scholarly journals Reduction of HIV transmission rates from mother to child in the era of antiretroviral therapy in the Lake Victoria zone, Tanzania

2015 ◽  
Vol 17 (3) ◽  
Author(s):  
Mariam M. Mirambo ◽  
Celine Simon ◽  
Alphaxard Kajura ◽  
Benson Kidenya ◽  
Mtebe Majigo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Lake Victoria ◽  
Published Data ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Pmtct Programme ◽  
Positive Rate ◽  
Mother To Child ◽  
Hiv 1

Background: Since the introduction of prevention of mother to child transmission (PMTCT) in Tanzania, HIV infection rates have been reduced in different regions across the country. However, there is limited published data from the Lake Victoria zone of Tanzania regarding the effectiveness of various regimens used for PMTCT. This study was done to assess the effectiveness of antiretroviral therapy in preventing mother to child transmission of HIVMethods: Infants aged ≤18 months born to HIV positive mothers undertaking PMTCT programme and those with no intervention program from Mara, Kagera, Mwanza and Shinyanga were tested for HIV-1 DNA polymerase chain reaction (PCR). Data were analysed using STATA version 10.0 to assess factors associated with outcome.Results: A total of 1,005 study subjects were enrolled in the study. Of these 55% (554/1005) were females. Majority (82.6%; 830/1005) of the infants studied were aged 1-6 months. The median age of the infant studied was 3 months (IQR 2-4). Out of 1005 non-repetitive samples; 61(6.1%) were HIV-1 DNA PCR positive. Positive dried blood spots (DBS) rates by region were 6.4%, 5.9%, 5.6% and 5.1% in Mwanza, Mara, Kagera and Shinyanga, respectively. During pregnancy interventions, the positive rate for women with no therapy was 12.6% and for zidovudine alone was 5.4% while for triple antiretroviral therapy was 0.5%. Women who were in highly active antiretroviral therapy (HAART) during pregnancy had significantly lower positive rate than those without HAART treatment (p=0.001). Of 755 infants who received nevirapine, 3.9% were DBS positive compared to 12.8% of those who didn’t receive nevirapine (p=0.001).Conclusion: The use of antiretroviral therapy in the PMTCT programme is effective in reducing HIV transmission from mother to child.

scholarly journals Call To action - Prevention of mother To child transmission of HIV

2009 ◽  
Vol 10 (4) ◽  
pp. 12
Author(s):  
Ashraf Hassen Coovadia ◽  
Ameena Ebrahim Goga ◽  
Laurie Schowalter
Keyword(s):  
Hiv Transmission ◽  
Hiv Infections ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Pmtct Programme ◽  
Is Implementation ◽  
Main Challenge ◽  
Drug Regimens ◽  
Development Goals ◽  
Mother To Child

The Prevention of Mother to Child Transmission of HIV (PMTCT)programme is a critical intervention to reduce the incidence of paediatric HIV infections . It is also a key intervention to decrease infant, child and maternal mortality. The optimal implementation of a sound, evidence-based PMTCT programme is essential to meet both the HIV reduction targets in the National Strategic Plan1 and to achieve Millennium Development Goals(MDGs) 4 (reducing infant and child mortality) and 5 (reducing maternal mortalty).2 Since 2001, South Africa has been implementing a programme to prevent mother-to-child transmission of HIV. Since 2007, national PMTCT policy has evolved into a strong, enabling framework that should reduce vertical transmission significantly. This paper reviews the milestone studies that have contributed to our knowledge about drug regimens to reduce MTCT (mother-to-child transmission of HIV), reviews the latest South African PMTCT guidelines and the possible future changes. Strengthened / revised drug regimens for PMTCT are, essential but insufficient for measureable decreases in HIV transmission and improvements in maternal and childl health. The main challenge is implementation. Until the enhanced PMTCT policy is effectively operationalised, measureable achievements will remain elusive.

Behandlung von HIV in der Schwangerschaft – Entwicklung über eine Dekade

2018 ◽  
Vol 223 (01) ◽  
pp. 26-32 ◽  
Author(s):  
Isabelle Pitzen ◽  
Lucia Otten ◽  
Till Dresbach ◽  
Christoph Boesecke ◽  
Jan-Christian Wasmuth ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Interdisziplinäre Zusammenarbeit ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child ◽  
Hiv 1

Zusammenfassung Einleitung Mehr als 50% der rund 37 Mio. Menschen, die weltweit mit HIV leben, sind Frauen. Heutzutage kann die MTCT (Mother-to-child Transmission) auf<1% reduziert werden. Intention der vorliegenden Untersuchung war es, die Entwicklung (1) des Schwangerschaftsverlaufs HIV-positiver Frauen, (2) des Entbindungsmodus und (3) der Postexpositionsprophylaxe der Neugeborenen, über den Verlauf der letzten Dekade aufzuzeigen. Methodik Im Zeitraum 2005–2016 wurden die HIV- und geburtshilflichen Daten aller HIV-positiver, schwangerer Frauen, der Bonner HIV-Kohorte und die neonatalen Daten der HIV-exponierten Kinder ausgewertet. Die HIV-MTCT wurde für diesen Zeitraum untersucht. Ergebnisse Es wurden 87 Schwangerschaften bei 61 Frauen identifiziert. 70 Kinder wurden an der Universitätsfrauenklinik Bonn lebend geboren. Die Frauen waren zu 53% afrikanischer Herkunft. Der Median der CD4+-Zellzahl betrug präpartal 510 Zellen/μl (IQR 444) und lag bei 32 Frauen (52%) über 500 Zellen/μl. Die HI-Viruslast war präpartal bei 77% vollständig supprimiert (<50 HIV-1-RNA Kopien/ml) und lag bei 92% präpartal<400 HIV-1-RNA Kopien/ml. Im Vergleich zu dem Zeitraum 2005–2011 kam es zu einer deutlichen Reduktion der primären Sectiorate von 77 auf 58% im Zeitraum 2012–2016. Der Anteil der Kinder, die nach der 37 Schwangerschaftswoche geboren wurden, stieg nach 2012 von 60 auf 69% erkennbar an. Während im Zeitraum 2005–2011 78% der Neugeborenen mit ihrem Geburtsgewicht zwischen der 10. und 90. Perzentile lagen, nahm der Anteil nach 2012 auf 92% zu. 54 der 70 Neugeborenen (77%) wurden einem niedrig-normalen Transmissionsrisiko zugeordnet. In keinem Fall (0/70) kam es zu einer HIV-Transmission von Mutter zu Kind. Zusammenfassung In den Jahren 2005–2016 der Analyse hat keine vertikale HIV-Transmission von Mutter zu Kind stattgefunden. Es kam zu einer deutlichen Reduktion der primären Sectiorate und und zu einem Rückgang der Frühgeborenenrate, was die Änderung der Behandlungsstrategie in diesem Zeitraum widerspiegelt. Eine optimale interdisziplinäre Zusammenarbeit bleibt Grundlage für eine erfolgreiche Versorgung HIV-positiver, schwangerer Frauen.

