Mother-to-Child Transmission of Human Papillomavirus in Burkina Faso

Introduction: Human papillomavirus (HPV) infection is the most widespread sexually transmitted infection in the world. Today, there is growing evidence that HPV can be transmitted early in life, and one potential route is mother-to-child transmission. Data on this route of HPV transmission are scarce in Africa and particularly in Burkina Faso, where no data on the subject are yet available. The aim of our study was to estimate the rate of mother-to-child transmission of HPV infection and to identify circulating genotypes. Methodology: Cervico-uterine samples were collected from 100 full-term pregnant women and, buccal samples were obtained from their newborns at Hopital Saint Camille de Ouagadougou (HOSCO) by the specialist physician. HPV DNA amplification and genotyping were performed by PCR followed by hybridization using the HPV Direct Flow Chips kit, detecting 36 genotypes including 18 high-risk and 18 low-risk. Results: The prevalence of HPV in newborns was 8% (8/100). Six (6) HPV-positive neonates had HPV-positive mothers, while 2 HPV-positive neonates had HPV-negative mothers. The vertical transmission rate was 26.09% (6/23). Mother-newborn genotypes were concordant. However, the genotype profile of the newborns was more restricted than that of the mothers. Conclusion: HPV DNA was found in 8% of newborns in our study. The genotype profile of the mother-newborn pair was concordant. Asymptomatic HPV infection in a pregnant woman could constitute a risk factor for vertical transmission.

Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

Deoxyribonucleic Acid-Polymerase Chain Reaction Status of HIV Exposed Infants in a Sub Regional Prevention of Mother-to-Child Transmission of HIV Programme during the Period 2009-2020

Introduction: Transitioning to more efficacious Antiretrovirals for HIV infected pregnant women and infant prophylaxis has reduced Mother to child transmission of HIV significantly. This study aimed to determine HIV infection status in HIVexposed infants who had their first DNA polymerase chain reaction test in our molecular Laboratory. Subjects, Materials and Methods: Dried Blood Spots for HIV DNA results from 5 states between 2009 and 2020 were analyzed in the PCR laboratory of the Federal Teaching Hospital, Gombe. Results: Nine thousand eight hundred and twenty-three Human Immunodeficiency Virus Deoxyribonucleic acid polymerase Chain Reaction results were analysed;4937 (50.2%) were males. During the study period, there was an overall declining trend in the mother-to-child transmission rate from 3.8% in 2009 to 1.0% in 2020. 6120 (62.3%) of HIV + mothers received Highly active antiretroviral therapy HAART before pregnancy. 7845 (76.2%) of the infants received Nevirapine prophylaxis. Dried blood spot samples were collected from 4077 (41.5%) at 6 - 8 weeks. 8438 (85.9%) received cotrimoxazole. 9469 (96.4%) were ever breastfed. Of the 9823 HIV DNA PCR results, 255 (2.6%) were positive while 69/4077 (1.7%) and 109/2662 (4.1%) were positive for HIV DNA at 6 - 8 weeks and > 12 weeks respectively. (p = 0.001). 86/747 (11.5%) of infants whose HIV-positive mothers received no ARVS were HIV DNA positive. (p = 0.001). 106/884 (12.0%) of infants who had no Antiretroviral prophylaxis had positive HIV DNA results;7/413 (1.7%) with Zidovudine/Nevirapine prophylaxis had positive results. (p = 0.001). 246/9469 (2.6%) of infants that were ever breastfed were positive for HIV DNA;11/354 (3.0%) that never breastfed had positive HIV DNA. Conclusion: Lack of maternal/infant ARVs and prolonged breastfeeding increased the risk of infant HIV infection.

