Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007–2013)

Abstract

Objective Guidelines for prevention of mother-to-child transmission of HIV have developed rapidly, yet little is known about how outcomes of HIV-exposed infants have changed over time. We describe HIV-exposed infant outcomes in Kinshasa, Democratic Republic of Congo, between 2007 and 2013. Design Cohort study of mother–infant pairs enrolled in family-centered comprehensive HIV care. Methods Accounting for competing risks, we estimated the cumulative incidences of early infant diagnosis, HIV transmission, death, loss to follow-up, and combination antiretroviral therapy (cART) initiation for infants enrolled in three periods (2007–2008, 2009–2010, and 2011–2012). Results 1707 HIV-exposed infants enrolled at a median age of 2.6 weeks. Among infants whose mothers had recently enrolled into HIV care (N = 1411), access to EID by age two months increased from 28% (95% confidence limits [CL]: 24,34%) among infants enrolled in 2007-2008 to 63% (95% CL: 59,68%) among infants enrolled in 2011–2012 (Gray's p-value <0.01). The 18-month cumulative incidence of HIV declined from 16% (95% CL: 11,22%) for infants enrolled in 2007–2008 to 11% (95% CL: 8,16%) for infants enrolled in 2011–2012 (Gray's p-value = 0.19). The 18-month cumulative incidence of death also declined, from 8% (95% CL: 5,12%) to 3% (95% CL: 2,5%) (Gray's p-value = 0.02). LTFU did not improve, with 18-month cumulative incidences of 19% (95% CL: 15,23%) for infants enrolled in 2007-2008 and 22% (95% CL: 18,26%) for infants enrolled in 2011–2012 (Gray's p-value = 0.06). Among HIV-infected infants, the 24-month cumulative incidence of cART increased from 61% (95% CL: 43,75%) to 97% (95% CL: 82,100%) (Gray's p-value < 0.01); the median age at cART decreased from 17.9 to 9.3 months. Outcomes were better for infants whose mothers enrolled before pregnancy. Conclusions We observed encouraging improvements, but continued efforts are needed.

Follow‐up and programmatic outcomes of HIV‐exposed infants registered in a large HIV centre in Lilongwe, Malawi: 2012–2014

“…In a recent study in five districts of central Malawi assessing the impact of Option B+, documentation of baseline characteristics and follow‐up parameters of HIV‐exposed infants was poor at 27%, with only 20% of infants having EID performed; and median age of testing varied from 10 to 16 weeks . Similar to our study, other recent studies from Mozambique , Nigeria , Tanzania and the Democratic Republic of the Congo have found large losses to follow‐up in HIV‐exposed infants, especially in relation to EID, where similar to the findings of our study infants also often come late for testing . Ways to reduce losses to follow‐up need to be found.…”

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

“…However, there is a lack of uniformity of methods used for collecting exclusive breastfeeding data in the countries under review. Infant feeding methods were reported in studies from Zambia, [ 37 ] Malawi, [ 7 ] Democratic Republic of Congo (DRC), [ 40 ] Ethiopia, [ 36 , 45 ] Cameroon, [ 42 , 47 ] Nigeria, [ 26 , 46 , 48 , 49 ] South Africa, [ 18 ] and Tanzania. [ 39 ] High levels of exclusive breastfeeding were reported, with Malawi reporting that 99% of HIV-exposed infants being exclusively breastfed in the first 6 months.…”

Implementation and Operational Research

“…Additional details on the program background and services provided to HIV-exposed infants are published elsewhere. 11 …”