Effect of Dolutegravir-Based First-Line Antiretroviral Therapy on Mother-to-Child Transmission of HIV Among HIV-Exposed Infants in Ethiopia: a Before-and-After Study

Background

Currently, Dolutegravir (DTG)-based regimens are administered to women on Option B plus to prevent mother-to-child transmission (MTCT) of the virus. However, its effect on reducing MTCT of human immunodeficiency virus (HIV) among HIV-exposed infants over the previously used Efavirenz (EFV)-based regimen is unknown.

Objective

This study aimed to compare the effects of DTG-based and EFV-based regimens on the MTCT of HIV among HIV-exposed infants in Ethiopia.

Methods

An uncontrolled before-and-after study design was conducted among 958 mother-infant pairs (479 on EFV-based and 479 on DTG-based regimens) enrolled in the prevention of mother-to-child transmission (PMTCT) care from September 2015 to February 2023. The outcome variable was the HIV infection status among the exposed infants. A log-binomial model was employed, and the proportion was computed to compare the incidence of MTCT of HIV in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess the predictor variables.

Results

Mothers on DTG-based regimens were approximately 44% (adjusted risk ratio (aRR): 0.56; 95% CI: 0.44, 0.70) less likely to transmit HIV to their infants than those on EFV-based regimens. In addition, poor or fair adherence to antiretroviral therapy (ART) (aRR: 5.82; 95% CI: 3.41, 9.93), home delivery (aRR: 3.61; 95% CI: 2.32, 5.62), mixed feeding practice (aRR: 1.83; 95% CI: 1.45, 2.3) and not receiving antiretroviral prophylaxis (aRR: 3.26; 95% CI: 1.6, 6.64) were found to increase the risk of MTCT of HIV infection, whereas older maternal age (aRR: 0.93; 95% CI: 0.9, 0.96) was a protective factor.

Conclusion

Mother-to-child transmission of HIV was less frequently observed in mother-infant pairs exposed to the DTG-based regimens as compared to those exposed to the EFV-based regimens. Thus, DTG-based first-line ART regimens supplementation should be sustained to achieve global and national targets for zero new infections in HIV-exposed infants.

A before-after full bayes multivariate intervention model to estimate the safety effectiveness of red light cameras

OBJECTIVE

Intersection-related crashes account for approximately 40% of all crashes and tend to be more severe. Red-light running (RLR) crashes are most severe as almost half of these crashes result in injuries and fatalities. To reduce RLR crashes, agencies have been deploying red light cameras (RLCs). The main objective of this study was to evaluate the safety effectiveness of RLCs in the City of Miami Beach, Florida.

METHOD

The full Bayes (FB) approach was conducted based on five treatment intersections with six RLCs and 14 comparison intersections without RLCs. The analysis focused on target crash types, including rear-end, sideswipe, and angle/left-turn/right-turn crashes, and crash severity.

RESULTS

The FB analysis indicated a significant sudden drop in all types of target crashes immediately after the installation of RLCs. Compared to the before-period, the after-period experienced: fewer angle/left-turn/right-turn crashes, fewer sideswipe crashes, and more rear-end crashes. The sideswipe and angle/left-turn/right-turn crashes dropped immediately after the installation of RLCs and then continued to increase, but they were still lower than the before- period. The rear-end crashes dropped immediately after the installation of RLCs and then continued to increase, but they increased at a steeper rate. Major and minor approaches AADT, higher speed limit, longer amber time, length of pedestrian crosswalk, and number of driveways within the intersection influence area increased the frequency of total target, PDO, and FI crashes. Intersections with all-red interval more than two seconds, major approach with more than two through lanes, and minor approach with more than one through lane, on the contrary, resulted in a fewer number of the total target, PDO, and FI crashes. The treatment indicator showed that treatment intersections experienced fewer FI, angle/left-turn/right-turn, and sideswipe crashes and more total, PDO, and rear-end crashes compared to the non-treatment intersections.

CONCLUSION

This study provides reliable estimates of the safety effectiveness of RLCs since it accounts for uncertainties in the data, regression-to-the-mean, and spillover effects.