An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort

Altan, Anna Maria Doro; Taafo, Francis; Fopa, François; Buonomo, E; Marazzi, Maria Cristina; Nielsen‐Saines, Karin; Orlando, Stefano; Scarcella, P; Ciccacci, Fausto; Lio, Massimo Magnano San; Palombi, Leonardo

doi:10.11604/pamj.2016.23.72.7958

Cited by 10 publications

(4 citation statements)

References 29 publications

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“…This finding, although not statistically significant, is in keeping with that reported in a Nigerian study where the risk of HIV transmission was significantly lower among babies whose mothers commenced HAART before pregnancy (3.4%) compared to those whose mothers initiated HAART during pregnancy (5.4%) [ 31 ]. Similar benefits of prior maternal ART on PMTCT of HIV have been reported in Cameroon [ 32 ] and South Africa [ 33 ]. The above results could be explained by the fact that one of the hypothesized benefits of lifelong ART is the protection against HIV transmission in subsequent pregnancies, resulting from greater chances of virologic suppression.…”

Section: Discussionsupporting

confidence: 73%

HIV-free survival among breastfed infants born to HIV-positive women in northern Uganda: a facility-based retrospective study

Aguti¹,

Kimbugwe²,

Apai³

et al. 2020

Pan Afr Med J

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Introduction the HIV-free survival rate is the gold-standard measure of the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting. However, data on HIV-free survival among the HIV-exposed infants followed up in most low-resource settings are lacking. We determined the HIV-free survival among breastfed infants in two tertiary facilities in a resource-poor setting in northern Uganda. Methods we conducted a retrospective cohort study in May 2019 and retrospectively reviewed records of HIV-exposed infants registered in 2014 through 2016 at two tertiary facilities in northern Uganda. We analyzed data using SPSS v16 software package. The chi-square and Student t-tests were used to compare factors among infant groups. Multivariate logistic regression analysis was used to determine factors independently associated with HIV-free survival. P-value <0.05 was considered for statistical significance. Results majority of the infants were males 55.6% (203/365) and 98.6% (360/365) received nevirapine prophylaxis. A total of 345 (94.5%) infants were exclusively breastfed, only 100/345 (29.0%) of whom were exclusively breastfed for at least 6 months, while the breastfeeding status of 44/345 (12.8 %) infants could not be ascertained. The overall HIV-free survival rate was 93.7% (342/365), while 2.7% (10/365) were HIV-infected and 3.6% (13/365) died. Infants´ age at enrolment in care (aOR 5.20, p=0.008) and treatment facility (aOR 3.76, p=0.027) were the independent determinants of HIV-free survival. Conclusion the HIV-free survival rate among the breastfed infants in the study setting marginally falls short of the recommended standard, thus calling for more efforts to improve survival.

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Section: Discussionsupporting

confidence: 73%

HIV-free survival among breastfed infants born to HIV-positive women in northern Uganda: a facility-based retrospective study

Aguti¹,

Kimbugwe²,

Apai³

et al. 2020

Pan Afr Med J

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“…Prior studies before Option B implementation have reported ∼25–50% of patients of women on ART at delivery lost to care within 6 months postpartum. 23–25 While the proportion of women on lifelong ART retained in care in this study was high, the proportion of women initiated on interrupted triple ART prophylaxis post-2013 was higher than the attrition rate in the DREAM cohort of pregnant women in Cameroon initiated on Option B (92.6% at 6 months); 26 our study reports follow-up status at 6 weeks postpartum and it is possible that retention may deteriorate over time. In Malawi, ∼17% of pregnant women initiated on Option B+ were lost to care by 6 months; most women were lost to follow-up on the day of HIV testing and ART initiation.…”

