Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya

Correlates of mother-to child-transmission of HIV infection in a tertiary hospital in Ebonyi state, Nigeria

BACKGROUND

Nigeria has the largest global burden of HIV new infections in children despite global and national concerted efforts at the reduction of mother-to-child transmission of HIV. The goal of this study was to determine the associations between maternal characteristics, practices and mother-to-child transmission of HIV infection among mothers living with HIV.

METHODS

This is a hospital-based descriptive cross-sectional study. Information was obtained using interviewer-administered questionnaire from the 240 participants. Data were analyzed with SPSS version 26, and P < 0.05 was considered statistically significant.

RESULTS

Out of the 240 mothers recruited, 129 (53.8%) were within 25-35 years of age, with a mean age of 31.08 ± 5.65. A total of 35 (14.6%) of the participants had at least a child with HIV infection. Maternal ART status before childbirth (AOR = 0.02, 95%CI = 0.01-0.05, P = < 0 .001) was the singular determinant of having a child with HIV infection. Mothers who delivered outside the health facility were about four-fold at risk of having an infected child (AOR = 3.89, 95%CI = 1.82-8.50, P = 0.070).

CONCLUSION

The prevalence rate of mother-to-child transmission of HIV is high. Routine HIV testing services and the provision of accessible and affordable reproductive health services are recommended for all women of childbearing age.

HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study

BACKGROUND

Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive.

METHODOLOGY

We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data.

RESULTS

Of 797 children tested, 463(58.1%) were male and 630(79.1%) were ≤18months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother-infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66/188). Child age >18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11-3.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic.

CONCLUSION

In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.

HIV counseling, testing, and test result receipt among East African women of reproductive age using recent national health surveys

Introduction

One of the most important public health concerns is still the Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS), particularly in developing countries. Although HIV testing is an important step in both prevention and treatment, its uptake remains low, and no study has looked into the scale of HIV counseling, testing, and test result receipt among East African women all at the same time. Therefore, this study aimed to investigate HIV counseling, testing, and test result receipt, as well as the factors that influence them, among East African women.

Methods

This analysis used Demographic and Health Survey data collected from 10 East African countries between 2011 and 2022. We examined the coverage of HIV counseling, testing, and test result receipt among East African women, as well as other characteristics. To select candidate factors and identify significant explanatory variables related to the outcome variable, binary and multiple logistic regression analyses were conducted, and the results were presented using adjusted odds ratios (AORs) with 95% confidence intervals. In the binary and multiple logistic regression analyses, P values of less than or equal to 0.2 and <0.05 were used to assess significant variables, respectively.

Results

A total of 41,627 weighted women included to this study. HIV counseling, testing, and test result receipt among East African women were found to be 77.86% (95% CI = 77.46, 78.26). Being 25-34 years old (AOR = 1.13, 95% CI, 1.06, 1.21), 35-49 years old (AOR = 1.15, 95% CI, 1.05, 1.26) as compared to 15-24 years old women, primary education (AOR = 1.75, 95% CI, 1.64, 1.86), secondary/higher education level (AOR = 1.96, 95% CI, 1.82, 2.13) as compared to not educated women, poor, (AOR = 1.22, 95% CI, 1.14, 1.29), middle wealth (AOR = 1.12, 95% CI, 1.04, 1.21) as compared to rich wealth index, mass media exposure (AOR = 1.29, 95% CI, 1.22, 1.35), 3-5 parity (AOR = 1.29, 95% CI, 1.21, 1.37), more than 5 parity (AOR = 1.46, 95% CI, 1.33, 1.61) as compared to <3 parity, health institution delivery (AOR = 1.65, 95% CI, 1.53, 1.76), were associated positively with the outcome variable respectively. However, being married (AOR = 0.79, 95% CI, 0.72, 0.87), not using contraceptive (AOR = 0.58, 95% CI, 0.51, 0.61), and traditional contraceptive method user (AOR = 0.47, 95% CI, 0.41, 0.54) as compared to modern users were associated negatively with outcome variable respectively.

