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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: Evaluation of a two-tiered approach
PLoS Medicine, Volume 4, No. 8, Year 2007
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Description
Background: Highly active antiretroviral treatment (HAART) has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term (4 wk) and long-term (12 mo) effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT) in Africa: women meeting the eligibility criteria of the World Health Organization (WHO) received HAART, and women with less advanced HIV disease received short-course antiretroviral (scARV) PMTCT regimens. Methods and Findings: The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, Côte d'Ivoire received either HAART for their own health or short-course antiretroviral (scARV) PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load (VL) was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged ≥ 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine (ZDV), lamivudine (3TC), and nevirapine (NVP) and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with sc(ZDV+3TC) with single-dose NVP during labour. Most (75%) of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% (95% confidence interval [CI] 0.3%-4.2%) and the cumulative rate at 12 mo was 5.7% (95% CI 2.5%-9.0%). The overall probability of infant death or infection with HIV was 4.3% (95% CI 1.7%-7.0%) at age week 4 wk and 11.7% (95% CI 7.5%-15.9%) at 12 mo. Conclusions: This two-tiered strategy appears to be safe and highly effective for short- and long-term PMTCT in resource-constrained settings. These results indicate a further benefit of access to HAART for pregnant women who need treatment for their own health. © 2007 Tonwe-Gold et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC1949842/bin/pmed.0040257.sd001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC1949842/bin/pmed.0040257.sd002.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC1949842/bin/pmed.0040257.sd003.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC1949842/bin/pmed.0040257.sd004.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC1949842/bin/pmed.0040257.sd005.pdf
Authors & Co-Authors
Tonwe-Gold, Besigin
Cote D'ivoire, Abidjan
Aconda
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
Ékouévi, Didier Koumavi
Cote D'ivoire, Abidjan
Aconda
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
Viho, Ida
Cote D'ivoire, Abidjan
Aconda
Cote D'ivoire, Abidjan
Ditrame Plus Project
Amani-Bossé, Clarisse
Cote D'ivoire, Abidjan
Aconda
Cote D'ivoire, Abidjan
Ditrame Plus Project
Touré, Siaka
Cote D'ivoire, Abidjan
Aconda
Coffié, Patrick Ahuatchi
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
Rouet, François
Cote D'ivoire, Abidjan
Centre Hospitalier Universitaire de Treichville
Becquet, Renaud
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
Leroy, Valeriane
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
El-Sadr, W. M.
United States, New York
Mailman School of Public Health
Abrams, Elaine J.
United States, New York
Mailman School of Public Health
Dabis, Franćois Ç.Ois
France, Bordeaux
Université de Bordeaux
France, Paris
Inserm
Statistics
Citations: 169
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pmed.0040257
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Locations
Multi-countries
Ivory Coast
Participants Gender
Female