Factors Associated with Mother-to-Child Transmission of HIV at the Maternity Unit of the Castors Urban Health Center in Bangui

Introduction: In spite of significant progress towards eliminating mother-to-child transmission (MCT) of HIV by 2025, trends in vertical mother-to-child transmission are still worrying in sub-Saharan African countries. This study aims to take stock of the factors associated with HIV MCT at the level of peripheral health training. Patients and Methods: This was a descriptive and analytical retrospective study, over a five-year period from January 1st, 2017 to December 31st, 2021. The study population was represented by HIV-positive women and their cared infants in the Parent-Child Transmission Prevention Unit (PCTP) of the Castors Urban Health Center (CUHC). Results: 288 medical records were selected out of a total of 347 HIV-positive mothers followed. HIV seroprevalence in the population of women who received PreNatal Consultation (PNC) during the study period was 8.2%. The HIV MCT rate was 3.7%. HIV+ mothers followed were mostly young (average age of 28), not living in a couple (96.9%), poorly educated (58.7%) and not engaged in income-generating activity (58.4%). They had all received triple therapy and the period of initiation of antiretroviral (ARV) therapy was in the majority of cases during the first trimester. Factors associated with MCT were: primiparity (OR = 18.4 [5.55 - 61.05];Khi2 = 32.61;p < 0.001), late discovery of infection during large or after childbirth (OR = 0.03 [0.007 - 0.10];Khi2 = 55.22;p < 0.001), WHO Clinical Stage 2 and 3 (OR = 0.007 [0.001 - 0.03];Khi2 = 108.73;p < 0.001), CD4 count 200/mm3 (OR = 14.12 [4.03 - 57.20];Khi2 = 21.68;p < 0.001), viral load > 1000 copies/mm3 (OR = 8.85 [2.33 - 43.20];Khi2 = 10.46;p = 0.001), prolonged labor (OR = 12.33 [3.45 - 57.25];Khi2 = 18.47;p < 0.001), premature rupture of membranes (OR = 24.03 [6.97 - 96.01];Khi2 = 40.60;p 2 = 5.96;p = 0.014), and artificial or mixed breastfeeding (OR = 0.01 [0.002 - 0.043];Khi2 = 97.65;p Conclusion: Taking into account the risk factors for PCTP is essential if we want to achieve the goal of “Zero New Infections in Children by the year 2025”.

Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

Status Report on the Elimination of Mother-to-Child Transmission (EMCT) of HIV at the Pikine National Hospital Center (CHNP), Dakar/Senegal

Introduction: For several years, the fight against the human immunodeficiency virus (HIV) has been a major public health issue in Africa. Since 2012, Senegal has adopted WHO option B+, consisting of systematic triple therapy for HIV-positive pregnant women, combined with breastfeeding and antiretroviral (ARV) prophylaxis for exposed newborns. It is in this dynamic that we set ourselves the objectives of evaluating the rate of transmission of HIV from mother to child and taking stock of the monitoring of children born to HIV-positive mothers at the Pediatric Department of the CHN of Pikine located in the Dakar suburbs. Methodology: Thus, we conducted a descriptive and analytical cross-sectional cohort follow-up study from 11/25/2014 to 03/09/2022 including all children born to HIV-positive mothers followed at the Pikine CHN since the start of care. Results: We had collected 51 children exposed to HIV and followed in our structure. They were exposed to HIV1 in 92% of cases. The HIV status of the mothers was known before pregnancy in more than half of the cases. The couples were serodiscordant in 56% of cases. The mothers were in clinical stage 1 of the disease in 69.6% of cases and were already under treatment in 47% of cases. The most used treatment regimen was ATRIPLA with Tenofovir (TDF) + Emtracitabine (FTC) + Efavirenz (EFV) in 59% of cases. Compliance was good in the majority of cases. The CD4 count during pregnancy was low in 10.6% of cases. The pregnancy was well followed in only 36.2% of cases. The mothers had given birth in our structure in 91.4% of cases. The vaginal route was found in 72.5% of cases and delivery was carried out by a midwife in 69.4% of cases. The average birth weight was 2733 ± 564. The majority of newborns had received antiretroviral (ARV) prophylaxis after birth, half of them between 12 and 24 hours. The most used therapeutic protocol was Zidovudine (AZT) + Lamivudine (3TC) + Lopinavir/Ritonavir (LPV/r). Protected breastfeeding was the option chosen in 76.8% of cases. The PCR performed at 6 weeks was negative in more than half of the cases. Retroviral serology was carried out after 14 months in 43% of cases. We noted a single positive case with a negative initial PCR, representing an overall transmission rate of 1.96%. Conclusion: Senegal’s current policy targeting EMTCT of HIV is on good momentum with a fairly low transmission rate thanks to screening of pregnant women and prophylaxis with antiretrovirals (ARV) for HIV-positive mothers during pregnancy and for life. And children exposed from birth and during breastfeeding up to 6 weeks with regular monitoring.