Conclusion

This study found that HIV counseling, testing, and test result receipt are still unsatisfactory. Strengthening maternal health services such as institutional delivery, family planning, and women's empowerment, as well as changing mass media and taking advantage of these opportunities, will boost the region's coverage of HIV counseling, testing, and obtaining results.

Comprehensive Knowledge, Attitudes, Behaviors, and Associated Factors of HIV/AIDS in Gondar City Public Health Facilities Among HIV Testing and Counselling Service Users, Northwest Ethiopia, 2022; an Ordinal Logistic Regression Analysis

BACKGROUND

The primary cause of HIV transmission is a failure to deliver proper HIV/AIDS information, which is a major public health issue in low- and middle-income nations. While global health coverage continues, there is still little understanding of HIV/AIDS in Ethiopia, and there is a data gap. As a result, the aim of this study was to investigate the factors that influence comprehensive HIV/AIDS knowledge among HIV testing and counselling (HTC) service users in Gondar, northwest Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from June to July 2022. About 423 clients were included. Data on HIV/AIDS knowledge, attitude, and behavior were collected. Stata 17 was used to analyze. A pre-tested questionnaires were used. Using ordinal logistic regression model, variables having p values of 0.2 and <0.05 were chosen as a candidate variable in binary and final model.

RESULTS

The total knowledge, favorable attitude, and good behaviors of HIV/AIDS were approximately 258 (61%), 220 (52%), and 210 (49.5%), respectively. Being male (AOR = 1.39, 95% CI = 1.28-3.01), age from 31 to 35 years (AOR = 2.13, 95% CI = 1.88-4.18), and above 36 years old (AOR = 2.21, 95% CI = 1.98-3.44), primary (AOR = 1.21, 95% CI = 1.67-3.20), and higher education (AOR = 1.19, 95% CI = 1.03-3.01), employed (AOR = 1.33, 95% CI = 1.09, 3.37), and media exposure (AOR = 2.02, 95% CI = 1.21, 3.61) were factors associated with comprehensive knowledge of HIV/AIDS, respectively.

CONCLUSION

The study participants' knowledge, attitudes, and behaviors regarding HIV/AIDS were rather low. Since HIV/AIDS is still a major public health issue, if the concerned body uses and designs media effectively, encouraging females to attend school, it will have a better chance of combating HIV/AIDS by increasing their knowledge.

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

BACKGROUND

The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented.

OBJECTIVE

We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon.

METHODS

All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as "high". This review was registered in the Prospero database, CRD42021224497.

RESULTS

We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07-8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21-21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71-9.24] without option-B+ versus 2.88% [95% CI: 5.03-9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58-11.27]) and mothers (OR: 3.59 [95% CI: 2.15-5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children.

CONCLUSION

In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.

Epidemiological drivers of mother to child HIV transmission in West Bengal, India: A retrospective cohort study

BACKGROUND

HIV transmission through vertical route can be reduced to a large extent with combination of medical interventions. Apart from maternal HIV status several other epidemiological attributes determine this transmission dynamics.Objective: The objective of this study was to identify various associated factors that determine and modify the risk of HIV transmission from a mother living with HIV to her child.Materials and method: A retrospective cohort-study was conducted with 518 HIV-positive pregnant women with delivering live babies between April 2016 - September 2018. The HIV status of the children was ascertained with polymerase chain reaction. A number of socio-demographic and medical attributes were compared between HIV-positive (41) and HIV-negative babies (477) using bivariate and multivariate methods to identify disease modifying factors.

RESULTS

Maternal HIV detection during the postnatal period (AOR = 11.2; 5.2 - 23.8), low birth weight (AOR = 2.7; 1.2 - 5.9), and vaginal delivery (AOR = 2.8; 1.01 - 7.7) were significantly associated with vertical transmission of HIV. Lower duration of maternal antiretroviral treatment and higher maternal age (>25 years) were also associated in bivariate analysis.

CONCLUSION

The battery of PPTCT (Prevention of Parent to Child Transmission) interventions should be tailored in such a way to address all the epidemiological attributes influencing vertical transmission.

