Decline in positivity rates among HIV-exposed infants with changes in prevention of mother-to-child transmission antiretroviral regimens in Nigeria: Evidence from 7 years of field implementation

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From: Journal of HIV and Human Reproduction(Vol. 3, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 3,181 words
Lexile Measure: 1600L

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Byline: Hadiza. Khamofu, Edward. Oladele, Uche. Ralph-Opara, Titi. Badru, Oluwasanmi. Adedokun, Mariya. Saleh, McPaul. Okoye, Olufunsho. Adebayo, Kwasi. Torpey

Objective: Demonstrate if the introduction of more and more efficacious antiretroviral (ARV) combinations for prevention of mother-to-child transmission (PMTCT) over time translated into a declining HIV-infection among HIV-exposed infants. Methods: This was a retrospective review of routinely collected PMTCT service data from 2008 to 2014 in 682 secondary and tertiary health facilities across Nigeria. The ARV regimen was measured by the proportions of different ARV regimens received by HIV-positive pregnant women each year and the HIV-infection among infants was determined by the rate of HIV-positive polymerase chain reaction tests each year. The District Health Information Software (DHIS) was used to extract data from health facilities. The same DHIS was used to aggregate and analyze data. Results: Maternal HIV positivity rates varied from 4.1% in 2008, 2.9% in 2011, and 3.2% in 2012, then declined steadily to 1.9% in 2014. The total number of pregnant women who tested positive for HIV and received different ARV regimen for PMTCT during the period (2008-2014) was 63,774; ranging from 7506 in 2008 to 10,388 in 2014. Uptake of single dose nevirapine by the positive pregnant women was 34.4%, 41.6%, and 45.9% in 2008, 2009, and 2010, respectively. HIV positive pregnant women on triple ARVs (prophylaxis or treatment) increased from 22% in 2008 to 99% in 2014. Infant HIV positivity rates showed a steady decline over the years, from 38% in 2008 to 6% in 2014 (P < 0.001). Conclusions: We demonstrated the declining trend of HIV-infection among HIV-exposed infant in Nigeria as more and more efficacious ARV regimens were available for HIV-positive pregnant women. We conclude that if current efforts were sustained and coverage widened, an alignment of the country's PMTCT program with the best available scientific evidence could lead to the elimination of mother to child transmission.

INTRODUCTION

The risk of mother to child transmission of HIV (MTCT) in Nigeria is high due to a combination of factors which include; a high fertility rate of 5.5%; [sup][1] HIV prevalence of 4.1% among women attending antenatal clinic (ANC); [sup][2] and low coverage of prevention of mother-to-child transmission (PMTCT) services (30% as at end of 2013). [sup][3] The 51,000 new HIV infections recorded in Nigeria in 2013 accounted for one-quarter of all new HIV infections among children in the 21 Global Plan priority countries. [sup][4],[5] MTCT is responsible for the majority of these HIV infections among children. [sup][6] Without antiretroviral drugs (ARVs), the rate of MTCT is estimated to be about 15-45%, with more than half of the HIV-infected infants dying before the age of 1 year. [sup][7]

Evidence from controlled studies has shown that the use of ARVs and other interventions have the potential to reduce pediatric HIV infections to <2%. [sup][8],[9] This has created the optimism that MTCT can be eliminated. Accordingly, PMTCT programs have provided ARVs to an increasing number of HIV-infected pregnant women. In Nigeria for example, the number of health facilities...

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Gale Document Number: GALE|A459265404