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Journal of the International AIDS Society
Published in: Journal of the International AIDS Society 1/2012

Open Access 01-12-2012 | Research

HIV-free survival among nine- to 24-month-old children born to HIV-positive mothers in the Rwandan national PMTCT programme: a community-based household survey

Authors: Hinda Ruton, Placidie Mugwaneza, Nadine Shema, Alexandre Lyambabaje, Jean de Dieu Bizimana, Landry Tsague, Elevanie Nyankesha, Claire M Wagner, Vincent Mutabazi, Jean Pierre Nyemazi, Sabin Nsanzimana, Corine Karema, Agnes Binagwaho

Published in: Journal of the International AIDS Society | Issue 1/2012

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Abstract

Background

Operational effectiveness of large-scale national programmes for the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa remains limited. We report on HIV-free survival among nine- to 24-month-old children born to HIV-positive mothers in the national PMTCT programme in Rwanda.

Methods

We conducted a national representative household survey between February and May 2009. Participants were mothers who had attended antenatal care at least once during their most recent pregnancy, and whose children were aged nine to 24 months. A two-stage stratified (geographic location of PMTCT site, maternal HIV status during pregnancy) cluster sampling was used to select mother-infant pairs to be interviewed during household visits. Alive children born from HIV-positive mothers (HIV-exposed children) were tested for HIV according to routine HIV testing protocol. We calculated HIV-free survival at nine to 24 months. We subsequently determined factors associated with mother to child transmission of HIV, child death and HIV-free survival using logistic regression.

Results

Out of 1448 HIV-exposed children surveyed, 44 (3.0%) were reported dead by nine months of age. Of the 1340 children alive, 53 (4.0%) tested HIV positive. HIV-free survival was estimated at 91.9% (95% confidence interval: 90.4-93.3%) at nine to 24 months. Adjusting for maternal, child and health system factors, being a member of an association of people living with HIV (adjusted odds ratio: 0.7, 95% CI: 0.1-0.995) improved by 30% HIV-free survival among children, whereas the maternal use of a highly active antiretroviral therapy (HAART) regimen for PMTCT (aOR: 0.6, 95% CI: 0.3-1.07) had a borderline effect.

