Effectiveness of Multidrug Antiretroviral Regimens to Prevent Mother-to-Child Transmission of HIV-1 in Routine Public Health Services in Cameroon

Tchendjou, Patrice; Same-Ekobo, Chantal; Nga, Annie; Tejiokem, Mathurin Cyrille; Kfutwah, Anfumbom; Nlend, Anne Njom; Tsague, Landry; Bissek, Anne Cécile Zoung-Kanyi; Ekoa, Daniel; Orne-Gliemann, Joanna; Rousset, Dominique; Pouillot, Régis; Dabis, François

doi:10.1371/journal.pone.0010411

Cited by 22 publications

(30 citation statements)

References 23 publications

(33 reference statements)

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“…; Tchendjou et al . ). However, transmission rates in rural group I are likely to be underestimated due to the unavailability of HIV PCR testing at that time.…”

Section: Discussionmentioning

confidence: 97%

Mortality risk factors among HIV‐exposed infants in rural and urban Cameroon

Boerma

Wit

Orock³

et al. 2014

Tropical Med Int Health

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Abstractobjectives HIV-exposed infants, including those who do not become infected, have higher morbidity and mortality rates than HIV unexposed infants. The underlying mechanisms of this difference are largely unknown. The objective of this study was to identify the risk factors for mortality among HIV-exposed (infected as well as uninfected) infants in a prevention of motherto-child transmission (PMTCT) programme in Cameroon. results Two hundred and eighty-five medical records were included in the final analysis. Infant mortality rates were 23.9%, 20.0% and 5.3% in group I, II and III, respectively (P = 0.02). Hazard ratios of infant mortality were 6.4 (P < 0.001) for prematurity, 4.6 (P = 0.04) for no maternal use of ARTs, 5.6 (P = 0.025) for mixed feeding, 2.7 for home deliveries (P = 0.087) and 0.4 (P = 0.138) for urban study group.conclusions In this programme, prematurity, no ART use, and the practice of mixed feeding were independent predictors of infant mortality. Mixed feeding and not using ART increased the hazard of death, probably through its increased risk of HIV infection. Although mortality rates were significantly higher in the rural area, rural setting was not a risk factor for infant mortality. These findings may contribute to the development of tailor-made programmes to reduce infant mortality rates among HIV-exposed infants.

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“…; Tchendjou et al . ). However, transmission rates in rural group I are likely to be underestimated due to the unavailability of HIV PCR testing at that time.…”

Section: Discussionmentioning

confidence: 97%

Mortality risk factors among HIV‐exposed infants in rural and urban Cameroon

Boerma

Wit

Orock³

et al. 2014

Tropical Med Int Health

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“…Maternal CD4+ count has been used as an indicator to assess eligibility for antiretroviral treatment & prophylaxis for prevention of HIV-1 mother-to-child transmission and low CD4+ lymphocyte count was found associated with increased mother-to-child transmission risk [47-53]. Available studies have also shown that CD4 count increases with the use of triple-drug combination therapy [54].…”

Section: Discussionmentioning

confidence: 99%

Socio-economic, clinical and biological risk factors for mother - to – child transmission of HIV-1 in Muhima health centre (Rwanda): a prospective cohort study

Bucagu

Bizimana²,

Muganda

et al. 2013

Arch Public Health

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BackgroundThree decades since the first HIV-1 infected patients in Rwanda were identified in 1983; the Acquired Immunodeficiency Syndrome epidemic has had a devastating history and is still a major public health challenge in the country. This study was aimed at assessing socioeconomic, clinical and biological risk factors for mother – to – child transmission of HIV- in Muhima health centre (Kigali/Rwanda).MethodsThe prospective cohort study was conducted at Muhima Health centre (Kigali/Rwanda).During the study period (May 2007 – April 2010), of 8,669 pregnant women who attended antenatal visits and screened for HIV-1, 736 tested HIV-1 positive and among them 700 were eligible study participants. Hemoglobin, CD4 count and viral load tests were performed for participant mothers and HIV-1 testing using DNA PCR technique for infants.Follow up data for eligible mother-infant pairs were obtained from women themselves and log books in Muhima health centre and maternity, using a structured questionnaire.Predictors of mother-to-child transmission of HIV-1 were assessed by multivariable logistic regression analysis.ResultsAmong the 679 exposed and followed-up infants, HIV-1 status was significantly associated with disclosure of HIV status to partner both at 6 weeks of age (non-disclosure of HIV status, adjusted odds ratio [AOR] 4.68, CI 1.39 to 15.77, p < 0.05; compared to disclosure) and at 6 months of age (non-disclosure of HIV status, AOR, 3.41, CI 1.09 to 10.65, p < 0.05, compared to disclosure).A significant association between mother’s viral load (HIV-1 RNA) and infant HIV-1 status was found both at 6 weeks of age (> = 1000 copies/ml, AOR 7.30, CI 2.65 to 20.08, p < 0.01, compared to <1000 copies/ml) and at 6 months of age (> = 1000 copies/ml, AOR 4.60, CI 1.84 to 11.49, p < 0.01, compared to <1000 copies/ml).ConclusionIn this study, the most relevant factors independently associated with increased risk of mother – to – child transmission of HIV-1 included non-disclosure of HIV status to partner and high HIV-1 RNA. Members of this cohort also showed socioeconomic inequalities, with unmarried status carrying higher risk of undisclosed HIV status. The monitoring of maternal HIV-1 RNA level might be considered as a routinely used test to assess the risk of transmission with the goal of achieving viral suppression as critical for elimination of pediatric HIV, particularly in breastfeeding populations.

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“…6,7 Many countries have adopted the international guidelines that recommend provider-initiated antenatal HIV testing ("opt-out" approach). 10 There is concern that women who find out that they are HIV positive during pregnancy may not complete the 4 ANC visits as recommended by WHO because of emotional disturbance and fear of stigma or discrimination. Posttest counseling for HIV-negative women provides an opportunity to discuss prevention of future infections.…”

Section: Introductionmentioning

confidence: 99%