Tenofovir Adherence in the Prevention of Mother-to-Child Transmission of Hepatitis B in the Democratic Republic of the Congo: A Qualitative Study Applying the Information-Motivation-Behavioral Skills Model

Background: Hepatitis B virus (HBV) remains a leading infectious cause of death worldwide, and is highly prevalent in Sub-Saharan Africa (SSA). The prevention of mother-to-child transmission (PMTCT) programs for HBV are critical to reaching elimination targets and utilizing existing HIV testing and treatment infrastructure. Building on a feasibility study to introduce tenofovir disoproxil fumarate antiviral therapy to pregnant women with high-risk HBV in the Democratic Republic of the Congo (DRC), we examine the social and psychological facilitators of medication adherence of women who participated in this HBV PMTCT program.Methods: This study utilizes a qualitative exploratory approach involving women in Kinshasa, DRC who were identified as high-risk HBV during pregnancy and completed the pilot tenofovir antiviral program. Six participants were identified and completed in-depth, open-ended phone interviews. This study adopts a modified Information-Motivation-Behavioral Skills model (IMB+) to identify emerging themes related to tenofovir adherence.Results: A strong trust in healthcare workers, family support, and improved awareness of the disease and treatment options through enrollment in the PMTCT program facilitated tenofovir adherence. Barriers to medication adherence included social stigma and low healthcare literacy specific to HBV.Conclusions: Our study highlights the feasibility of medication adherence in HBV PMTCT programs in a low-resource setting and the importance of incorporating initiatives that address hepatitis B stigma and other social barriers. These findings are relevant to future HBV PMTCT scale-up, which is needed in the DRC and in similar African contexts with high HBV prevalence. Trial registration: The parent study was registered with clinicaltrials.gov under identifier NCT03567382. Date of registration: 25/06/2018

A Review and Analysis of Outcomes from Prevention of Mother-to- Child Transmission of HIV Infant Follow-up Services at a Pediatric Infectious Diseases Unit of a Major Tertiary Hospital in Nigeria: 2007-2020

Background and Objective: Above 90% of childhood HIV infections result from mother-to child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria. Methods: This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client’s folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status. Results: Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative. Conclusion and Global Health Implications: Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival. Copyright © 2021 Ugochukwu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

THE OUTCOME OF PMTCT GUIDELINE IMPLEMENTATION TOWARDS THE PROGRAM PERFORMANCE FOR THE ELIMINATION OF HIV TRANSMISSION FROM MOTHER TO CHILD IN DENPASAR CITY

UNAIDS report on the level of HIV transmission from mother to child shows that Indonesia is in the highest rank in the world. This study aims to conduct rapid assessment about the full extent of PMTCT program and services in Denpasar City, Bali. This study located Denpasar City as a capital of Bali with high HIV cases and currently apply PMTCT services. The study conducted through FGDs, in-depth interview and observation in the primary health centers and hospitals. The data was validated by triangulating data from several sources. The results showed that the there is no specific local policy for PMTCT programs and services. There is no PMTCT program management guideline or SOP for PMTCT services at the Health Office and primary health centers. In Denpasar City there are already 5 primary health centers that provide comprehensive HIV and AIDS prevention and treatment services (LKB), and this includes providing PMTCT services consisting of HIV testing and ARV treatment for pregnant women. However, there is no ARV treatment for infant, this service must be obtained at general hospital through a referral mechanism. There is funding from local government (APBD) to buy diagnostic test for HIV and to capacity strengthening of human resources, but no support for further laboratory examinations. The empowerment for midwives to be involved in PMTCT program is limited, there has never been a comprehensive training on PMTCT and no empowerment of private practice midwives for PMTCT. The assistance’s activities to ensure ARV adherence is limited. There has been assistance for HIV positive mothers by NGOs in Denpasar City. Women with HIV still get stigma and discrimination from the community and health workers. There are also some challenges in data input, including error in inputting the data that need permission to edit it. It is recommended to improve: the HIV test coverage to 100% for pregnant women (for the first 90); the coverage and quality of ARV treatment (for the second 90); the capacity of PMTCT human resources; the commitment of local government; and data utilization.

Arresting Vertical Transmission of Hepatitis B Virus (AVERT-HBV) in the Democratic Republic of the Congo

Background: Hepatitis B virus (HBV) remains endemic throughout sub-Saharan Africa despite the widespread availability of effective vaccines. We evaluated the feasibility of adding HBV testing and treatment of pregnant women and birth-dose vaccination of HBV-exposed infants to the HIV prevention of MTCT (PMTCT) program infrastructure in the Democratic Republic of the Congo (DRC), where HBV treatment and birth-dose vaccination programs are not established. Methods: As part of the HIV PMTCT program at two maternity centers in Kinshasa, DRC, pregnant women were screened for HBV at routine prenatal care registration. Pregnant women with high viral load and/or HBeAg positivity were offered tenofovir disoproxil fumarate (TDF). HBV-exposed infants received a birth-dose of HBV vaccine within 24 hours of life. The primary endpoint was the feasibility and acceptability of the study. Results: Of 4,016 women screened, 109 (2.7%) were HBsAg-positive. Ten of 91 (11.1%) women evaluated had high-risk disease. Of 88 infants, 60 (68.2%) received a birth-dose vaccine; of these, 46 (76.7%) received a timely birth-dose. No cases of HBV MTCT were observed in our cohort. There were no serious adverse events associated with TDF nor with birth-dose vaccine. The study procedures were highly acceptable (>80%) among mothers. Conclusions: Adding HBV screening and treatment of pregnant women and infant birth-dose vaccination to existing HIV PMTCT platforms is feasible in countries like the DRC. Birth-dose vaccination against HBV integrated within the current Expanded Programme on Immunization (EPI) and HIV PMTCT program could accelerate progress toward HBV elimination in Africa.

