incidence of wasting or stunting did not differ between exposure groups. Lower weights in HAART-exposed uninfected infants at birth were rapidly corrected during the first 6 months of life.

Acceptance of counseling, voluntary HIV testing and use of prophylactic nevirapine in labour and immediate puerperium at Muhimbili national hospital, Tanzania

Background: Mother to child transmission contributes significantly to the incidence of HIV in our country. A PMTCT program exists in Muhimbili National Hospital (MNH) and some surrounding public hospitals since 2000. Inspite of this it has been observed that a substantial number of women delivering at MNH have not had VCT and therefore cannot benefit from the PMTCT intervention. Objective: To determine the acceptance of counseling, voluntary HIV testing and prophylactic use of Nevirapine among pregnant women during labour / immediate postpartum at Muhimbili National Hospital. Methodology: This descriptive Cross-sectional study was done in the labour ward of MNH. Data collection: Trained counselors invited all women who met inclusion criteria as they were admitted. Patients who had obstetric complications were excluded. Women who accepted counseling were taken to private rooms for discussion and those who consented were screened for HIV using rapid tests. Direct observed therapy with Nevirapine was done. Data was filled in a structured questionnaire and analysed by EPI Info 6 and SPSS software. Results: We recruited 885 women with unknown sero-status through convenient sampling. The overall acceptance of pre-test counseling in labour among women with unknown sero-status was 71.7% while acceptance of counseling and voluntary HIV testing was 56.6%. Among those who accepted pre-test counseling in labour, 78.9% accepted HIV testing and 8.6% of these were found to be HIV infected. Eighty-three percent of women diagnosed to be HIV infected accepted Nevirapine. Counselor's experience of more than 3 years had a significant impact on acceptance of counseling and testing of HIV in labour. Conclusion and recommendation: The results of this study show that HIV testing during labour and use of prophylactic ARV is acceptable in our setting. Women with unknown serostatus in labour should be offered counseling and testing in order to prevent MTCT of HIV. Keywords:Acceptance, HIV testing in labour. Tanzania Medical Journal Vol. 21 (1) 2006: pp. 1-5