Section: Discussionmentioning

confidence: 52%

Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa

et al. 2016

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PurposeThe Hlabisa pregnancy cohort was established to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) guideline revisions. The objectives of the Hlabisa pregnancy cohort are to: (1) provide cohort-level information on maternal health up to 6 weeks postpartum in a high HIV prevalence setting; and to (2) evaluate aspects of PMTCT care that have policy relevance.ParticipantsThe pregnancy cohort is located in primary health clinics in the Hlabisa subdistrict of rural KwaZulu-Natal, South Africa. Baseline data collection between 2010 and 2014 has been completed with the enrolment of 25 608 pregnancies; age ranged from 15–49 years. Pregnant women were assessed during routine antenatal visits: first visit, follow-up 1 week later, 32 weeks (HIV test), infant delivery and 6 weeks postpartum. Demographic, pregnancy, clinical, laboratory and HIV data were collected through Department of Health interviews, laboratory tests and routine data linkage. Treatment data for HIV-infected pregnant women were linked to the Africa Centre Hlabisa HIV Treatment and Care Programme for detailed antiretroviral therapy (ART) history and laboratory tests.Findings to dateThe proportion of women initiated on ART post-2013 were higher (n=437; 100%) than pre-2013 (n=768; 84.2%). The proportion of women in care at 6 weeks (73.8%) was also higher post-2013 relative to earlier years (58.5%). The majority of HIV-infected pregnant women were either on lifelong ART or ART prophylaxis; pre-2013, ∼ 9.6% of women were not on any ART. Pregnancy viral load monitoring was inadequate.Future plansThis cohort will be used to: (1) determine HIV acquisition risk during pregnancy and postpartum; (2) determine the effect of HIV and ART on birth outcomes; (3) examine the effect of pregnancy on virological response to ART; and (4) characterise the effect of sequential pregnancies on access to clinical care, response to prolonged ART and birth outcomes.

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“…Likewise, in a study of 298 women in Cameroon, in which 51% of women were receiving ART prior to pregnancy, 12-month HIV transmission was 1.2%. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda

Gill¹,

Hoffman

Ndatimana³

et al. 2017

Medicine

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Lifelong antiretroviral therapy (ART) provision to all pregnant HIV-positive women (“Option B+”) has been recommended by the World Health Organization since 2013, but there remain limited data on the effects of Option B+ on long-term HIV-free survival in breastfeeding HIV-exposed infants. The Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) study enrolled HIV-positive women from the third trimester of pregnancy to 2 weeks postpartum in 14 heath facilities implementing Option B+ in Kigali, Rwanda. Mother–child pairs in the longitudinal observational cohort were followed until 24 months postpartum, with HIV diagnostic testing at 6 weeks, and 9, 18 and 24 months. The Kaplan–Meier method was used to estimate HIV transmission, survival, and HIV-free survival through 24 months. We enrolled 608 HIV-positive women in 2013–2014; birth outcome data were available for 600 women and 597 live-born infants. By 6 weeks, 11 infants had died and 3 infants had confirmed HIV infection (0.5% transmission; 95% confidence interval [CI] 0.2–1.6). At 9 months, there were 9 additional deaths and 2 new infections (cumulative transmission 0.9%, 95% CI 0.4–2.2). At 18 months, there were 6 additional deaths and no new infant infections. At 24 months, there were no additional child deaths and 1 new infection (cumulative 2.2%, 95% CI 0.7–7.0), for an overall 24-month HIV-free survival of 93.2% (95% CI 89.5–95.6). Low transmission rates and high HIV-free survival at 24 months were achieved in breastfeeding infants of HIV-positive mothers receiving universal ART in urban health facilities in Rwanda, though vigilance on maintaining viral suppression for ART-experienced women is needed.

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An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort

Cited by 10 publications

References 29 publications

HIV-free survival among breastfed infants born to HIV-positive women in northern Uganda: a facility-based retrospective study

HIV-free survival among breastfed infants born to HIV-positive women in northern Uganda: a facility-based retrospective study

Cohort profile: the Hlabisa pregnancy cohort, KwaZulu-Natal, South Africa

24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda

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