Tracking Progress Toward Elimination of Mother to Child Transmission of HIV in Zambia: Findings from the Early Infant Diagnosis of HIV Program (2009-2017).
Anti-Retroviral Agents
/ therapeutic use
DNA, Viral
/ blood
Female
HIV
/ genetics
HIV Infections
/ diagnosis
Humans
Infant
Infant, Newborn
Infectious Disease Transmission, Vertical
/ prevention & control
Male
Polymerase Chain Reaction
Post-Exposure Prophylaxis
Pregnancy
Pregnancy Complications, Infectious
Registries
Zambia
HIV
early infant diagnosis
effectiveness of PMTCT
elimination
mother-to-child-transmission of HIV
risk factors
Journal
Journal of tropical pediatrics
ISSN: 1465-3664
Titre abrégé: J Trop Pediatr
Pays: England
ID NLM: 8010948
Informations de publication
Date de publication:
01 02 2020
01 02 2020
Historique:
pubmed:
16
5
2019
medline:
1
9
2020
entrez:
16
5
2019
Statut:
ppublish
Résumé
We carried out analyses of early infant testing results at Livingstone Central Hospital in Zambia to assess time of testing, linkages to care and availability of test results for clinical decision making. We abstracted data from registers of HIV-exposed infants who had dried blood spots cards (DBS) collected for DNA-PCR from January 2009 to December 2017. Only those tested from 2014 to 2017 had additional data which were used to estimate risk factors for mother-to-child HIV transmission using logistic regression models. DBS were collected from 2630 children. The proportion of HIV-positive tests decreased from 21% in 2009 to 2% in 2016 and 2017. Median turnaround time for results was 9 weeks (IQR: 5, 15) for HIV-negative, 7 weeks (IQR: 5, 13) for HIV-positive children. Only 2% of infants whose mothers took antiretroviral therapy (ART) were HIV positive, while 18% of infants whose mothers took short course antiretroviral drugs (ARVs) were infected. Infants of mothers who did not take ARVs had 9 times the odds of an HIV positive test (OR = 8.9, 95% CI: 3.6, 22.6). Infants of mothers who received short course ARVs were 40% less likely to get an HIV test within the first 2 months of life (OR = 0.6, 95% CI: 0.4, 0.9) compared to infants of mothers who received ART. Only 52% had a third test at median age 52 weeks (IQR: 50, 54). Long turnaround time for test results and low retention in care after the initial HIV test were critical challenges to clinical decision making.
Sections du résumé
BACKGROUND
We carried out analyses of early infant testing results at Livingstone Central Hospital in Zambia to assess time of testing, linkages to care and availability of test results for clinical decision making.
METHODS
We abstracted data from registers of HIV-exposed infants who had dried blood spots cards (DBS) collected for DNA-PCR from January 2009 to December 2017. Only those tested from 2014 to 2017 had additional data which were used to estimate risk factors for mother-to-child HIV transmission using logistic regression models.
RESULTS
DBS were collected from 2630 children. The proportion of HIV-positive tests decreased from 21% in 2009 to 2% in 2016 and 2017. Median turnaround time for results was 9 weeks (IQR: 5, 15) for HIV-negative, 7 weeks (IQR: 5, 13) for HIV-positive children. Only 2% of infants whose mothers took antiretroviral therapy (ART) were HIV positive, while 18% of infants whose mothers took short course antiretroviral drugs (ARVs) were infected. Infants of mothers who did not take ARVs had 9 times the odds of an HIV positive test (OR = 8.9, 95% CI: 3.6, 22.6). Infants of mothers who received short course ARVs were 40% less likely to get an HIV test within the first 2 months of life (OR = 0.6, 95% CI: 0.4, 0.9) compared to infants of mothers who received ART. Only 52% had a third test at median age 52 weeks (IQR: 50, 54).
CONCLUSIONS
Long turnaround time for test results and low retention in care after the initial HIV test were critical challenges to clinical decision making.
Identifiants
pubmed: 31089687
pii: 5489341
doi: 10.1093/tropej/fmz030
pmc: PMC7156365
doi:
Substances chimiques
Anti-Retroviral Agents
0
DNA, Viral
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
56-65Subventions
Organisme : NIAID NIH HHS
ID : R01 AI093856
Pays : United States
Informations de copyright
© The Author(s) [2019]. Published by Oxford University Press.
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