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Reducing pediatric HIV infection: estimating mother to child transmission rates in a program setting in Zambia

Reducing pediatric HIV infection: estimating mother to child transmission rates in a program setting in Zambia
Reducing pediatric HIV infection: estimating mother to child transmission rates in a program setting in Zambia
BACKGROUND: Vertical transmission of HIV remains the main source of pediatric HIV infection in Africa with transmission rates as high as 25%-45% without intervention. Even though effective interventions to reduce vertical transmission of HIV are now available and remarkable progress has been made in scaling up prevention of mother-to-child transmission (PMTCT) services, the effectiveness of PMTCT interventions is unknown in Zambia. In this study, we estimate HIV vertical transmission rates at different age bands among perinatally exposed children.

METHODS: The study analyzed program data of DNA polymerase chain reaction results and selected client information on dried blood spot samples from perinatally exposed children aged 0-12 months sent to the polymerase chain reaction laboratory from 5 provinces between September 2007 and January 2009.

RESULTS: Samples of 8237 babies between 0 and 12 months were analyzed, with 84% of the mothers having ever breastfed their children. The observed transmission rate was 6.5% (5.1%, 7.8%) among infants aged 0-6 weeks when both mother and infant received interventions compared with 20.9% (12.3%, 29.5%) where no intervention was given to either mother or baby. Observed HIV transmission with single-dose nevirapine (sdNVP) was 8.5% (5.9%, 11.0%) among infants aged 0-6 weeks, whereas zidovudine with sdNVP (zidovudine + NVP) and highly active antiretroviral therapy were associated with observed transmission rates of 6.8% (4.5%, 9.1%) and 5.0% (3.0%, 7.0%), respectively; whereas these estimates were not significantly different from one another, they were all significantly lower than no intervention for which the estimated rate was 20.9%. Regardless of the intervention, the observed transmission rates were higher among infants aged 6-12 months.

CONCLUSIONS: PMTCT interventions, including sdNVP, are working in program settings. However, postnatal transmission especially after 6 months through suboptimal feeding practises remains an important challenge to further reduce pediatric HIV.
1525-4135
415-422
Torpey, Kwasi
815aebdc-b12c-4c50-b772-4e1923fd61c0
Kasonde, Prisca
9296067c-a81d-4991-b8da-e4800136f3ed
Kabaso, Mushota
180b4c6b-f956-4d1e-a371-ea03917ad42a
Weaver, Mark A
428b919f-dd35-41c1-917a-ffa751bd85d9
Bryan, Gail
df897f30-aacc-469f-9c80-6bb7c5b13ed2
Mukonka, Victor
7309275d-3fdd-4e40-8fc9-27b1b99fad91
Bweupe, Maximillian
d181c40c-4e11-4acb-b0b0-601921eeb19d
Zimba, Chilunje
77e3fe23-7f93-4081-aa3c-f4966c671975
Mwale, Felicitas
92a965ed-f086-41f7-ad03-45ac2cf444c4
Colebunders, Robert
434a9a0b-bc01-4614-a2cf-25c47f45bb57
Torpey, Kwasi
815aebdc-b12c-4c50-b772-4e1923fd61c0
Kasonde, Prisca
9296067c-a81d-4991-b8da-e4800136f3ed
Kabaso, Mushota
180b4c6b-f956-4d1e-a371-ea03917ad42a
Weaver, Mark A
428b919f-dd35-41c1-917a-ffa751bd85d9
Bryan, Gail
df897f30-aacc-469f-9c80-6bb7c5b13ed2
Mukonka, Victor
7309275d-3fdd-4e40-8fc9-27b1b99fad91
Bweupe, Maximillian
d181c40c-4e11-4acb-b0b0-601921eeb19d
Zimba, Chilunje
77e3fe23-7f93-4081-aa3c-f4966c671975
Mwale, Felicitas
92a965ed-f086-41f7-ad03-45ac2cf444c4
Colebunders, Robert
434a9a0b-bc01-4614-a2cf-25c47f45bb57

Torpey, Kwasi, Kasonde, Prisca, Kabaso, Mushota, Weaver, Mark A, Bryan, Gail, Mukonka, Victor, Bweupe, Maximillian, Zimba, Chilunje, Mwale, Felicitas and Colebunders, Robert (2010) Reducing pediatric HIV infection: estimating mother to child transmission rates in a program setting in Zambia. JAIDS Journal of Acquired Immune Deficiency Syndromes, 54 (4), 415-422. (doi:10.1097/QAI.0b013e3181e36616). (PMID:20517161)

Record type: Article

Abstract

BACKGROUND: Vertical transmission of HIV remains the main source of pediatric HIV infection in Africa with transmission rates as high as 25%-45% without intervention. Even though effective interventions to reduce vertical transmission of HIV are now available and remarkable progress has been made in scaling up prevention of mother-to-child transmission (PMTCT) services, the effectiveness of PMTCT interventions is unknown in Zambia. In this study, we estimate HIV vertical transmission rates at different age bands among perinatally exposed children.

METHODS: The study analyzed program data of DNA polymerase chain reaction results and selected client information on dried blood spot samples from perinatally exposed children aged 0-12 months sent to the polymerase chain reaction laboratory from 5 provinces between September 2007 and January 2009.

RESULTS: Samples of 8237 babies between 0 and 12 months were analyzed, with 84% of the mothers having ever breastfed their children. The observed transmission rate was 6.5% (5.1%, 7.8%) among infants aged 0-6 weeks when both mother and infant received interventions compared with 20.9% (12.3%, 29.5%) where no intervention was given to either mother or baby. Observed HIV transmission with single-dose nevirapine (sdNVP) was 8.5% (5.9%, 11.0%) among infants aged 0-6 weeks, whereas zidovudine with sdNVP (zidovudine + NVP) and highly active antiretroviral therapy were associated with observed transmission rates of 6.8% (4.5%, 9.1%) and 5.0% (3.0%, 7.0%), respectively; whereas these estimates were not significantly different from one another, they were all significantly lower than no intervention for which the estimated rate was 20.9%. Regardless of the intervention, the observed transmission rates were higher among infants aged 6-12 months.

CONCLUSIONS: PMTCT interventions, including sdNVP, are working in program settings. However, postnatal transmission especially after 6 months through suboptimal feeding practises remains an important challenge to further reduce pediatric HIV.

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Published date: August 2010
Organisations: Mathematical Sciences

Identifiers

Local EPrints ID: 353692
URI: http://eprints.soton.ac.uk/id/eprint/353692
ISSN: 1525-4135
PURE UUID: dd8e3143-c39f-439c-887a-255b5270d8c3

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Date deposited: 13 Jun 2013 15:22
Last modified: 08 Jan 2022 06:03

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Contributors

Author: Kwasi Torpey
Author: Prisca Kasonde
Author: Mushota Kabaso
Author: Mark A Weaver
Author: Gail Bryan
Author: Victor Mukonka
Author: Maximillian Bweupe
Author: Chilunje Zimba
Author: Felicitas Mwale
Author: Robert Colebunders

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