Is it feasible to "eliminate" vertical HIV transmission: a Zimbabwe study.
Article Type: Report
Subject: Disease transmission (Prevention)
Disease transmission (Risk factors)
HIV (Viruses) (Prevention)
HIV (Viruses) (Risk factors)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 220 Strategy & planning
Organization: Organization: World Health Organization; UNAIDS
Geographic: Geographic Scope: Zimbabwe Geographic Code: 6ZIMB Zimbabwe
Accession Number: 296571606
Full Text: UNAIDS and WHO have set a goal of "virtual elimination" of mother-to-child transmission of HIV to below 5% in developing countries. A study of uptake of treatment for prevention of mother-to-child transmission among a cohort of HIV-positive pregnant or breastfeeding women in Zimbabwe looked at which combinations of treatment and breastfeeding might lead to a greater reduction in vertical transmission and the effect of women dropping out in the process between the first antenatal visit and cessation of breastfeeding. They found that even with the optimum of 95% uptake of treatment based on WHO's 2010 guidelines, projected transmission risks were estimated to be 6.1%-7.7%. Two cohorts of women were followed from first antenatal visit to two years after giving birth. Cohort I included women already HIV-positive at their first antenatal visit. Cohort 2 included all women getting pregnant each year in Zimbabwe. HIV prevalence amongst pregnant women was at the time 16% at the first antenatal visit and HIV incidence was 1% during late pregnancy and breastfeeding. They evaluated three regimens and four levels of PMTCT uptake--reported rates in 2008 and 2009 (36% and 56%) and target goals for 2008 and 2009 (80% and 95%). They also reviewed the current level of drop-out in the PMTCT services.

PMTCT uptake increased from 36% in 2008 to 56% in 2009, with a corresponding decrease in vertical transmission from 20.3% to 18%. However, the proportion of women completing care was as low as 61% by delivery and 51% by weaning. Vertical transmission risk was the same up to 4-6 weeks after delivery regardless of when women dropped out. However, the proportion of mother-infant pairs receiving post-natal care had a considerable effect on 12-month vertical transmission risk. The authors conclude that strategies to improve access to services to near 100%, retain women in care and support adherence to treatment throughout pregnancy and breastfeeding are essential alongside WHO-recommended treatment regimens, if "virtual elimination" is to be achieved in Zimbabwe or other resource-poor settings with a high HIV prevalence and prolonged breastfeeding. (1)

(1.) Ciaranello AL, Perez F, Keatinge J, et al. What will it take to eliminate pediatric HIV?. Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: a model-based analysis. PLoS Medicine 2012;9,1:e1001156.

Doi: 10.1016/S0968-8080(12)39622-5
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