Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi

Maria H. Kim, Saeed Ahmed, Geoffrey A. Preidis, Elaine J. Abrams, Mina C. Hosseinipour, Thomas P. Giordano, Elizabeth Y. Chiao, Mary E. Paul, Avni Bhalakia, Debora Nanthuru, Peter N. Kazembe

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere64979
JournalPLoS One
Volume8
Issue number5
DOIs
StatePublished - May 31 2013
Externally publishedYes

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Malawi
Mothers
HIV
disease control
community health workers
Therapeutics
CD4 Lymphocyte Count
pregnancy
Pregnancy Trimesters
DNA
Polymerase Chain Reaction
Maternal Age
cells
Logistics
Logistic Models
Health

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Kim, M. H., Ahmed, S., Preidis, G. A., Abrams, E. J., Hosseinipour, M. C., Giordano, T. P., ... Kazembe, P. N. (2013). Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi. PLoS One, 8(5), [e64979]. https://doi.org/10.1371/journal.pone.0064979

Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi. / Kim, Maria H.; Ahmed, Saeed; Preidis, Geoffrey A.; Abrams, Elaine J.; Hosseinipour, Mina C.; Giordano, Thomas P.; Chiao, Elizabeth Y.; Paul, Mary E.; Bhalakia, Avni; Nanthuru, Debora; Kazembe, Peter N.

In: PLoS One, Vol. 8, No. 5, e64979, 31.05.2013.

Research output: Contribution to journalArticle

Kim, MH, Ahmed, S, Preidis, GA, Abrams, EJ, Hosseinipour, MC, Giordano, TP, Chiao, EY, Paul, ME, Bhalakia, A, Nanthuru, D & Kazembe, PN 2013, 'Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi', PLoS One, vol. 8, no. 5, e64979. https://doi.org/10.1371/journal.pone.0064979
Kim MH, Ahmed S, Preidis GA, Abrams EJ, Hosseinipour MC, Giordano TP et al. Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi. PLoS One. 2013 May 31;8(5). e64979. https://doi.org/10.1371/journal.pone.0064979
Kim, Maria H. ; Ahmed, Saeed ; Preidis, Geoffrey A. ; Abrams, Elaine J. ; Hosseinipour, Mina C. ; Giordano, Thomas P. ; Chiao, Elizabeth Y. ; Paul, Mary E. ; Bhalakia, Avni ; Nanthuru, Debora ; Kazembe, Peter N. / Low Rates of Mother-to-Child HIV Transmission in a Routine Programmatic Setting in Lilongwe, Malawi. In: PLoS One. 2013 ; Vol. 8, No. 5.
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abstract = "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.",
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AU - Kim, Maria H.

AU - Ahmed, Saeed

AU - Preidis, Geoffrey A.

AU - Abrams, Elaine J.

AU - Hosseinipour, Mina C.

AU - Giordano, Thomas P.

AU - Chiao, Elizabeth Y.

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AU - Nanthuru, Debora

AU - Kazembe, Peter N.

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N2 - 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.

AB - 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.

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