Determinants of HIV infection among children born to HIV positive mothers on prevention of mother to child transmission program at referral hospitals in west Amhara, Ethiopia; case control study

BACKGROUND

Human Immune Deficiency Virus infection among children has continued to be a global concern with an estimated 160,000 new infections in 2018. Over 90% acquire HIV from their mother. Currently, 92% of pregnant women are on antiretroviral therapy (ART). Despite, greater achievements in coverage of PMTCT and ARV drug in Ethiopia as well as in west Amhara, child HIV infections are yet an important public health problem with a high transmission rate. There are limited studies done in Ethiopia on identifying determinants of child HIV infection.

OBJECTIVE

This study was aimed at identifying determinants of HIV infection among children born to HIV positive mothers on the PMTCT program at referral hospitals in the west Amhara, Ethiopia, 2021.

METHODS

An unmatched case-control study was conducted at referral hospitals in the west Amhara region, Ethiopia. Data were collected through document review, which has been registered from July 1, 2016 to July 1, 2020. A two-stage sampling technique was applied. Consecutive sampling technique for cases and simple random sampling technique for controls was done to include a total of 320 samples (66 cases and 254 controls). Epi data 4.6 for data entry and SPSS 23 for analysis were used. Variables with p- value ≤0.2 in bivariate regression were run in the multivariable logistic regression and AOR with 95% CI and a p-value ≤0.05 was used to declare determinants.

RESULT

Home delivery (AOR = 4.3; 95%CI: 2.0, 11.6), mixed feeding (AOR = 10; 95%CI: 3.2, 17.9), poor maternal ARV drug adherence (AOR = 4.3; 95% CI: 1.4, 13.4), advanced WHO clinical stage (AOR = 11.4; 95% CI: 4.1,19.1), poor nevirapine adherence (AOR = 10; 95% CI: 3.2, 22.4) and late enrollment of the infant (AOR = 15; 95% CI: 3.0, 3.0,20.5) were determinants.

CONCLUSION

Minister of Health and NGOs should work on mobilization of the community and awareness creation on the important of exclusive breast feeding, drugs adherence, on benefit of health institutional delivery as well as the risk of homedelivery.

Evaluation of infants with HIV-infected mothers and perinatal transmission in Turkey: A single-center experience

OBJECTIVE:

The most common route of HIV infection in children is through perinatal transmission. In this study, we aimed to evaluate the characteristics of infants with HIV-infected mothers and perinatal HIV transmission.

METHODS:

We conducted a retrospective, single-center study of HIV-exposed infants in between December 2017 and October 2019 in a Marmara University Pendik Training and Research Hospital.

RESULTS:

A total of 18 infants were examined. All babies were born by cesarean section, and none of them were breastfed. Seventeen mothers were diagnosed with HIV before pregnancy. These mothers had received antiretroviral therapy (ART) during pregnancy, and their viral loads before delivery were negative. An antiretroviral prophylaxis with oral zidovudine was started in all infants within their 1^st day of birth and continued for at least 6 weeks. All infants were tested for their HIV viral load within the first 48 h of birth, with negative results, and 12 infants were tested for anti-HIV antibodies at the 18^th month, again with negative results. In this study, we determined that none of the infants had been infected with HIV.

CONCLUSION:

Our findings highlight the importance of initiating ART for all HIV-infected pregnant women and the importance of protection modalities during pregnancy, delivery, and the postnatal period for the prevention of perinatal transmission of HIV.

Infant HIV diagnosis and turn-around time for testing in Malawi, 2015

Background

For HIV-exposed infants in Malawi, there are missed opportunities at each step of the testing and treatment cascade.

Objective

This study assessed factors associated with HIV positivity among infants in Malawi and turn-around times for infant HIV testing.

Methods

HIV testing data for infants aged 0–18 months from 2012 to 2015 were extracted from the Malawi HIV laboratory information management system and analysed using logistic regression. Turn-around time was defined as time between collection of samples to results dispatch from the laboratory.

