Effectiveness of a Prevention of Mother-to-Child HIV Transmission Programme in an Urban Hospital in Angola

Abstract

BackgroundAntiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007–2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa.ResultsData for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07–1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31–20.15, p = 0.019).ConclusionsAmong the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.

The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care

“…Twenty studies were from sub-Saharan Africa: four [16–19] from South Africa, two each from Kenya [20,21], Nigeria [22,23], Mozambique [24,25], Malawi [26,27], Uganda [28,29], and Ethiopia [30,31], one from each of the following: Zimbabwe [32], Cameroon [33], Angola [34], and Tanzania [35]. Three studies were from India [36–38], and one each from United Kingdom and Ireland [39,40].…”

Effectiveness of prevention of mother‐to‐child HIV transmission programmes in Kilimanjaro region, northern Tanzania

“…Lussiana et al . () in Angola reported the outcomes of women and infants who delivered and were followed up in a local PMTCT programme and clearly show that accessing the PMTCT programme for the full 18 months is associated with significant individual benefits in terms of HIV transmission and survival.…”

Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial

“…Así, en Zambia, en un estudio de más de 8.000 niños la tasa de transmisión vertical fue del 20,9% (12,3-29,5%) cuando no hubo intervención frente a 6,5% (5,1-7,8%) con intervención 19 , y en un estudio en Angola las tasas de transmisión vertical y/o muerte en el seguimiento a las 74 semanas en 107 niños expuestos a la infección por VIH fueron del 38,9 vs 8,5%, respectivamente 20 .…”