Conclusions

HIV-free survival among HIV-exposed children aged nine to 24 months is estimated at 91.9% in Rwanda. The national PMTCT programme could achieve greater impact on child survival by ensuring access to HAART for all HIV-positive pregnant women in need, improving the quality of the programme in rural areas, and strengthening linkages with community-based support systems, including associations of people living with HIV.
Literature
1.
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO): AIDS epidemic update: November 2009.
2.
Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA: Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008,22(8):973–981.PubMedCrossRef
3.
European Collaborative Study: Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 2005,40(3):458–465.CrossRef
4.
Ostergren M, Malyuta R: Elimination of HIV infection in infants in Europe--challenges and demand for response. Semin Fetal Neonatal Med 2006,11(1):54–57.PubMedCrossRef
5.
Torpey K, Kabaso M, Kasonde P, Dirks R, Bweupe M, Thompson C, Mukadi YD: Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting. BMC Health Serv Res 2010, 10:29.PubMedCrossRef
6.
Stordal K: HIV transmission from mother to child--can the epidemic be stopped? Tidsskr Nor Laegeforen 2010,130(5):480–482.PubMedCrossRef
7.
Stringer EM, Chi BH, Chintu N, Creek TL, Ekouevi DK, Coetzee D, Tih P, Boulle A, Dabis F, Shaffer N, Wilfert CM, Stringer JS: Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Bull World Health Organ 2008,86(1):57–62.PubMedCrossRef
8.
WHO/UNAIDS/UNICEF: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. 2009.
9.
WHO/UNAIDS/UNICEF: Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report 2010. 2010.
10.
United Nations General Assembly: Report of the Secretary General: Implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS - Uniting for universal access: Towards zero new HIV infections, zero discrimination and zero AIDS-related deaths. New York: United Nations; Sixty-fifth session; 2011.
11.
World Health Organization (WHO): Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach 2010 version. 2010.
12.
Technical Consultation on Elimination of Mother-to-Child Transmission - Meeting of the Inter Agency Task Team (IATT) on Prevention of HIV infection in Pregnant Women, Mothers and their Children: A Global Action Framework for Elimination of Mother-to-Child Transmission of HIV. Geneva, Switzerland; 2010.
13.
World Health Organization: PMTCT strategic vision 2010–2015: preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. 2010.
14.
Sarker M, Sanou A, Snow R, Ganame J, Gondos A: Determinants of HIV counselling and testing participation in a prevention of mother-to-child transmission programme in rural Burkina Faso. Trop Med Int Health 2007,12(12):1475–1483.PubMedCrossRef
15.
Albrecht S, Semrau K, Kasonde P, Sinkala M, Kankasa C, Vwalika C, Aldrovandi GM, Thea DM, Kuhn L: Predictors of nonadherence to single-dose nevirapine therapy for the prevention of mother-to-child HIV transmission. J Acquir Immune Defic Syndr 2006,41(1):114–118.PubMedCrossRef
16.
Kasenga F, Hurtig AK, Emmelin M: Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi. AIDS Care 2007,19(5):646–652.PubMedCrossRef
17.
Center for Treatment and Research on AIDS Malaria Tuberculosis and Other Epidemics Rwanda: HIV and AIDS in Rwanda 2010 Epidemiologic Update. 2010.
18.
Lim Y, Kim JY, Rich M, Stulac S, Niyonzima JB, Smith Fawzi MC, Gahire R, Mukaminega M, Getchell M, Peterson CW, Farmer PE, Binagwaho A: Improving prevention of mother-to-child transmission of HIV care and related services in eastern Rwanda. PLoS Med 2010,7(7):e1000302.PubMedCrossRef
19.
Peltier CA, Ndayisaba GF, Lepage P, van Griensven J, Leroy V, Pharm CO, Ndimubanzi PC, Courteille O, Arendt V: Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS 2009,23(18):2415–2423.PubMedCrossRef
20.
Franke MF, Stulac SN, Rugira IH, Rich ML, Bucyibaruta JB, Drobac PC, Iyamungu G, Bryant CM, Binagwaho A, Farmer PE, Mukherjee JS: High Human Immunodeficiency Virus-Free Survival of Infants Born to Human Immunodeficiency Virus-Positive Mothers in an Integrated Program to Decrease Child Mortality in Rural Rwanda. Pediatr Infect Dis J 2011,30(7):614–616.PubMedCrossRef
21.
Center for Treatment and Research on AIDS, Tuberculosis and Other Epidemics (TRACPlus): HIV/AIDS and STIs Unit (2009) 2008 ANNUAL REPORT. Rwanda. 2009.
22.
World Health Organisation (WHO): Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access. Recommendations for a public health approach. 2006.
23.
Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Micochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB: Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999,354(9181):795–802.PubMedCrossRef
24.
WHO and UNAIDS continue to support use of nevirapine for prevention of mother-to-child HIV transmissionJ Adv Nurs 2002,39(6):519.
25.