Results

A total of 106 997 tests were included in the analyses. A subset of 76 006 observations with complete dates were included in the turn-around time analysis. Overall positivity was 4.2%. Factors associated with positivity were increasing age (infants aged 3–6 months: adjusted odds ratio [aOR] = 2.24; infants aged 6–9 months: aOR = 3.42; infants aged > 9 months: aOR = 4.24), female sex (aOR = 1.08) and whether the mother was alive and not on antiretroviral therapy at time of the infant’s test (aOR = 1.57). Provision of HIV prophylaxis to the infant after birth (aOR = 0.38) was found to be protective against HIV positivity. The median turn-around time was 24 days (increased from 19 to 34 days between 2012 and 2015).

Conclusion

Infant HIV positivity has decreased in Malawi, whereas turn-around time has increased. Factors associated with positivity include increasing age, female sex, and whether the mother was alive and not on antiretroviral therapy at the time of the infant’s test.

Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis

Background

Human immunodeficiency virus (HIV) is one of the most important global health problems. More than one and half million of children are living with HIV in the world, and majority of them are found in sub-Saharan Africa. There are primary fragmented study findings, and no review was conducted with regard to vertical HIV infection in East Africa. Therefore, this review aimed to assess the prevalence of vertical HIV infection and its risk factors among HIV-exposed infants in East Africa.

Main body

Eligible studies were retrieved by relevant search terms in CINHAL, Pub-MED, Google Scholar, EMBASE, Web of Science, SCOPUS, Cochrane, African Journals Online databases, and Ethiopian University research repositories. Data were extracted with Microsoft Excel and analyzed with Stata version 11 software. The random effect model was used to estimate the pooled prevalence of vertical HIV infection in East Africa. The variation between studies was quantified with an I ² statistic test. Furthermore, sub-group and meta-regression analyses were done to identify the sources of heterogeneity between the studies. The publication bias was assessed by Egger test. This systematic review and meta-analysis have included a total of 33 research articles. The overall pooled prevalence of vertical HIV infection in East Africa was 7.68% with a 95% confidence interval [CI]: (6.23, 9.12) with a heterogeneity of I ² = 86.8 with a p value < 0.001. In subgroup analysis, the pooled prevalence of vertical HIV infection in cross-sectional studies was 6.58%, while in cohort studies were 9.37%. Mixed feeding, AOR = 6.22 (1.02, 11.41); home delivery, AOR = 2 (1.01, 3); mothers took ART less than 4 weeks, AOR = 1.92 (1.79, 2.06); and infants who have not received ARV prophylaxis, AOR = 2.02 (1.05, 2.98) were the associated factors for vertical HIV infection for exposed infants.

Conclusions

The pooled prevalence of the mother to child transmission of HIV is way more than the desired target of the World Health Organization, which is less than 5% in breastfeeding populations. Thus, strengthening the prevention of vertical HIV transmission, promotion of exclusive breastfeeding, timely initiation of ART prophylaxis for HIV exposed infants, encouragement of hospital delivery, and the start of ART at the time of diagnosis of every HIV-positive person may all reduce the transmission of vertical HIV infection.

Barriers and enablers of adherence to infant nevirapine prophylaxis against HIV 1 transmission among 6-week-old HIV exposed infants: A prospective cohort study in Northern Uganda

Background

Sub-optimal adherence to infant prophylaxis has been associated with mother-to-child-transmission of HIV. However, the factors associated have not been well characterised in different settings. This study describes barriers and enablers of adherence to infant prophylaxis among 6-week-old HIV exposed infants in Lira district, Northern Uganda.

Methods

This prospective cohort study was conducted from 2018–2020 at the PMTCT clinic at Lira Regional Referral Hospital and included 472 mother-infant pairs. HIV-infected pregnant women were recruited, followed up at delivery and 6 weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and adherence. Data were analysed using Stata to estimate adjusted risk ratios using Poisson regression models to ascertain barriers and enablers of adherence to infant nevirapine prophylaxis.

Results

Barriers to infant adherence are maternal characteristics including: younger age (≤20 years adjusted risk ratio (ARR) = 1.55; 95% CI: 1.1–2.2), missing a viral load test during pregnancy (ARR: 1.4; 95% CI: 1.1–1.7) and not receiving nevirapine syrup for the baby after childbirth (ARR = 6.2; 95% CI: 5.1–7.6). Enablers were: having attained ≥14 years of schooling (ARR = 0.7; 95% CI: 0.5–0.9), taking a nevirapine-based regimen (ARR = 0.6; 95% CI: 0.4–0.9), long-term ART (≥ 60 months ARR = 0.75; 95% CI: 0.6–0.9), accompanied by a husband to hospital during labour and childbirth (ARR = 0.5; 95% CI: 0.4–0.7) and labour starting at night (ARR = 0.7; 95% CI: 0.6–0.8).