scholarly journals Modifiable factors within the prevention of mother-to-child transmission programme associated with failure to prevent HIV transmission in the Onandjokwe district of Namibia

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
Flavia Strato Shayo ◽  
Bob Mash
Keyword(s):  
Hiv Transmission ◽  
Health Workers ◽  
Hiv Infections ◽  
Coordination Of Care ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Pmtct Programme ◽  
Paediatric Hiv ◽  
Modifiable Factors ◽  
Mother To Child

Background: Ending new paediatric HIV infections continues to be a global health priority. Cuba and other countries have demonstrated that elimination of mother-to-child transmission is possible through Prevention of Mother-to-Child Transmission (PMTCT) interventions. As Namibia works on improving PMTCT there is a need to identify the local modifiable factors to achieve zero new HIV infections.Aim: This study aimed to identify the modifiable factors within the PMTCT programme, which contributed to the acquisition of HIV infection among children.Setting: The study was carried out in the Onandjokwe District, Northern Namibia.Methods: A descriptive audit was undertaken of 59 medical records of mothers and their children under two years, who acquired HIV despite the PMTCT programme between 2014 and 2016.Results: The study found that overall HIV transmission was only 2%, but 80% of the paediatric HIV infections could be prevented by implementing the existing Namibian PMTCT recommendations. Overall 61% of modifiable factors were related to mothers, 30% to health workers and 10% to the health system. The top three modifiable factors were the mother defaulting on ART during pregnancy or breastfeeding, the health worker not intervening when the mother failed the first-line ART regimen, and poor coordination of care between the hospital and primary care.Conclusion: Although overall transmission is low with the PMTCT programme, the majority of remaining HIV infections among children under two years could be prevented by addressing the modifiable factors identified in this study.

scholarly journals OC 8450 ABSENCE OF MINORITY HIV-1 DRUG-RESISTANT VARIANTS FOLLOWING MOTHER-TO-CHILD TRANSMISSION DOES NOT PREDICT VIROLOGIC SUCCESS OF FIRST-LINE ANTIRETROVIRAL THERAPY

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A6.3-A7
Author(s):  
Cissy Kityo ◽  
Tobias Rinke De Wit ◽  
Immaculate Nankya ◽  
Sheilla Balinda ◽  
Kim Sigaloff ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Mutation Frequency ◽  
Drug Resistant ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
First Line ◽  
Group I ◽  
Mother To Child ◽  
Hiv 1

BackgroundAlthough minority HIV-1 drug-resistant HIV-1 variants may be selected under antiretroviral pressure, leading to therapy failure, their clinical significance remains controversial. This is particularly relevant in the case of prevention of mother-to-child transmission (MTCT), where transmitted drug resistance can affect treatment outcomes.MethodsAn ultrasensitive HIV-1 genotyping assay based on deep sequencing (DEEPGENHIV) with a 1% mutation frequency sensitivity, was used to quantify MTCT drug-resistant variants in 38 prenatally HIV-infected children experiencing (Group I, n=27) or not (Group II, n=11) virologic failure 12 months after initiating first-line antiretroviral therapy (ART) as part of a paediatric cohort in Uganda.ResultsInfants were infected with subtype A(n=20), D(n=16) or C(n=2) HIV-1 strains, distributed equally between both patients’ groups. Similarly, no significant difference was observed in intra-patient HIV-1 diversity among viruses obtained from Group I or II individuals at baseline. DEEPGENHIV was able to detect all the mutations originally detected in samples obtained from four control patients in Group II, where drug resistance was identified at baseline using Sanger sequencing, e.g. K65R (78% mutation frequency), K103N (47%), or M184V (85%). More importantly, a series of low abundance (<20% detection limit of Sanger) primary and compensatory mutations associated with resistance to PIs (D30N, Q48V), NRTIs (D67N, K219Q), or NNRTIs (L100I, K103N) were identified in both groups of patients, although just a few seem to have been selected and became majority variants after 12 or 24 months of ART.ConclusionDEEPGENHIV improves the detection of minority viral variants in infants following MTCT; however, most of the emergent HIV-1 drug resistance mutations were not present at low frequency at baseline in subjects failing ART, most likely being generated and selected following exposure to treatment. Further studies, using this or other ultrasensitive assays, are needed to better understand the transmission, dynamics and overall evolution of minority drug-resistant viruses in MTCT.

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