Reducing mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria

Abstract

BackgroundEarly diagnosis of HIV in infants provides a critical opportunity to strengthen follow-up of HIV-exposed children and assure early access to antiretroviral (ARV) treatment for infected children. This study describes findings from an Early Infant Diagnosis (EID) program and the effectiveness of a prevention of mother-to-child transmission (PMTCT) intervention in six health facilities in Cross-River and Akwa-Ibom states, south-south Nigeria.MethodsThis was a retrospective study. Records of 702 perinatally exposed babies aged six weeks to 18 months who had a DNA PCR test between November 2007 and July 2009 were reviewed. Details of the ARV regimen received to prevent mother-to-child transmission (MTCT), breastfeeding choices, HIV test results, turn around time (TAT) for results and post test ART enrolment status of the babies were analysed.ResultsTwo-thirds of mother-baby pairs received ARVs and 560 (80%) babies had ever been breastfed. Transmission rates for mother-baby pairs who received ARVs for PMTCT was 4.8% (CI 1.3, 8.3) at zero to six weeks of age compared to 19.5% (CI 3.0, 35.5) when neither baby nor mother received an intervention. Regardless of intervention, the transmission rates for babies aged six weeks to six months who had mixed feeding was 25.6% (CI 29.5, 47.1) whereas the transmission rates for those who were exclusively breastfed was 11.8% (CI 5.4, 18.1). Vertical transmission of HIV was eight times (AOR 7.8, CI: 4.52-13.19) more likely in the sub-group of mother-baby pairs who did not receive ARVS compared with mother-baby pairs that did receive ARVs. The median TAT for test results was 47 days (IQR: 35-58). A follow-up of 125 HIV positive babies found that 31 (25%) were enrolled into a paediatric ART program, nine (7%) were known to have died before the return of their DNA PCR results, and 85 (67%) could not be traced and were presumed to be lost-to-follow-up.ConclusionReduction of MTCT of HIV is possible with effective PMTCT interventions, including improved access to ARVs for PMTCT and appropriate infant feeding practices. Loss to follow up of HIV exposed infants is a challenge and requires strategies to enhance retention.

Effectiveness of Infant Feeding Strategies to Prevent Mother-to-Child HIV Vertical Transmission in Ekiti State

“…Among the 80 infants aged 6 months or less, 40(50%) were exclusively breastfed, 30(37.5%) replacement feeding (received formula) and 10(12.5%) received mixed feeding. Similar to our findings, Anoje et al [55] from southern Nigeria reported high prevalence of 80% exclusive breast-feeding and Torpey [46] in Zambia reported 84% of babies receiving exclusive breast milk as compared with other feeding option. Our study showed that the risk of vertical transmission of HIV associated with exclusive breast feeding was considerably lower reported as 3(1.9%) compared with 4(2.5%) in replacement feeding and 8(5.0%) in mixed feeding.…”

Infant Feeding Choices Practiced among HIV Positive Mothers Attending a Prevention of Mother to Child Transmission (PMTCT) of HIV Program in Nnewi, Nigeria

“…Our findings in this study are in agreement with the report of Becquet et al [19] and Coutsoudis et al [20], in Cote d'Ivoire and KwaZulu-Natal respectively, that exclusive breastfeeding is rare but disagrees with their observation that mixed feeding was the common practice among HIV positive mothers. Our findings also differ from the findings of ChukwuemekaAnoje et al [21] from southern Nigeria who reported 80% exclusive breast-feeding and Torpey et al [22] in Zambia who reported 84% of babies receiving breast milk.…”

Early infant diagnosis and outcomes in HIV-exposed infants at a central and a district hospital, Northern Malawi

“…This is a shorter turnaround time than in rural Zambia, 8 longer than the 9 days reported in Botswana, 22 but comparable to times found in Kenya, Tanzania, Uganda and Nigeria. 7,16,17,23 Long turnaround times may contribute to guardians not receiving results and delayed ART initiation. 7 Compared to the median ART initiation age of 9 months reported elsewhere in Malawi, 24 the age at ART initiation was younger at MZCH and older at CDH.…”

“…5,13 According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 58 000 HIV-infected women delivered babies in Malawi in 2013; however, only 15% underwent DNA PCR testing for HIV within 2 months of birth. 14 Past studies have indicated particular problems in timely EID uptake and implementation, 5,13,[15][16][17] but few have further explored how testing implementation may impact routine programme outcomes. We hypothesised that infants in an EID programme situated in a central hospital that performs DNA PCR testing on site might have better performance and outcomes than those enrolled in an EID programme in an outlying district health facility, where samples have to be sent to a central laboratory for testing.…”