Conclusion and recommendations

Despite mothers receiving nevirapine syrup from the health workers for the infant, non-adherence rates still prevail at 14.8%. The health system needs to consider giving HIV infected pregnant women the nevirapine syrup before birth to avoid delays and non-adherence. There is need to pay particular attention to younger women and those who recently started ART.

PMTCT Option B+ 2012 to 2018 - Taking stock: barriers and strategies to improve adherence to Option B+ in urban and rural Uganda

Since 2012, PMTCT Option B+ has been recommended by the World Health Organization to reduce vertical transmission but numerous adherence challenges remain. We conducted a qualitative study at baseline using six focus group discussions and 14 in-depth interviews to explore knowledge, beliefs, attitudes and challenges towards the Option B+ strategy for PMTCT among HIV-infected pregnant and post-partum women and health workers engaged in Uganda's national Option B+ PMTCT programme. Data were analysed using a thematic approach to capture latent and manifest content with the social ecological model as a theoretic foundation in order to make contextual sense of key stakeholders' needs for an effective Option B+ intervention. Overall, among all study participants, we found multi-level barriers to adhering to Option B+ cutting across all levels of the social ecological model. In line with the model, our study revealed barriers at personal, relational, organizational and societal levels. Some personal beliefs such as that the baby's health is more important that the mother's, organizational (negative attitudes and behaviour of health workers), structural such as poverty, work conflicts, fear and lack of disclosure related to community stigma were all critical obstacles to women adhering to the Option B+ programme. We found that both health workers and participants in the programme have a relatively clear understanding of the benefits of adhering to their treatment; though a more nuanced understanding and thus emphasis in counselling on side effects, is critical to helping patients adhere.

Filling the gaps in the Peruvian care continuum for HIV-infected pregnant mothers: a case-control study in metropolitan Lima-Callao, Peru

Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case-control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55-0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01-0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06-1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01-1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.

Enhanced Signaling Through the TLR9 Pathway Is Associated With Resistance to HIV-1 Infection in Chinese HIV-1-Exposed Seronegative Individuals

Innate immunity is the first line of defense against invading pathogens and may mediate HIV-1 resistance in HIV-1–exposed seronegative (HESN) individuals. This study aims to identify components of innate immunity that confer natural HIV-1 resistance in Chinese HESN individuals. Specifically, we compared the expression levels of Toll-like receptors (TLRs) and associated pathway molecules in peripheral blood mononuclear cells (PBMCs), monocytes/macrophages, and plasma obtained from HESN and control individuals. HESN individuals had higher expression of TLR9, IRF7, IFN-α/β, RANTES, and MIP-1α/1β in PBMCs and plasma than control subjects. Upon TLR9 stimulation, significantly higher expression of TLR9 and IRF7, as well as higher production of IFN-α/β, RANTES, and MIP-1α/1β, was observed in PBMCs and monocytes/macrophages from HESN individuals than in the corresponding cells from control individuals. More importantly, both with and without TLR9 stimulation, the levels of HIV-1 replication in monocyte-derived macrophages (MDMs) from HESN individuals were significantly lower than those in MDMs from control individuals. These data suggest that increased TLR9 activity and subsequent release of antiviral factors contribute to protection against HIV-1 in HESN individuals.

Adapting the HIV Infant Tracking System to Support Prevention of Mother-to-Child Transmission of HIV in Kenya: Protocol for an Intervention Development Pilot Study in Two Hospitals

Background

Despite progress to expand access to HIV testing and treatment during pregnancy in Kenya, gaps still remain in prevention of mother-to-child transmission of HIV (PMTCT) services. This study addresses the need for effective and scalable interventions to support women throughout the continuum of care for PMTCT services in low-resource settings. Our research team has successfully implemented the HIV Infant Tracking System (HITSystem), a Web-based, system-level intervention to improve early infant diagnosis (EID) outcomes.

