scholarly journals HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

2019 ◽  
Author(s):  
Richard Nyeko ◽  
Irene Aguti ◽  
Charles Kimbugwe ◽  
Patricia Apai ◽  
Siraji Munyaga
Keyword(s):  
Survival Rate ◽  
Low Income ◽  
World Health ◽  
Northern Uganda ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Free Survival ◽  
Breastfed Infants ◽  
Post Conflict ◽  
Mother To Child

Abstract Background Without interventions, the risk of mother-to-child transmission of HIV is up to 25% during pregnancy, labour and delivery with an additional risk of 5-20% during breastfeeding period, leading to an overall rate of up to 45%. Giving anti-retroviral therapy to the mother and anti-retroviral prophylaxis to the infant has been shown to significantly reduce the risk of HIV transmission through breastfeeding to less than 5%. According to the World Health Organization standard, the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting is measured by its HIV-free survival rate. We therefore carried out a study aimed at determining the HIV-free survival among breastfed infants in a resource poor setting in relation breastfeeding duration. Methods A cross-sectional retrospective study using routine clinical data and involving 365 HIV exposed infants followed up in two tertiary facilities in northern Uganda between 2014 and 2016. Data was analysed using Statistical Package for Social Scientists version 16 software package. Results Of the three hundred and sixty five (365) infants sampled for this study, 86.8% (317/365) were enrolled within the first 2 months of life, 12.1% (44/365) between 3-12 months of age and 1.1% (4/365) enrolled after 12 months of age. Almost all the infants (98.4%) were initiated on Nevirapine prophylaxis, 97.5% (356/365) of whom were initiated within 72 hours. The overall HIV-free survival rate in the current study was 93.7% (342/365), while 6.3% (23/365) were either HIV-infected (2.7%) or died (3.6%). The infants’ age at enrolment was the single most important factor significantly associated with HIV-free survival. The overall duration of breastfeeding did not significantly affect the HIV-free survival: 98.1% (304/310) for children breastfed > 12 months versus 100% (15/15) for those breastfed ≤12 months, though exclusive breastfeeding for at least 6 months was protective. Conclusions Adherence to current approaches to prevention of mother-to-child transmission of HIV with support to breastfeeding in low income countries can greatly enhance HIV-free survival for breastfed infants, and supports the current infant and young child feeding recommendations. Key words: HIV-free survival, Mother-to-child transmission, Breastfeeding, Antiretroviral therapy

scholarly journals HIV-free survival among breastfed infants born to HIV-positive women in northern Uganda: a facility-based retrospective study.

2020 ◽  
Author(s):  
Irene Aguti ◽  
Charles Kimbugwe ◽  
Patricia Apai ◽  
Siraji Munyaga ◽  
Richard Nyeko
Keyword(s):  
Survival Rate ◽  
Statistical Significance ◽  
Resource Poor Setting ◽  
P Value ◽  
Northern Uganda ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Free Survival ◽  
Breastfed Infants ◽  
Mother To Child

Abstract Background: Without interventions, the risk of mother-to-child transmission of HIV is 25% during pregnancy, labour and delivery with an additional risk of 5-20% during the breastfeeding, leading to an overall risk of 45%. The effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting is measured by its HIV-free survival rate. We carried out a study to determine the HIV-free survival among breastfed infants enrolled by 2 months of age in a resource-poor setting. Methods: We conducted a cross-sectional survey of early infant diagnosis registers at two tertiary facilities in northern Uganda and retrospectively reviewed records of exposed infants enrolled from 2014 to 2016. We used simple random sampling and analyzed data using SPSS v16 software package. The chi-square and Student t-tests were used to compare factors among HIV-free survivors (HIV-uninfected and alive at 18 months) and those who became HIV-infected or died. Multivariate analysis using logistic regression was used to determine the factors that were independently associated with HIV-free survival. Odds ratios with 95% confidence interval were used to measure the strength of association between the outcome and predictor variables. P-value <0.05 was considered for statistical significanceResults: The mean age at enrolment of the 317 infants was 1.57 (SD 0.23), majority of whom were males 55.5% (176/317). All except two infants were initiated on Nevirapine prophylaxis. Less than one third, 29.3% (93/317) of the infants were exclusively breastfed for at least 6 months, while the breastfeeding status of 30 infants could not be ascertained. The overall HIV-free survival rate in the current study was 94.6% (300/317), while 2.5% (8/317) were HIV-infected and 2.8% (9/317) died. Gender and treatment facility were the factors independently significantly associated with HIV-free survival. Conclusions: Our study estimates that the HIV-free survival rate in the study setting for breastfed infants enrolled by 2 months of age was 94.6%, below the WHO goal of >95% HIV-free rate in breastfeeding population for virtual elimination of HIV. A further prospective study would be necessary to assess a more accurate HIV-free survival rate given the limitations of retrospective data.

Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1

AIDS ◽  
2007 ◽  
Vol 21 (4) ◽  
pp. 509-516 ◽  
Author(s):  
Debra J Jackson ◽  
Mickey Chopra ◽  
Tanya M Doherty ◽  
Mark SE Colvin ◽  
Jonathan B Levin ◽  
...  
Keyword(s):  
South African ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
The South ◽  
Operational Effectiveness ◽  
Free Survival ◽  
Mother To Child ◽  
Hiv 1

scholarly journals The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality

2012 ◽  
Vol 13 (4) ◽  
pp. 178 ◽  
Author(s):  
D Besada ◽  
G Van Cutsem ◽  
E Goemaere ◽  
N Ford ◽  
H Bygrave ◽  
...  
Keyword(s):  
South African ◽  
Population Level ◽  
World Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Trade Offs ◽  
The Individual ◽  
Mother To Child ◽  
African Journal ◽  
In Pregnancy

In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1):28-33.). Highlighting the benefits of the World Health Organization’s proposed options for the prevention of mother-to-child transmission (PMTCT) of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.

scholarly journals Prevention of mother-to-child transmission of HIV guidelines: Nurses’ views at four primary healthcare facilities in the Limpopo Province

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Barbara A. Hanrahan ◽  
Adri Williams
Keyword(s):  
Patient Education ◽  
Registered Nurses ◽  
Primary Healthcare ◽  
Limpopo Province ◽  
World Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Pmtct Programme ◽  
Healthcare Facilities ◽  
Mother To Child

Background: When new guidelines for existing programmes are introduced, it is often the clinicians tasked with the execution of the guidelines who bear the brunt of the changes. Frequently their opinions are not sought. In this study, the researcher interviewed registered nurses working in the field of the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) to gain an understanding of their perspectives on the changes introduced to the guidelines. The guideline changes in 2014 were to move from the World Health Organization (WHO) Option B to Option B + which prescribes lifelong antiretroviral therapy (ART) for all HIV-positive pregnant women regardless of CD4 cell count.Objective: To determine what the registered nurses’ perspectives are on the PMTCT programme as implemented at four PHC facilities in the Limpopo Province.Method: For this qualitative investigation, a descriptive research design was implemented. The data were collected during semi-structured interviews with nurses from four primary healthcare facilities in the Limpopo Province of South Africa. Data were analysed using thematic analysis.Results: Challenges preventing effective implementation (e.g. increased workloads, viz. staff shortages; poor planning of training; equipment and medication shortages and long lead times; poor patient education) were identified.Conclusion: In spite of the successes of the PMTCT programme, considerable challenges still prevail; lack of patient education, poor facilities management and staff shortages could potentially influence the implementation of the PMTCT guidelines negatively.

scholarly journals Community-based approaches to prevention of mother-to-child transmission of HIV: Findings from a low-income community in Kenya

2007 ◽  
Author(s):  
Susan Kaai ◽  
Carolyn Baek ◽  
Scott Geibel ◽  
Peter Omondi ◽  
Benson Ulo ◽  
...  
Keyword(s):  
Low Income ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Community Based ◽  
Mother To Child
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