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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia
AIDS, Volume 19, No. 12, Year 2005
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Description
Objective: To determine the population effectiveness of a city-wide perinatal HIV prevention program. Design: An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP). Methods: All 10 public-sector delivery centers in Lusaka, Zambia participated. All mother-infant pairs delivering during the 12-week surveillance period at the participating centers and who received antenatal care at a public-sector facility in Lusaka were included in the study. The main outcome measure was population NVP coverage, defined as the proportion of HIV-infected women and HIV-exposed infants in the population that ingested NVP. Results: Of 8787 women in the surveillance population, 7204 (82%) had been offered antenatal HIV testing, of which 5149 (71%) had accepted, and of which 5129 (99%) had received a result. Overall, 2257 of 8787 (26%) were cord seropositive. Of the 1246 (55%) cord blood seropositive women who received an antenatal HIV test result, 1112 (89%) received a positive result; the other 134 comprise seroconverters and clerical errors. Only 751 of 1112 (68%) women who received a positive antenatal test result and a NVP tablet for ingestion at labor onset had NVP detected in the cord blood (i.e., maternal non-adherence rate was 32%). A total of 675 infants born to 751 adherent mothers (90%) received NVP before discharge. Thus, only 675 of 2257 (30%) seropositive mother-infant pairs in the surveillance population received both a maternal and infant dose of NVP. Conclusions: Successful perinatal HIV prevention requires each mother-infant pair to negotiate a cascade of events that begins with offering HIV testing and continues through adherence to the prescribed regimen. This novel surveillance demonstrates that failures occur at each step, resulting in reduced coverage and diminished program effectiveness. © 2005 Lippincott Williams & Wilkins.
Authors & Co-Authors
Stringer, Jeffrey S.A.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
University of Zambia School of Medicine
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Sinkala, Moses M.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
Zambian Ministry of Health
Maclean, Courtney C.
United States, Durham
Duke University School of Medicine
Levy, Jens W.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kankasa, Chipepo
Zambia, Lusaka
University of Zambia School of Medicine
Zambia, Lusaka
University Teaching Hospital Lusaka
Degroot, Alain
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Stringer, Elizabeth Mc Phillips
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
University of Zambia School of Medicine
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Acosta, Edward P.
United States, Birmingham
The University of Alabama at Birmingham
Goldenberg, Robert L.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Vermund, Sten Havlor
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Statistics
Citations: 150
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1097/01.aids.0000180102.88511.7d
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Zambia
Participants Gender
Female