Beliefs and practices of young women on utilization of prevention of mother to child transmission of HIV services in Malawi

This study explored beliefs and actual practices of young women on utilization of Prevention of Mother to Child Transmission (PMTCT) of HIV services in Balaka district of Southern Malawi. The study design wascross sectional which utilized qualitative data collection and analysis methods. In-depth interviews were conducted on 12 young mothers of 15 to 24 years old. The respondents were drawn from 6 health centres in the district during their visits to either the under-five clinic, HIV and AIDS support groups or HIV follow up clinics. Data were analyzed using thematic analysis approach. Overall the respondents had positive beliefs on utilization of PMTCT services. They believed that adherence to PMTCT guidelines such as condom use, taking of Nevirapine (NVP) and exclusive breastfeeding protected the baby from contracting the virus. Nevertheless, all respondents believed that HIV testing was mandatory and that early weaning caused malnutrition and death of babies. Actual practice was very low. Very few young mothers breastfed exclusively, weaned their babies abruptly and took NVP as recommended. Not all positive beliefs translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. Culture was also a major barrier because traditionally babies are expected to be breastfed and supplements are fed to babies too. Therefore, there is a need to mobilize communities on PMTCT of HIV. Education programmes in HIV should emphasize behavior change interventions and should focus on both men and women and significant others. There is also need to intensify monitoring and evaluation of health workers’ activities to ensure that beliefs translate into positive behavior.

The Effect of Human Immunodeficiency Virus-1 Infection on Low Birth Weight, Mother to Child HIV Transmission and Infants’ Death in African Area

Background: It is yet a controversy subject whether low birth weight and infant death are associated to human immunodeficiency virus-1 infection. Objective: To appreciate association between low birth weights, mother to child HIV transmission and infant mortality in HIV-1 infected pregnant women delivering between 2011 and 2016. Materials: We conducted 6 years cohort study in urban Mali. Outcome included preterm delivery, small for gestational age, infant survival status and HIV transmission. Comparison concerned women clinical WHO stage, mother viro-immunological status, and newborn anthropometric parameters. Results: HIV-1 infected women who delivered low birth weight newborn were 20.9% (111/531) versus 16.5% (1910/11.546) in HIV negative patients (p = 0.016). CD4 T cell counts low than 350 T cells count were strongly associated to LBW (p = 0.000;RR = 3.03;95% CI [1.89 - 3.16]). There is no significant association between ART that was initiated during pregnancy (p = 0.061, RR = 0.02;CI 95% (1.02 - 1.99)) or during delivery (p = 0.571;RR = 1.01;CI 95% (0.10 - 3.02)) and LBW delivery. In multivariate analysis ART regimens containing protease inhibitor (PI) were lone regimens associated with LBW ((p = 0.030;RR = 1.001;95% confidence interval [1.28 - 3.80]). Very low birth weight was statistically associated to women HIV infection (adjusted relative risk, 2.02;p = 0.000;95% confidence interval (2.17 - 4.10)). There is no significant difference between mother to child HIV transmission rate in the two HIV-infected pregnant women (10 infected children in group 2: MTCT rate 4.5%) and 3 infected children in group 1 (MTCT rate: 2.7%) (p = 0.56;RR, 0.59;CI 95% (0.18 - 4.39)). In multivariate analysis, LBW was associated with infant death (p = 0.001;RR = 2.04;CI 95% [1.04 - 5.05]). The median weight of infant at the moment of death in group 1 was 851 g (IQR: 520 - 1833 g). Significant relationship was found between infant death among LBW newborn with mother WHO stage 2 (p = 0.004;adjusted RR = 3.22;CI 95% [2.25 - 6.00]), CD4 T cells count 3 (p = 0.005;RR = 2.81;CI 95% [1.20 - 4.11]), PI regimens (p = 0.030;RR = 1.00;CI 95% [1.28 - 3.80]). Conclusion: We confirm increased risk of low birth weight and mother HIV-1 infection and we identified strongest association between mortality in infant born to HIV-1 infected mother and LBW.

