Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey

Abstract

In Swaziland, no data are available on the rates of HIV infection and HIV-free survival among children at the end of the breastfeeding period. We performed a national crosssectional community survey of children born 18-24 months prior to the study, in randomly selected constituencies in all 4 administrative regions of Swaziland, from April to June 2015. Mother-to-child transmission (MTCT) of HIV and HIV-free survival rates were calculated for all HIV-exposed children. The overall HIV-free survival rate at 18-24 months was 95.9% (95% CI 94.1-97.2). The estimated proportion of HIV infected children among known HIV-exposed children was 3.6% (95% CI 2.4-5.2). Older maternal age, delivering at a health facility, and receiving antenatal antiretroviral drugs were independently associated with reduced risk for child infection or death. The Swaziland program for prevention of MTCT achieved high HIV-free survival (95.9%) and low MTCT (3.6%) rates at 18-24 months of age when Option A (infant prophylaxis) of the WHO 2010 guidelines was implemented.

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

“…Nonetheless, this highlights the impact of the current effort to eliminate mother-to-child transmission of HIV implemented initially as PMTCT option B+, and now as test and treat or treat all (mothers tested and if HIV positive, initiated on lifelong ART regardless of CD4 count or clinical stage, and infants were given ARV prophylaxis from birth for 6 or 12 weeks depending on risk classification while mothers are encouraged to exclusively breastfeed for at least 6 months). The 18-months HIV-free survival rate in the study setting only marginally falls short of the >95% HIV-free survival rate recommended among breastfeeding populations, and is lower than the 95.9% HIV-free survival rate reported in a community-based survey in Swaziland (13). However, the rate in the current study compares well with the 93.2% 24-month HIV-free survival under similar Option B+ program in Rwanda (14) and is higher than the pooled estimates of 89.8% and 85.8% for 12-month and 24-month HIV-free The mortality rate of 2.8% in the current study was generally low but higher than the 1.1% reported in Mma Bana trial in Botswana (16), a difference possibly explained by the fact that infants in the Mma Bana trial breastfed for a shorter duration of 6 months (median 5.8 months).…”

18-24-month HIV-free survival as measurement of the effectiveness of prevention of mother-to-child transmission in the context of lifelong antiretroviral therapy: Results of a community-based survey

“…Eight of the ten children have been in contact with health system for various services. However, contrary to the recommendation that all HIV-exposed children should have the final HIV test at 18-24 months or six weeks after cessation of breastfeeding, this was not the case for the eight children [8]. Five out of ten had tested HIV-negative initially but had not had subsequent test, while three children whose mothers were on ART had never been tested.…”

“…Similarly, in a study in Eswatini, that reported HIV-free survival prior to the era of lifelong ART for pregnant and breastfeeding women in that country, HIV-free survival was 95.9% (95% CI: 94.1-97.2) though the authors reported a low death rate due to cultural sensitivities in collecting death data which may have impacted overall HIV-free survival [8].…”

“…Most of the infections among children remain attributable to mother-to-child transmission (MTCT) [4,5]. Program data are now starting to emerge, demonstrating the effectiveness of these approaches in preventing MTCT using real world data which strengthen global reports that use modelling data [2,[6][7][8]. Most of these studies report HIV-free survival before lifelong antiretroviral therapy (ART) was rolled out.…”

“…Community-based studies to estimate HIV-free survival among HIV-exposed children overcome some bias concerns in facility-based studies. However, since 2013, when the Lesotho Ministry of Health (MOH) adopted the World Health Organization PMTCT guidelines on universal treatment [8], no community-based assessment of HIV-free survival has been undertaken in Lesotho. The Lesotho population-based impact assessment survey found an overall MTCT rate of 2.8% [14,15].…”