Prevention of Mother to Child Transmission in HIV Antenatal and Postnatal Screening in Khulna Medical College

Introduction: Prevention of Mother to Child Transmission (PMTCT) program, offers a range of services for women of reproductive age living with or at risk of HIV to maintain health and stop their infants from acquiring HIV. PMTCT services should be commenced before conception and throughout pregnancy, labor and breast feeding. Around 1.4 million HIV infections among children were prevented between 2010 and 2018 by PMTCT program. UNFPO started antenatal screening program in collaboration with AIDS/STD program in Bangladesh from 2013, in 12 centers (BSMMU, 4 Medical College Hospitals, 3 Sadar Hospitals, 3 Health Complexes and Memon Maternity Hospital, Chittagong). Materials and Methods: Observational study of Antenatal and postnatal cases in HIV screening in KMCH during the period of Nov’2017 to March’2020. Results: From November 2017 to March 2020, total 18,911 patients screened, 11 patients were found HIV positive. 2 patients dropped out. Among 9 patients, 6 patients were detected in antenatal and 3 in postnatal period. 6 patients had vaginal delivery, 2 elective caesarean section and 1 patient had abortion. Screening was done by Alere Determine HIV- ½ Ag/Ab Combotest and diagnosis was confirmed by Uni-Gold HIV Rapid Test and First Response HIV 1-2-0 Card test. Conclusion: Following confirmation, ARV started with proper counseling. All babies were breast fed. The neonates were screened by PCR at their age of 45 days and found negative. WHO guideline was strictly maintained during labor conduction and cesarean sections. PMTCT program should be expanded in all institutions to detect cases, reduce transmission, contraception counselling to reduce confirmed cases. Medicine Today 2021 Vol.33(1): 7-11

Non Detection of HIV-1 Proviral DNA in PBMCs of the Neonates Born to Iranian HIV-infected Mothers in PMTCT Program

Background: Early diagnosis of immunodeficiency virus-1 infection in children and access to treatment for this infection is critical in decreasing infant mortality. Objectives: The aim of the current survey was to determine the presence of HIV-1 genomic RNA in plasma and proviral DNA in peripheral blood mononuclear cell (PBMC) specimens of neonates born to HIV-infected mothers. Methods: leprevention of mother-to-child transmission (PMTCT) program were enrolled in this study to compare two different diagnostic methods. After the extraction of viral RNA of plasma and genomic DNA of PBMC specimens, HIV-1 RNA and proviral DNA was tested by amplification of the long terminal repeat (LTR) region of HIV-1 using real-time PCR. Results: Out of 73 evaluated infants, 41 infants (56.2%) were male. The average age of the mothers with HIV-1 infection was 30.7 ± 5.2 (range: 19–47) years. The results revealed that none of the infants were infected with HIV-1, and also all were negative for HIV-1 genomic RNA in plasma specimen and proviral DNA of HIV-1 in PMBC samples. During the present study, 20 infants born to HIV-1 positive mothers who were not included in the PMTCT project were accidentally identified. Four infants (20%) out of these 20 infants were infected with HIV, all were infected with CRF35-AD of HIV, and none carried variants with surveillance drug-resistant mutations. Conclusions: The results of the present study showed that two molecular methods of detecting HIV infection (presence of genomic RNA of HIV-1 in plasma and proviral DNA of HIV-1 in PBMC specimens) are completely in agreement with each other, and the PMTCT program is possibly an effective program.

Barriers of PMTCT (Prevention Mother to Child Transmission) Program: Systematic Review

HIV infection during pregnancy is a serious problem that requires special attention because the number of case increasing every year. According to UNAIDS data, more than 36.9 million people were living with HIV on 2017. An increase of 1.8 million new cases and 940,000 deaths occurs in the same year. In Indonesia especially, there were about 630,000 HIV cases on 2017 and nearly 49,000 new cases reported. This number consists of cases of vertical transmission from mother to child during pregnancy. The government has implemented PMTCT (Prevention Mother to Child Transmission) program as a solution to reduce the number of HIV cases. Nevertheless this program has not been running well due to several barriers regarding to its implementation. This study aimed to provide an understanding of various barriers to PMTCT program implementation. A systematic review approach by PRISMA design was used to study literatures from databases. Stigma or discrimination from community and health care, experienced by HIV patients, was major barrier that impede PMTCT program. In addition, lack of support from partner or family, depression, economic factors, stigma from health workers, and health workers’ income-workload discrepancy were also significantly affected the implementation. Contrary, the active role of health workers to provide counseling and education about HIV/AIDS among community as well as to client’s families was a success key of PMTCT program.