Mother to Child Transmission of HIV after Option B+ in Low Income Environment

Abstract

Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive protocol. The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaoundé I. Methods: It was a retrospective, cross-sectional study over a period of four years (2013-2017). We included HIV positive mothers not on previous antiretroviral treatment and who received a single tablet daily of combined tenofovir (300 mg) + Lamivudine (300 mg) + Efavirenz (600 mg) started at any time during pregnancy. Newborn received nevirapine syrup according to WHO option B+ protocol. Results: 179 women were included. The average age was 33.5 ± 2.92 years, all ages were represented. Blood donation was the most frequent HIV positive screening opportunity, voluntary testing rate was 29% (29/179), and adherence rate was 98.9%. Few male partners were involved (58/179). Premature deliveries and low birth weight were rare (5/179; 10/179)), the indication of mode of delivery was strictly obstetrical, newborn feeding choice didn't affect the transmission outcome, and the mother to child transmission rate was 2.2% (4/179). Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings.

The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

“…Data collected for this review were summarised in Table 2, which identified 22 studies from 11 African Countries that met inclusion criteria (Cameroon, Ethiopia, Lesotho, Malawi, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe). Study designs varied as follows: there were 13 retrospective cohort studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36] ; five prospective cohort studies [37][38][39][40]45 ; two cross-sectional studies 41,42 and one randomised control trial (RCT). 43 Sample sizes ranged from 124 13,15 to 2505 women.…”

“…26 More commonly, infant HIV status was determined at an older age or whenever the infant was brought to the clinic. Loss to follow-up (LTFU) was addressed in only 14 of the 22 studies and varied from 3% 24 to 47%. 37 Studies were carried out in many settings ranging from urban hospitals and clinics (13 studies) to rural clinics (3 studies).…”

“…A total of 16 studies reported MCTC rates of >2% to 5% with Option B+ implementation. Studies were from Cameroon, 24 Ethiopia at 2 years, 25,27 Lesotho at 2 years, 44 Malawi, 28,29,30,41,42 Rwanda at 2 years, 31 Swaziland, 37 Tanzania, 42 Zambia 33,34,40 and Zimbabwe. 36 A study from Uganda 32 and a study from Zambia 34 reported MTCT rates of above 5%, surpassing the WHO target for elimination of HIV transmissions from mother to child.…”

Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria

“…A study from Zimbabwe reported an 18-month MTCT final outcome of 0.3% among a nationally-representative sample of 6,051 HEI [ 22 ], which was approximately 10 times lower than we found in our Nigerian cohort. However, there is wide variation across the continent; non-population-based studies from other African countries have reported post-breastfeeding/final outcome HIV positivity rates ranging from 2.2% to 9.6% for cohorts with approximately 170 to 3,780 HEI [ 23 – 27 ].…”