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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi
PLoS ONE, Volume 8, No. 5, Article e64979, Year 2013
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Description
Background:The Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery. We evaluated the impact of antiretroviral (ARV) regimen and maternal CD4+ count on HIV transmission within the Tingathe program in Lilongwe, Malawi.Methods:We reviewed clinical records of 1088 mother-infant pairs enrolled from March 2009 to March 2011 who completed follow-up to first DNA PCR. Eligibility for antiretroviral treatment (ART) was determined by CD4+ cell count (CD4+) for women not yet on ART. ART-eligible women initiated stavudine-lamivudine-nevirapine. Early ART was defined as ART for ≥14 weeks prior to delivery. For women ineligible for ART, optimal ARV prophylaxis was maternal AZT ≥6 weeks+sdNVP, and infant sdNVP+AZT for 1 week. HIV transmission rates were determined for ARV regimens, and factors associated with vertical transmission were identified using bivariate logistic regression.Results:Transmission rate at first PCR was 4.1%. Pairs receiving suboptimal ARV prophylaxis were more likely to transmit HIV (10.3%, 95% CI, 5.5-18.1%). ART was associated with reduced transmission (1.4%, 95% CI, 0.6-3.0%), with early ART associated with decreased transmission (no transmission), compared to all other treatment groups (p = 0.001). No association was detected between transmission and CD4+ categories (p = 0.337), trimester of pregnancy at enrollment (p = 0.100), or maternal age (p = 0.164).Conclusion:Low rates of MTCT of HIV are possible in resource-constrained settings under routine programmatic conditions. No transmissions were observed among women on ART for more than 14 weeks prior to delivery. © 2013 Kim et al.
Authors & Co-Authors
Kim, Maria H.
United States, Houston
Baylor College of Medicine International Pediatric Aids Initiative at Texas Children's Hospital
Ahmed, Saeed
United States, Houston
Baylor College of Medicine International Pediatric Aids Initiative at Texas Children's Hospital
Preidis, Geoffrey A.
United States, Houston
Baylor College of Medicine International Pediatric Aids Initiative at Texas Children's Hospital
Abrams, Elaine J.
United States, New York
Mailman School of Public Health
Hosseinipour, Mina C.
Malawi, Lilongwe
Unc Project-malawi
United States, Chapel Hill
Unc School of Medicine
Giordano, Thomas P.
United States, Houston
Baylor College of Medicine
Chiao, Elizabeth Y.
United States, Houston
Baylor College of Medicine
Paul, Mary Elizabeth
United States, Houston
Baylor College of Medicine International Pediatric Aids Initiative at Texas Children's Hospital
Bhalakia, Avni
United States, Houston
Baylor College of Medicine International Pediatric Aids Initiative at Texas Children's Hospital
Nanthuru, Debora
Malawi, Lilongwe
Baylor College of Medicine-abbott Fund Children's Clinical Center of Excellence
Kazembe, Peter Nicholas
Malawi, Lilongwe
Baylor College of Medicine-abbott Fund Children's Clinical Center of Excellence
Statistics
Citations: 47
Authors: 11
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0064979
e-ISSN:
19326203
Research Areas
Genetics And Genomics
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Malawi
Participants Gender
Female