Evaluating the Knowledge of HIV Transmission and Prevention of Mother to Child Transmission (PMTCT) of HIV among HIV-Positive Mothers Accessing Care in Military Hospital in Lagos, Nigeria

Introduction: The prevention of mother-to-child transmission (PMTCT) plays a major role in limiting the number of children being infected by HIV. There is dearth of studies that explored the knowledge of HIV transmission and PMTCT among women living with HIV. Methods: This was a cross-sectional, descriptive study of HIV-positive mothers receiving medical care at the adult antiretroviral therapy (ART) clinic, 68 Nigeria Army Reference Hospital Yaba. A pre-tested structured questionnaire was used to collect information from the subjects concerning their socio-demographic, knowledge of HIV transmission and mother-to-child transmission of HIV and preventive measures. SPSS v23 was used for data analysis. Results: Out of the 374 participants, 282 (75.4%) were aware that HIV can be transmitted to an unborn baby from the positive mother. Of these, 240 (85.1%) were well-informed that increase mother’s viral load can increase the chances of mother-to-child transmission. 268 (95%) understood that giving of antiretroviral drugs during and after pregnancy can lower transmission risk, while 254 (90.1%) saw the use of breast milk substitutes as another prevention strategy. There was statistically significant association between the respondents’ knowledge of PMTCT and their husbands’/partners’ awareness of their HIV status. Conclusion: In conclusion, our study demonstrated a good knowledge of HIV transmission, MTCT and PMTCT among women who were receiving ART in our centre. Disclosure is a significant factor found to be associated with PMTCT knowledge. More studies can also explore if the observations in our study with women living with HIV will be comparable in similar population in different settings.

A survey of awareness and knowledge of mother-to-child transmission of HIV in pregnant women attending Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Objective: To determine the knowledge and awareness of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and mother-to-child transmission (MTCT) among women attending the antenatal clinic. Methods and Subjects: This was primarily a descriptive cross-sectional study carried out at the antenatal clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from July 1st, 2010 to October 31st, 2010. Results: The age range of the respondents was 18 - 41 years, (mean 29 ± 5 years). One hundred and forty-nine (92.5%) were married. All the respondents interviewed were aware of HIV/AIDS and 93 (57.8%) had been aware of the disease for ≥5 years. The main sources of information were television 93 (57.8%), radio 77 (47.8%), health workers 53 (32.9%), friends, relatives and neighbors 41 (25.5%) and posters 34 (21.1%). Majority of the respondents identified sexual intercourse as a route of transmission of HIV. Sharing of sharp objects and blood transfusion were identified as routes of transmission by 99 (61.5%) and 82 (50.9%) respectively. One hundred and sixteen (72%) of the respondents knew an apparently healthy person could be living with HIV. Majority of the respondents 125 (77.6%) were aware that HIV can coexist with pregnancy and 120 (74.5%) were aware of MTCT of HIV. Vaginal delivery and breastfeeding were identified as routes of HIV transmission by 44 (27.3%) and 53 (32.9%) of respondents respectively. Delivery by caesarean section was identified as a method of prevention of MTCT by 25 (15.5%) respondents while as many as 48 (29.8%) respondents did not know any method of prevention of MTCT of HIV. Conclusion: This study demonstrates a low level of awareness of methods of prevention of MTCT of HIV among pregnant women booking for antenatal care in our center. Thus, there is the need for adequate counseling about HIV/AIDS and specific aspects of prevention of mother-to-child transmission in our antenatal clinics.

Mother-to-Child Transmission of HIV/AIDS during Pregnancy and Delivery and Associated Factors in the Region of Couffo in Benin

Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest rate of transmission, which was 16.1%. The study aimed to determine transmission rate during pregnancy and delivery as well as the factors associated with it. This is a retrospective and analytical study based on a sample of seventy (70) babies born to HIV-infected mothers in 2016 in Couffo. Key findings showed, there is a perinatal transmission of five percent (5%) and the factors associated with this transmission are: delay in carrying out first antenatal visits at the health facility, low frequency of visits performed versus number requested and appropriate time, poor health condition of mothers during pregnancy, absence or late start of antiretroviral care and treatment during pregnancy, irregular intake of intermittent presumptive treatment at sulfadoxine-pyrimethamine to prevent malaria, a short antiretroviral therapy (less than three months) for mothers before delivery and the default in cleaning mother’s genital tract with betadine after the woman’s water broke.

