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Tassembedo S, Mwiya M, Mennecier A, Kankasa C, Fao P, Molès JP, Kania D, Chunda-Liyoka C, Sakana BLD, D’Ottavi M, Taofiki AO, Rutagwera D, Wilfred-Tonga MM, Tylleskär T, Nagot N, Van de Perre P. Evaluation of the prevention of mother-to-child transmission of HIV programs at the second immunization visit in Burkina Faso and Zambia. AIDS 2024; 38:875-885. [PMID: 38181091 PMCID: PMC10994186 DOI: 10.1097/qad.0000000000003827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Our study aimed to assess the PMTCT indicators in Burkina Faso and Zambia using a patient-orientated innovative strategy based on the second visit in the Expanded Program on Immunization (EPI-2) visit at 6-8 weeks. DESIGN This was a cross sectional study. METHODS We assessed women attending EPI-2 at primary healthcare facilities in Burkina Faso and Zambia with their children about their exposure to PMTCT interventions. For women living with HIV (WLHIV), viral load was measured and their children were tested for HIV DNA using point of care devices. RESULTS Overall, 25 093 were enrolled from Burkina Faso and 8961 women from Zambia. Almost, all women attended at least one antenatal care visit. Among those aware of their HIV-positive status, 95.8 and 99.2% were on antiretroviral therapy (ART) in Burkina Faso and Zambia, respectively. Among WLHIV on ART, 75 and 79.2% achieved a viral load suppression (viral load <1000 copies/ml) in Burkina Faso and Zambia, respectively. Infant postnatal prophylaxis was administered from birth until EPI-2 to 60.9 and 89.7% of HIV-exposed children in Burkina Faso and Zambia, respectively. In Burkina Faso, only 60 of 192 (31.3%) of HIV-exposed children were sampled at day 42 for early infant diagnosis (EID) and 3 (1.6%) received a result by EPI-2. In Zambia, these figures were 879 of 1465 (64.0%) and 9.9% (145/1465), respectively for HIV-exposed children sampled at birth. CONCLUSION This evaluation strategy at EPI-2 visit could strengthen program monitoring and help identifying gaps to be addressed on the last mile towards elimination of MTCT of HIV.
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Affiliation(s)
- Souleymane Tassembedo
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Mwiya Mwiya
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | - Anais Mennecier
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Chipepo Kankasa
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | - Paulin Fao
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Jean Pierre Molès
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Dramane Kania
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | | | | | - Morgana D’Ottavi
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Ajani Ousmane Taofiki
- Infectious Disease Research Programme, Centre MURAZ/National Institute of Public Health, Bobo-Dioulasso, Burkina Faso
| | - David Rutagwera
- Pediatric center of excellence, University Teaching Hospitals, Lusaka, Zambia
| | | | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Univ. Montpellier, Inserm, EFS, Univ. Antilles, Montpellier, France
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Tassembédo S, Traoré IT, Traoré-Barro M, Diallo I, Maré D, Diallo-Barry F, Rajaonarivelo C, Coulibaly B, Nikiema A, Poda A, Vande Perre P, Nagot N. Using adult care visits to diagnose HIV infection in children, Burkina Faso. Bull World Health Organ 2024; 102:187-195. [PMID: 38420571 PMCID: PMC10898281 DOI: 10.2471/blt.23.289606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024] Open
Abstract
Objective To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. Methods We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women ≤ 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18 months and 5 years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Findings Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (P-value: 0.003) and they had not been tested before (P-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (P-value: < 0.001) and had more recently learnt their HIV status (P-value: 0.01) than mothers of HIV-negative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Conclusion Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV-infected children is recommended.
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Affiliation(s)
- Souleymane Tassembédo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulassso, Programme de Recherche sur les Maladies Infectieuses, Centre Muraz 2054 Avenue Mamadou Konate, Bobo-Dioulasso, Burkina Faso
| | | | - Makoura Traoré-Barro
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Ismael Diallo
- Département de Médecine, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Fatimata Diallo-Barry
- Centre Médical avec Antenne Chirurgicale de Pissy, Direction Régionale de la Santé du Centre, Ouagadougou, Burkina Faso
| | | | - Bethem Coulibaly
- Centre Médical avec Antenne Chirurgicale de Dafra, Direction Régionale de la Santé des Hauts-Bassins, Bobo-Dioulasso, Burkina Faso
| | - Amélie Nikiema
- Centre Médical avec Antenne Chirurgicale de Do, Direction Régionale de la Santé des Hauts-Bassins, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Département de Médecine, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - Philippe Vande Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Institut national de la santé et de la recherche médicale (INSERM), Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Institut national de la santé et de la recherche médicale (INSERM), Montpellier, France
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Giuliano M, Orlando S, Andreotti M, Mthiko B, Mphwere R, Kavalo T, Ciccacci F, Marazzi MC, Floridia M. Maternal retention and early infant HIV diagnosis in a prospective cohort study of HIV-positive women and their children in Malawi. Int J STD AIDS 2023; 34:54-61. [PMID: 36285600 PMCID: PMC10658750 DOI: 10.1177/09564624221136647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Post-partum loss to follow-up and lack of early HIV infant diagnosis (EID) can significantly affect the efficiency of programs for the prevention of mother-to-child transmission. METHODS In a prospective observational study 167 women were enrolled at week 36 of gestation and followed with their infants up to one year after delivery. Retention was defined as the proportion of women who attended the 12 months visit and EID as an HIV PCR test performed within 2 months. Determinants for retention and EID were assessed in univariate analyses and in multivariable logistic regression models. RESULTS Women lost to follow-up (24/167 or 14.4%) had a shorter duration of antiretroviral therapy (ART) at enrolment in comparison to women retained in care (p = 0.025). Lack of EID (occurring in 18.9% of the cases) was directly correlated, although not significantly, with a history of child death (p = 0.071), a higher educational level (p = 0.083), and female infant gender (p = 0.064). CONCLUSIONS Longer duration of ART at enrolment significantly predicted a better post-partum retention, suggesting that specific counselling interventions should be targeted to recent ART initiators. A low proportion of infants did not receive an EID, but predictive factors were difficult to identify.
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Affiliation(s)
- Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Bryan Mthiko
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | | | - Thom Kavalo
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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