Jackson JB, Musoke P, Fleming T, Guay LA, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Owor M, Ducar C, Desyve M, Mwatha A, Emel L, Duefield C, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Gigliotti M, Bray D, Mmiro F: Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet 2003,362(9387):859–868.PubMedCrossRef
26.
National AIDS Control Commission Republic of Rwanda (CNLS): United Nations General Assembly Special Session on HIV and AIDS (UNGASS) Country Progress Report 2010. National AIDS Control Commission Republic of Rwanda;
27.
Jackson DJ, Chopra M, Doherty TM, Colvin MS, Levin JB, Willumsen JF, Goga AE, Moodley P: Operational effectiveness and 36 week HIV-free survival in the South African programme to prevent mother-to-child transmission of HIV-1. AIDS 2007,21(4):509–516.PubMedCrossRef
28.
Franke MF, Stulac SN, Rugira IH, Rich ML, Bucyibaruta JB, Drobac PC, Iyamungu G, Bryant CM, Binagwaho A, Farmer PE, Mukherjee JS: High Human Immunodeficiency Virus-Free Survival of Infants Born to Human Immunodeficiency Virus-Positive Mothers in an Integrated Program to Decrease Child Mortality in Rural Rwanda. Pediatr Infect Dis J 2011,2011(14):4.
29.
World Health Organisation (WHO): HIV and infant feeding - Guidelines for decision-makers. 2003.
30.
Stanecki K, Daher J, Stover J, Akwara P, Mahy M: Under-5 mortality due to HIV: regional levels and 1990–2009 trends. Sex Transm Infect 2010,86(Suppl 2):ii56–61.PubMedCrossRef
31.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010,375(9730):1969–1987.PubMedCrossRef
32.
Tonwe-Gold B, Ekouevi DK, Viho I, Amani-Bosse C, Toure S, Coffie PA, Rouet F, Becquet R, Leroy V, El-Sadr WM, et al.: Antiretroviral Treatment and Prevention of Peripartum and Postnatal HIV Transmission in West Africa: Evaluation of a Two-Tiered Approach. PLoS Med 2007,4(8):e257.PubMedCrossRef
33.
Marazzi MC, Nielsen-Saines K, Buonomo E, Scarcella P, Germano P, Majid NA, Zimba I, Ceffa S, Palombi L: Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding. Pediatr Infect Dis J 2009,28(6):483–487.PubMedCrossRef
34.
The Kesho Bora Study Group: Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. The Lancet Infectious Diseases 2011,11(3):171–180.CrossRef
35.
Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, Kasonde P, Scott N, Vwalika C, Walter J, Bulterys M, Tsai WY, Thea DM, Zambia Exclusive Breastfeeding Study: Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med 2008,359(2):130–141.PubMedCrossRef
36.
Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Kasonde P, Mwiya M, Tsai WY, Thea DM: Differential effects of early weaning for HIV-free survival of children born to HIV-infected mothers by severity of maternal disease. PLoS One 2009,4(6):e6059.PubMedCrossRef
37.
Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Rwanda: Protocol for Prevention of Mother-to-Child Transmission of HIV in Rwanda. Kigali, Rwanda: Ministry of Health; 2010.
38.
Tsague L, Tsiouris FO, Carter RJ, Mugisha V, Tene G, Nyankesha E, Koblavi-Deme S, Mugwaneza P, Kayirangwa E, Sahabo R, Abrams EJ: Comparing two service delivery models for the prevention of mother-to-child transmission (PMTCT) of HIV during transition from single-dose nevirapine to multi-drug antiretroviral regimens. BMC Public Health 2010, 10:753.PubMedCrossRef
39.
40.
Cacioppo JT, Ernst JM, Burleson MH, McClintock MK, Malarkey WB, Hawkley LC, Kowalewski RB, Paulsen A, Hobson JA, Hugdahl K, Spiegel D, Berntson GG: Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. Int J Psychophysiol 2000,35(2–3):143–154.PubMedCrossRef
41.
Segrin C, Passalacqua SA: Functions of loneliness, social support, health behaviors, and stress in association with poor health. Health Commun 2010,25(4):312–322.PubMedCrossRef
42.
Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SC: Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. J Pers Soc Psychol 1993,65(6):1243–1258.PubMedCrossRef
43.
Ashton E, Vosvick M, Chesney M, Gore-Felton C, Koopman C, O'Shea K, Maldonado J, Bachmann MH, Israelski D, Flamm J, Spiegel D: Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS. AIDS Patient Care STDS 2005,19(9):587–598.PubMedCrossRef
44.
Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C: Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr 2010,56(1):76–82.
Metadata
Title
HIV-free survival among nine- to 24-month-old children born to HIV-positive mothers in the Rwandan national PMTCT programme: a community-based household survey
Authors
Hinda Ruton
Placidie Mugwaneza
Nadine Shema
Alexandre Lyambabaje
Jean de Dieu Bizimana
Landry Tsague
Elevanie Nyankesha
Claire M Wagner
Vincent Mutabazi
Jean Pierre Nyemazi
Sabin Nsanzimana
Corine Karema
Agnes Binagwaho
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of the International AIDS Society / Issue 1/2012
Electronic ISSN: 1758-2652
DOI
https://doi.org/10.1186/1758-2652-15-4

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