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) Visits and Associated Programmatic Predictors: A Pilot Study

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = &minus;0.73, p = 0.029) and level of satisfaction with PMTCT services (β = &minus;0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = &minus;2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.

A meta-analysis of lamivudine for interruption of mother-to-child transmission of hepatitis B virus

AIM:To determine the therapeutic effect of lamivudine in late pregnancy for the interruption of motherto-child transmission(MTCT) of hepatitis B virus(HBV).METHODS:Studies were identified by searching available databases up to January 2011.Inclusive criteria were HBV-carrier mothers who had been involved in randomized controlled clinical trials(RCTs) with lamivudine treatment in late pregnancy,and newborns or infants whose serum hepatitis B surface antigen(HBsAg),hepatitis B e antigen(HBeAg) or HBV DNA had been documented.The relative risks(RRs) for interruption of MTCT as indicated by HBsAg,HBV DNA or HBeAg of newborns or infants were calculated with 95% confidence interval(CI) to estimate the efficacy of lamivudine treatment.RESULTS:Fifteen RCTs including 1693 HBV-carrier mothers were included in this meta-analysis.The overall RR was 0.43(95% CI,0.25-0.76;8 RCTs;Pheterogeneity = 0.04) and 0.33(95% CI,0.23-0.47;6 RCTs;Pheterogeneity = 0.93) indicated by newborn HBsAg or HBV DNA.The RR was 0.33(95% CI,0.21-0.50;6 RCTs;Pheterogeneity = 0.46) and 0.32(95% CI,0.20-0.50;4 RCTs;Pheterogeneity = 0.33) indicated by serum HBsAg or HBV DNA of infants 6-12 mo after birth.The RR(lamivudine vs hepatitis B immunoglobulin) was 0.27(95% CI,0.16-0.46;5 RCTs;Pheterogeneity = 0.94) and 0.24(95% CI,0.07-0.79;3 RCTs;P heterogeneity = 0.60) indicated by newborn HBsAg or HBV DNA,respectively.In the mothers with viral load < 106 copies/mL after lamivudine treatment,the efficacy(RR,95% CI) was 0.33,0.21-0.53(5 RCTs;Pheterogeneity = 0.82) for the interruption of MTCT,however,this value was not significant if maternal viral load was > 106 copies/mL after lamivudine treatment(P = 0.45,2 RCTs),as indicated by newborn serum HBsAg.The RR(lamivudine initiated from 28 wk of gestation vs control) was 0.34(95% CI,0.22-0.52;7 RCTs;Pheterogeneity = 0.92) and 0.33(95% CI,0.22-0.50;5 RCTs;Pheterogeneity = 0.86) indicated by newborn HBsAg or HBV DNA.The incidence of adverse effects of lamivudine was not higher in the mothers than in controls(P = 0.97).Only one study reported side effects of lamivudine in newborns.CONCLUSION:Lamivudine treatment in HBV carriermothers from 28 wk of gestation may interrupt MTCT of HBV efficiently.Lamivudine is safe and more efficient than hepatitis B immunoglobulin in interrupting MTCT.HBV MTCT might be interrupted efficiently if maternal viral load is reduced to < 106 copies/mL by lamivudine treatment.

Dynamic Characteristic Analysis of HIV Mother to Child Transmission in China

Objective to explore dynamic characteristics of the HIV mother to child transmission （MTCT） epidemic in China.Methods A deterministic dynamic transmission model was used to determine the effect of key parameters on the likely long-term trends of the HIV MTCT epidemic in China.Matlab 7.0 was used to develop the model.Results The number of the susceptibles （S）,the transmission rate （β）,and the screening proportion （α） of HIV positive pregnant women have the greatest impact on the HIV MTCT epidemic in China.The growth of the MTCT epidemic in China could not be controlled only by decreasing the MTCT transmission rate.The prevalence of HIV positive women should be reduced and more pregnant women should be tested for HIV.Conclusion Prevention of MTCT （PMTCT） should focus not only on the reduction of HIV transmission rates and incidences of HIV among women but also on the increase of HIV testing for pregnant women.The most cost-effective PMTCT means for China should be investigated in future studies.

