Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria


Autoři: Ademola Joshua Itiola aff001;  Ameena Ebrahim Goga aff002;  Vundli Ramokolo aff002
Působiště autorů: School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa aff001;  Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa aff002;  HIV Prevention Research Unit, South African Medical Research Council, Pretoria, South Africa aff003;  Department of Paediatrics, University of Pretoria, Pretoria, South Africa aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224670

Souhrn

Background

Research studies have demonstrated a reduction in the risk of mother-to-child transmission of HIV (MTCT) to less than 2%, or 5% in non-breastfeeding and breastfeeding populations, respectively, with antiretroviral interventions. However, the risk of MTCT in routine health-facility settings, where service delivery is usually sub-optimal needs monitoring.

Method

We conducted a retrospective review of data from 2008–2014, in two health facilities in Adamawa State, Nigeria. Descriptive statistics were used to estimate overall MTCT rate and MTCT rate by year, and period of prevention of mother-to-child transmission of HIV (PMTCT) protocol implementation. We conducted simple and multiple logistic-regression analyses, to identify predictors of MTCT.

Results

Data from 1,651 mother-to-infant pairs, with HIV deoxyribonucleic acid (DNA) polymerase-chain reaction (PCR) test results from 2008 (n = 49), 2009 (n = 246), 2010 (n = 280), 2011 (n = 335), 2012 (n = 290), 2013 (n = 225) and 2014 (n = 226) were analysed. The overall MTCT rate among HIV exposed infants (HEIs) was 9.7% (95% CI 8.3% - 11.1%) at a median age of 8 weeks (IQR = 6–20). The MTCT rate decreased from 14.3% (4.4%-24.2%) in 2008 to 4.9% (2.1%-7.7%) in 2014 (p = 0.016). The MTCT rate was the lowest (5.4% [3.7% - 7.0%]) when all pregnant women living with HIV received triple antiretroviral therapy, as treatment or prophylaxis (ARVT/P). Using the pooled data, we found that infant age, breastfeeding option, antiretroviral regimen and year were predictors of MTCT. The adjusted odds of MTCT were significantly higher, when neither mother nor HEI received ARVT/P (Adjusted odds ratio (AOR) 26.4 [14.0–49.8], and lower amongst infants born in 2012, compared with those born in 2008 (AOR 0.2 [0.0–1.0]).

Conclusion

The MTCT rate declined significantly between 2008 and 2014 in these two routine health-facility settings in Nigeria. Our study suggests that ARVT/P yields the lowest MTCT. Thus, efforts to scale up lifelong ARVT/P (Option B+) in Nigeria should be accelerated.

Klíčová slova:

Antiretrovirals – Infants – Nigeria – Polymerase chain reaction – Pregnancy


Zdroje

1. UNAIDS. Prevention Gap Report. 2016a. Available: http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf. Downloaded: 23.05.2017

2. UNAIDS. HIV and AIDS Estimates. 2015. Available: http://www.unaids.org/en/regionscountries/andcountries/Nigeria Accessed: 23.05.2017

3. Federal Ministry of Health Nigeria. National Guidelines for Prevention of Mother-to-Child Transmission of HIV (PMTCT). 2010a. Downloaded: http://www.emtct-iatt.org/wp-content/uploads/2013/04/Nigeria_National-PMTCT-Guidelines_2010.pdf Accessed: 21.08.2013

4. Agboghoroma C, Sagay S, Ikechebelu J. Nigerian Prevention of Mother to Child Transmission of Human Immunodeficiency Virus Program: The Journey So Far. Journal of HIV and Human Reproduction, 2013;1(1): 1–7.

5. National Agency for the Control of AIDS. PMTCT Demand Creation for Accelerated Uptake of Services: A National Prevention of Mother-to-Child Transmission (PMTCT) of HIV Communication Strategy, Nigeria. 2014. Available: http://sbccvch.naca.gov.ng/sites/default/files/PMTCT%20demand%20creation%20strategy.pdf Accessed: 12.04.2015

6. Khamofu H, Oladele EA, Ralph-Opara U, Badru T, Adedokun O, Saleh M et al. Decline in positivity rates among HIV-exposed infants with changes in the prevention of mother-to-child transmission antiretroviral regimens in Nigeria: Evidence from 7 years of field implementation. J HIV Hum. Reprod. 2015; 3:34–40 Available from: http://www.j-hhr.org/text.asp?2015/3/2/34/186351 Accessed 12.02.2018

7. Federal Government of Nigeria. Second National Strategic Health Development Plan (2018–2022). 2018

8. UNAIDS. Country Factsheets: Nigeria. 2018. Available from: http://www.unaids.org/en/regionscountries/countries/nigeria/ Accessed 04.12.2018

