Pediatr Infect Dis J. 2018 Mar 27. doi: 10.1097/INF.0000000000001997. [Epub ahead of print]
Chi BH1, Mutale W2, Winston J1, Phiri W1, Price JT1, Mwiche A3, Ayles H4,5, Stringer JSA1.
1 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
2 School of Public Health, University of Zambia, Lusaka, Zambia.
3 Zambian Ministry of Health, Lusaka, Zambia.
4 Zambart, Lusaka, Zambia.
5 London School of Hygiene and Tropical Medicine, London, UK.
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.
