Infant HIV-Free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-Based Cohort Study from Rural Zambia.


Chi, BH; Mutale, W; Winston, J; Phiri, W; Price, JT; Mwiche, A; Ayles, H; Stringer, JSA; (2018) Infant HIV-Free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women: A Community-Based Cohort Study from Rural Zambia. The Pediatric infectious disease journal. ISSN 0891-3668 DOI: https://doi.org/10.1097/INF.0000000000001997

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Abstract

Lifelong antiretroviral therapy (ART) is now recommended for all HIV-infected pregnant and breastfeeding women; however, few have described overall infant outcomes in this new era for the prevention of mother-to-child HIV transmission (PMTCT). As part of an assessment of PMTCT program impact, we enrolled a prospective cohort study in four predominantly rural districts in Zambia. HIV-infected mothers and their newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months, and 12 months postpartum; infant specimens were tested via HIV DNA PCR. In Kaplan-Meier analyses, we estimated overall infant HIV-free survival and then stratified by district, community, and maternal ART use. We investigated the relationship between community-level 12-month, self-reported maternal ART use and infant HIV-free survival via linear regression. From June 2014 to November 2015, we enrolled 827 mother-infant pairs in 33 communities. At 12 months, small proportions of infants had died (2.8%), were HIV-infected (3.0%), or were lost to follow-up (4.3%). Overall, infant HIV-free survival was 99.0% (95%CI: 98.0-99.5%) at 6 weeks, 97.5% (95%CI: 96.1-98.4%) at 6 months, and 96.3% (95%CI: 94.8-97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, p=0.01). Differences were noted at the district and site levels (p=0.01). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and self-reported maternal ART use (p=0.65). While encouraging, these findings highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 29601456
URI: http://researchonline.lshtm.ac.uk/id/eprint/4647227

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