9. National Agency for the Control of AIDS. Revised National HIV and AIDS Strategic Framework 2019–2021. 2019. Available from: https://naca.gov.ng/revised-national-hiv-and-aids-strategic-framework-2019-2021/ Accessed 05.06.2019

10. Ezegbe C, Stephenson N. The Reach and Limits of The US President's Emergency Plan for AIDS Relief (PEPFAR) Funding of Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Nigeria. African Journal of Reproductive Health. 2012;16(1):23–34. 22783665

11. Federal Ministry of Health. National Guidelines for HIV Prevention Treatment and Care. 2016.

12. Federal Ministry of Health. National Guidelines on Prevention of Mother to Child Transmission of HIV (PMTCT). 2007.

13. Agboghoroma CO, Audu LI, Iregbu KC. Effectiveness of Prevention of Mother-to-Child Transmission of HIV Program in Abuja. Journal of HIV & Human Reproduction. 2015;3(1):7–13. Available: http://www.j-hhr.org/temp/JHIVHumReprod317-5201927_142659.pdf Accessed: 05.06.2017

14. Chama C, Gashau W, Oguche S. The Value of Highly Active Antiretroviral Therapy in the Prevention of Mother-to-Child Transmission of HIV. Journal of Obstetrics and Gynaecology. 2007;27(2):134–137. doi: 10.1080/01443610601113854 17454457

15. Chama CM, Bello M, Ajayi BA, Zarma S, Gashau W. The Use of Highly Active Antiretroviral Therapy for the Prevention of Mother-to-Child Transmission of the Human Immunodeficiency Virus in Nigeria. Journal of Obstetrics and Gynaecology. 2010;30(4):362–366. doi: 10.3109/01443611003672104 20455718

16. Esene H, Omoigberale AI. Prevalence of HIV among Exposed Infants in University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. Journal of Biomedical Sciences. 2012;11(1):105–115.

17. Okafor I, Ugwu E, Obi S, Odugu B. Virtual Elimination of Mother-to-Child Transmission of Human Immunodeficiency Virus in Mothers on Highly Active Antiretroviral Therapy in Enugu, South-Eastern Nigeria. Annals of Medical and Health Sciences Research. 2014;4(4):615–618. doi: 10.4103/2141-9248.139344 25221715

18. Isah AM, Igboeli NU, Adibe MO, Ukwe CV. Evaluation of Prevention of Mother-to-Child Transmission (PMTCT) of HIV in a Tertiary Health Institution in South-Eastern Nigeria. Journal of AIDS and HIV Research. 2016;8 (8):114–120. Available: http://www.academicjournals.org/JAHR Accessed: 20.09.2016

19. Afe AJ, Adewum N, Emokpa A, Fagorala T, Aruma ED, Abidoye G et al. Outcome of PMTCT Services and Factors Affecting Vertical Transmission of HIV Infection in Lagos, Nigeria. HIV & AIDS Review. 2011;10(1):14–18.

20. Audu R, Onwuamah C, Salu O, Okwuraiwe A, Ou Chin-Yih BO, Bond KB et al. Development and Implementation Challenges of a Quality Assured HIV Infant Diagnosis Program in Nigeria Using Dried Blood Spots and DNA Polymerase Chain Reaction. AIDS Research and Human Retroviruses. 2014;31(4):433–438. Available: Accessed: 10.06.2017 doi: 10.1089/AID.2014.0159 25381805

21. Anoje C, Aiyenigba B, Suzuki C, Badru T, Akpoigbe K, Odo M. et al. Reducing Mother-to-Child Transmission of HIV: Findings from an Early Infant Diagnosis Program in South-South Region of Nigeria. BMC Public Health. 2012;12(184):1–8.

22. Sagay AS, Ebonyi AO, Meloni ST, Musa J, Oguche S, Ekwempu CC. et al. Mother-to-Child Transmission Outcomes of HIV-Exposed Infants Followed Up in Jos North-Central Nigeria. Current HIV Research. 2015;13(3):193–200. 25986370

23. Kalu S, Reynolds F, Petra G, Ikechebelu J, Dada M, Oluboyo B. et al. Infant Feeding Choices Practiced among HIV-Positive Mothers attending a Prevention of Mother-to-Child Transmission (PMTCT) of HIV Program in Nnewi. Nigeria. J AIDS Clin Res. 2014;5(5):1–6.

24. Chukwuemeka IK, Fatima MI, Ovavi ZK, Olukayode O. The Impact of a HIV Prevention of Mother to Child Transmission Program in a Nigerian Early Infant Diagnosis Centre. Nigerian Medical Journal. 2014;55(3):204–208. doi: 10.4103/0300-1652.132039 25013250

25. WHO. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. 2016. Available: https://apps.who.int/iris/bitstream/handle/10665/246260/9789241549707-eng.pdf;jsessionid=20B34703B8A4503F72FCF14DF9260542?sequence=1. Accessed: 12.05.2017

26. Stata. Stata. 2017. Available: https://www.stata.com/stata14/#. Accessed: 07.06.2017

27. Newell M. Prevention of Mother-to-Child Transmission of HIV: Challenges for the Current Decade. Bulletin of the World Health Organization. 2001;79(01): 1138–1144.