Evaluation of the Implementation of the WHO’s 2010 Guide on Prevention of Mother To-Child Transmission (PMTCT) of HIV/Aids: Case of Two Hospitals in Yaoundé

Introduction: The prevalence of HIV infection amongst pregnant women in Cameroon is 5.6%. Mother-to-child transmission is a major expansion factor. In 2010, Cameroon adopted new strategies pegged to WHO guidelines. Objectives: The objective of this study was to evaluate the implementation of the new guidelines of prevention of mother to-child transmission (PMTCT) of HIV in the Yaoundé Central Hospital and the Yaoundé Teaching Hospital. Methodology: It was a cross sectional descriptive and prospective study over a period of 6 months in Yaoundé. It included all HIV-positive women, doing their antenatal care in the above cited hospitals, and having given their consent. The studied variables included socio demographic features, obstetrical history, the antenatal care, the initiation of anti retroviral (ARV) drugs, the ARV regimen, the number of years on ARV drugs, the mode of delivery and the mother and child outcome. The data was collected using a pre-tested questionnaire. They were obtained by interview of the seropositive pregnant women. Data were analysed using Epi info 3.5.3. Results: We performed 3104 antenatal consultations and 287 women were recruited in the study. The prevalence of HIV infection was 9.24%. The mean age of women was 28.77 (SD: 5.13) years. The women were aged between 20 and 29 years in 51.20%. Amongst the 156 women who knew their status before pregnancy, 109 (70.50%) had their first ANC in the first trimester. All were managed according to the 2010 WHO recommendations on PMTCT of HIV. Amongst the women unaware of their status, 25.20% had their booking ANC in the first trimester, 25.14% started ARVs at 14 weeks, 69.46% at 28 weeks. We had 125 live births, 84.8% by vaginal route, neonatal prophylaxis in all babies was effective. Conclusion: PMTCT of HIV is available and guidelines are well applied in Yaoundé. Late treatment initiation still remains a problem to optimize care.

Examine a dynamic of mother-to-child transmission of HIV in the population-based surveys

The main source of HIV infection in young children is of their mothers, during pregnancy, labor and delivery, or by breastfeeding. The rate of HIV transmission from infected mothers to their newborn children varies from 15% to 40% with one-thirds of these infections was through breastfeeding. This paper examines cross-sectional population-based survey data of HIV test results among mothers and their children in Uganda, Swaziland to estimates of mother-to- child transmission (MTCT) rate of HIV infection. The prevalence of HIV among women aged 15 - 49 who gave birth in the past 5 years in Uganda is 7.3%, and in Swaziland is 37.9%. The HIV prevalence of children who mothers were HIV positive were very similar: 10.3% in Uganda and 11.5% in Swaziland. This association represents the crude rate of MTCT in these two countries at the time of the survey. Presence of HIV antibody in early age (0 - 11 months) is due to both true infection and passive antibody from mothers. The seroconversion dropped nearly half in the second year of age which was likely that many of these children died before reaching the age of 12 - 23 months and passive antibody were gradually cleared at this point. This analysis demonstrated that cross-sectional data can be used to estimate indirectly the magnitude and dynamic of MTCT.

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

Background: The elimination of HIV transmission from mother to child is currently possible. Cote d’Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Cote d’Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% - 11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 - 13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 - 32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current recommendations should be considered to prevent mother-to-child HIV transmission.

Patient-Reported Factors Facilitating Participation in Prevention of Mother to Child Transmission of HIV Programs in Kara, Togo, West Africa

