Advertisement

 

 

Infant HIV-Free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-Based Cohort Study from Rural Zambia.

Infant HIV-Free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-Based Cohort Study from Rural Zambia.
Author Information (click to view)

Chi BH, Mutale W, Winston J, Phiri W, Price JT, Mwiche A, Ayles H, Stringer JSA,


Chi BH, Mutale W, Winston J, Phiri W, Price JT, Mwiche A, Ayles H, Stringer JSA, (click to view)

Chi BH, Mutale W, Winston J, Phiri W, Price JT, Mwiche A, Ayles H, Stringer JSA,

Advertisement

The Pediatric infectious disease journal 2018 03 27() doi 10.1097/INF.0000000000001997

Abstract
BACKGROUND
Lifelong antiretroviral therapy (ART) is now recommended for all HIV-infected pregnant and breastfeeding women; however, few have described overall infant outcomes in this new era for the prevention of mother-to-child HIV transmission (PMTCT).

METHODS
As part of an assessment of PMTCT program impact, we enrolled a prospective cohort study in four predominantly rural districts in Zambia. HIV-infected mothers and their newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months, and 12 months postpartum; infant specimens were tested via HIV DNA PCR. In Kaplan-Meier analyses, we estimated overall infant HIV-free survival and then stratified by district, community, and maternal ART use. We investigated the relationship between community-level 12-month, self-reported maternal ART use and infant HIV-free survival via linear regression.

RESULTS
From June 2014 to November 2015, we enrolled 827 mother-infant pairs in 33 communities. At 12 months, small proportions of infants had died (2.8%), were HIV-infected (3.0%), or were lost to follow-up (4.3%). Overall, infant HIV-free survival was 99.0% (95%CI: 98.0-99.5%) at 6 weeks, 97.5% (95%CI: 96.1-98.4%) at 6 months, and 96.3% (95%CI: 94.8-97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, p=0.01). Differences were noted at the district and site levels (p=0.01). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and self-reported maternal ART use (p=0.65).

CONCLUSION
While encouraging, these findings highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.

Submit a Comment

Your email address will not be published. Required fields are marked *

5 × four =

[ HIDE/SHOW ]