28. Ikechebelu JI, Ugboaja JO, Kalu SO, Ugochukwu EF. The Outcome of Prevention of Mother to Child Transmission (PMTCT) of HIV Infection Programme in Nnewi, Southeast Nigeria. Nigerian Journal of Medicine. 2011;20(4):421–425. 22288315

29. Azcoaga-Lorenzo A, Ferreyra C, Alvarez A, Palma PP, Velilla E, del Amo J. Effectiveness of a PMTCT Programme in Rural Western Kenya. AIDS Care. 2011;23(3):274–280. doi: 10.1080/09540121.2010.507750 21347890

30. Aliyu MH, Blevins M, Megazzini KM, Audet CM, Dunlap J, Sodangi IS. et al. Correlates of Sub-optimal Entry into Early Infant Diagnosis in Rural North Central Nigeria. Journal of Acquired Immune Deficiency Syndromes. 2014;67(1): e19–e26. Available: Accessed: 11.06.2017 doi: 10.1097/QAI.0000000000000215 24853310

31. Inalegwu A, Phillips S, Datir R, Chime C, Ozumba P, Peters S. et al. Active Tracking of Rejected Dried Blood Samples in a Large Program in Nigeria. World Journal of Virology. 2016;5(2):73–81. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861873/ Accessed: 12.06.2017 doi: 10.5501/wjv.v5.i2.73 27175352

32. UNAIDS. The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2016c. Available: http://www.unaids.org/sites/default/files/media_asset/GlobalPlan2016_en.pdf Accessed: 26.12.2018

33. Erekaha SC, Cornelius LJ, Bessaha ML, Ibrahim A, Adeyemo GD, Fadare M. et al. Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study. SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance. 2018;15(1):128–137. doi: 10.1080/17290376.2018.1527245 30253709

34. Myrtil MP, Puttkammer N, Gloyd S, Robinson J, Yuhas K, Domercant JW. et al. ART Attrition across Health Facilities Implementing Option B+ in Haiti. J Int Assoc Provid AIDS Care. 2018;17:1–10 Available: http://journals.sagepub.com/doi/full/10.1177/2325958218774037

35. Coetzee D, Hilderbrand K, Boulle A, Draper B, Abdullah F, Goemaere E. Effectiveness of the First District-wide Programme for the Prevention of Mother-to-Child Transmission of HIV in South Africa. Bulletin of the World Health Organization. 2005;83(7):489–494. 16175822

36. Torpey K, Mandala J, Kasonde P, Bryan-Mofya G, Bweupe M, Mukundu J. et al. Analysis of HIV Early Infant Diagnosis Data to Estimate Rates of Perinatal HIV Transmission in Zambia. PLoS ONE. 2012; 7(8):e42859 doi: 10.1371/journal.pone.0042859 22912752

37. Wise J. Breast Feeding Safer than Mixed Feeding for Babies of Mothers with HIV. British Medical Journal. 2001;322(7285): 512.

38. WHO. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach– 2nd Ed. 2016. Available: http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1 Downloaded: 01.07.2017

39. Goga AE, Dinh TH, Jackson DJ. Evaluation of the Effectiveness of the National Prevention of Mother-to-Child Transmission (PMTCT) Programme Measured at Six Weeks Postpartum in South Africa, 2010. 2012. Available: http://www.mrc.ac.za/healthsystems/SAPMTCTE2010.pdf Accessed: 03.06.2013

40. Lussiana C, Clemente SV, Ghelardi A, Lonardi M, Pulido Tarquino IA, Floridia M. Effectiveness of a Prevention of Mother-to-Child HIV Transmission Programme in an Urban Hospital in Angola. PLoS ONE. 2012;7(4): e36381 doi: 10.1371/journal.pone.0036381 22558455

41. Nkwo PO. Prevention of Mother to Child Transmission of Human Immunodeficiency Virus: The Nigerian Perspective. Annals of Medical and Health Sciences Research. 2012;2(1):56–65. doi: 10.4103/2141-9248.96940 23209993

42. Goga A, Jackson D, Lombard C, Ramokolo V, Ngandu N, Sherman G. et al. Highest Risk of Mother To Child Transmission of HIV or Death in the first 6 Months Postpartum: Results from 18 Month Follow-up of an HIV-Exposed National Cohort, South Africa. 2016. Available: http://programme.aids2016.org/Abstract/Abstract/6477 Accessed: 23.06.2017


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