Background: Despite efforts to expand prevention of mother-to-child transmission (PMTCT) of HIV in resource-limited settings, only 53% of women in sub-Saharan Africa receive adequate PMTCT services. Understanding factors that enable successful program completion are crucial to improving adherence rates to PMTCT programs in these settings. Using a positive deviance approach, we explored patient and provider’s perspectives on factors enabling women to successfully access and adhere to PMTCT services to identify areas of program improvement and further reduce HIV transmission. Methods: Semi-structured interviews were conducted with 11 health care workers (HCWs) at two health centers in Kara, Togo and 34 women who had successfully completed the PMTCT program at those facilities. Women were identified using purposive sampling and content theme analysis was used to analyze the data. Results: Knowledge and belief in the potential to give birth to an HIV-negative child, supported by facilitating factors on the individual and community levels, was the cornerstone to women’s PMTCT program success. Effective program education and peer-to-peer interactions fostered the participants’ knowledge and belief in PMTCT, with the resulting internal motivation driving continued participation and adherence. The welcoming environment, availability of peer support groups and financial assistance from the health facility, further facilitated success, with women using this facility-based community to seek advice and support from HCWs and peers. Financial, physical, and emotional support from relatives was also important in ensuring unhindered access. Finally, the faith-based communities’ acceptance and support for HIV-positive women further encouraged participants to adhere to the program. Conclusion: Understanding and believing in the ability to have an HIV-negative baby was the most important facilitator for PMTCT program adherence. This led to internal motivation that was continually reinforced through facility and community supportive environments focused on addressing barriers. Efforts to improve PMTCT success should focus on all of these factors through a patient-centered approach.

Research Progress of Related Laboratory Testing Indexes before and after Mother-Infant Blocking in HIV/AIDS Pregnant Women

More than 90% of HIV-positive children come from mother-to-child transmission, so mother-to-child interdiction is the main measure to prevent AIDS in children. Relevant data show that the incidence of mother-to-child transmission of HIV usually fluctuates between 15% and 50% without intervention. Standardized and effective comprehensive intervention can reduce the transmission rate of mother to child to less than 1%. At present, it is believed that mother-to-child transmission of AIDS can be blocked by comprehensive intervention, and its mechanism has been clearly studied. Combined with highly effective antiviral treatment, safe labor and artificial feeding, the mother to child transmission rate can be reduced to less than 1%. However, due to the effect of drugs on mother-to-child transmission of AIDS may lead to some changes in the main biochemical indicators of mother-to-child, there is no systematic analysis of the viral load, T lymphocyte subsets and major biochemical indicators of HIV/AIDS pregnant women before and after maternal-to-child transmission. In this study, the viral load, T lymphocyte subsets and major biochemical indicators of HIV/AIDS pregnant women before and after maternal-infant blockade were dynamically analyzed. It is hoped that this study will help to observe the basic physical fitness and disease development of pregnant women with HIV/AIDS during pregnancy, to provide a strong basis for the treatment and evaluation of maternal-infant blockade of HIV/AIDS pregnant women, and to establish a complete set of laboratory indicators to understand the body status of pregnant women at all stages to minimize the probability of fetal transmission, which will make good economic and social benefits.

Qualitative Detection of Proviral-DNA of HIV-1 in Infants to Determine the Efficacy of Antiretroviral Therapy in the Prevention of Vertical Transmission of HIV-1 in The Gambia

The priority of The Gambia government is to eliminate maternal to child transmission of HIV and in line with this priority, the country implemented an antiretroviral therapy (ART) program. With this, all HIV infected pregnant and breastfeeding mothers and infants have access to ARV drugs. This study aims to determine the prevalence of vertical transmission of HIV among women receiving the ARV drugs. Dried blood spot samples were collected from 109 HIV-exposed infants enrolled in 13 PMTCT sites across the country. A qualitative detection of proviral-DNA of HIV-1 was performed using the RealTime Abbott PCR assay. Data from 105 mothers were analyzed using SPSS version 16.0 and association of risk factors to PCR results were analyzed using (Crosstabs) Pearson Chi-Square. The p-value of significant was set at p < 0.05. This study has found that the prevalence of vertical transmission of HIV is 0.0% (0/64) among women that received the ARV prophylaxis then started ART, 7.1% (2/28) among mothers that received HIV prophylaxis only, and 38.4% (5/13) among women who neither receive HIV-prophylaxis nor ART during pregnancy or breastfeeding. Other risk factors of vertical transmission such as late initiation of treatment, default during treatment and first born of twins were found to be significantly associated with vertical transmission p = 0.001, p = 0.022 and p = 0.000 respectively. This study has found that the early intervention of ART at the onset of pregnancy through breastfeeding can eliminates Maternal to Child transmission of HIV-1and a high risk of vertical transmission was found among women who neither receive prophylaxis nor ART. If the effectiveness of the antiretroviral therapy is maintain, The Gambia, in the near future will attain the WHO’s goal to eliminate maternal to child transmission of HIV.