Objective

This study will expand the scope of the HITSystem to address PMTCT services to bridge the gap between maternal and pediatric HIV services and improve outcomes. This paper describes the intervention development protocol to adapt and pilot an HITSystem version 2.0 to assess acceptability, feasibility, and preliminary PMTCT outcomes in Kenya.

Methods

This is a 3-year intervention development study to adapt the current HITSystem intervention to support a range of PMTCT outcomes including appointment attendance, antiretroviral therapy (ART) adherence, hospital deliveries, and integration of maternal and pediatric HIV services in low-resource settings. The study will be conducted in 3 phases. Phase 1 will elicit feedback from intervention users (patients and providers) to guide development and refinement of the new PMTCT components and inform optimal implementation. In Phase 2, we will design and develop the HITSystem 2.0 features to support key PMTCT outcomes guided by clinical content experts and findings from Phase 1. Phase 3 will assess complete PMTCT retention (before, during, and after delivery) using a matched randomized pilot study design in 2 hospitals over 18 months. A total of N=108 HIV-positive pregnant women (n=54 per site) will be enrolled and followed from their first PMTCT appointment until infant HIV DNA Polymerase Chain Reaction testing at the target age of 6 weeks (<7 weeks) postnatal.

Results

Funding for this study was received in August 2015, enrollment in Phase 1 began in March 2016, and completion of data collection is expected by May 2019.

Conclusions

This protocol will extend, adapt, and pilot an HITSystem 2.0 version to improve attendance of PMTCT appointments, increase ART adherence and hospital-based deliveries, and prompt EID by 6 weeks postnatal. The HITSystem 2.0 aims to improve the integration of maternal and pediatric HIV services.

Trial Registration

ClinicalTrials.gov NCT02726607; https://clinicaltrials.gov/ct2/show/NCT02726607 (Archived by WebCite at http://www.webcitation.org/78VraLrOb)

International Registered Report Identifier (IRRID)

DERR1-10.2196/13268

A systematic review and meta-analysis of vertical transmission route of HIV in Ethiopia

BACKGROUND

The burden of mother-to-child transmission rate of HIV is high and risk factors are common in Ethiopia. This systematic review and meta-analysis intended to provide the pooled estimation of mother-to-child transmission rate and its risk factors in Ethiopia.

METHODS

We searched PubMed, Google Scholar, EMBASE and Web of Science electronic databases for all available references. We included observational studies including case-control, cohort, and cross-sectional studies. The search was further limited to studies conducted in Ethiopia and publish in English. Heterogeneity was checked using the I² statistic. Egger's test and the funnel plot were used to assess publication bias. A meta-analysis using a weighted inverse variance random-effects model was performed.

RESULTS

A total of 18 studies with 6253 individuals were included in this systematic review and meta-analysis. Of these, 14 studies with 4624 individuals were used to estimate the prevalence. The estimated pooled prevalence of mother-to-child transmission of HIV was 11.4% (95% CI = 9.1-13.7). The pooled adjusted odds ratio (AOR) of mother-to-child transmission of HIV for the infants from rural area was 3.8 (95% CI = 1.4 to 6.3), infants delivered at home was 3.2 (95% CI = 1.2 to 5.2), infant didn't take antiretroviral prophylaxis was 5.8 (95% CI = 1.5 to 10.3), mother didn't take antiretroviral prophylaxis was 6.1 (95% CI = 2.5 to 9.6), mothers didn't receive PMTCT intervention was 5.1 (95% CI = 1.6, 8.6), and on mixed feeding was 4.3 (95% CI = 1.8 to 6.7).

CONCLUSIONS

This systematic review and meta-analysis showed that mother-to-child transmission rate of HIV was high in Ethiopia. Being from the rural residence, home delivery, not taking antiretroviral prophylaxis, the absence of PMTCT intervention, and mixed infant feeding practices increased the risk of HIV transmission.

TRIAL REGISTRATION

It is registered in the Prospero database: (PROSPERO 2017: CRD42017078232 ).