Amanda B Burrage1, Angela Mushavi2, Ray W Shiraishi1, Beth Tippett Barr3, Geral Shambira4, Justice Nyakura4, Shirish Balachandra3, Peter H Kilmarx5, Thu-Ha Dinh6. 1. Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia. 2. AIDS and TB Department, Ministry of Health and Child Care of Zimbabwe, Harare, Zimbabwe. 3. Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Center for Global Health, Harare, Zimbabwe. 4. Department of Community Health, University of Zimbabwe, Harare, Zimbabwe. 5. Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia; Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Center for Global Health, Harare, Zimbabwe. 6. Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Center for Global Health, Atlanta, Georgia. Electronic address: dvt1@cdc.gov.
Abstract
PURPOSE: We assessed 18-month cumulative mother-to-child HIV transmission (MTCT) risk and risk factors for no antiretroviral medication use during pregnancy among adolescent, young women, and adult mothers in Zimbabwe. METHODS: We analyzed data from a prospective survey of 1,171 mother-infant pairs with HIV-exposed infants aged 4-12 weeks who were recruited from 151 immunization clinics from February to August 2013. HIV-exposed infants were followed until diagnosed with HIV, death, or age 18 months. Findings were weighted and adjusted for complex survey design and nonresponse. RESULTS: The 18-month cumulative MTCT risk was highest among adolescent aged ≤19 years (12%) followed by young women aged 20-24 years (7.5%) and adult women aged ≥25 years (6.9%). Across these groups, more than 94% had ≥1 antenatal care visit by 21 weeks of gestation, more than 95% had ≥1 HIV test, and more than 98% knew their HIV status. Of known HIV-positive mothers, maternal antiretroviral medication coverage during pregnancy was 76.8% (95% confidence interval: 65.1-85.5), 83.8% (78.6-87.9), and 87.8% (84.6-90.4) among adolescent, young women, and adult mothers, respectively. Among HIV-positive mothers diagnosed prenatally, the adjusted odds ratio of no ARV use during pregnancy was increased among those who had no antenatal care attendance (adjusted odds ratio: 7.7 [3.7-16.0]), no HIV testing (7.3 [2.3-23.5]), no prepartum CD4 count testing (2.1 [1.3-3.4]), and maternal HIV identification during pregnancy (2.9 [1.8-4.8]). Age was not a risk factor. CONCLUSIONS: With similar coverage of prevention of MTCT services, the 18-month cumulative MTCT risk was higher among adolescents and young women, compared with adults. Additional research should examine the causes to develop targeted interventions. Published by Elsevier Inc.
PURPOSE: We assessed 18-month cumulative mother-to-child HIV transmission (MTCT) risk and risk factors for no antiretroviral medication use during pregnancy among adolescent, young women, and adult mothers in Zimbabwe. METHODS: We analyzed data from a prospective survey of 1,171 mother-infant pairs with HIV-exposed infants aged 4-12 weeks who were recruited from 151 immunization clinics from February to August 2013. HIV-exposed infants were followed until diagnosed with HIV, death, or age 18 months. Findings were weighted and adjusted for complex survey design and nonresponse. RESULTS: The 18-month cumulative MTCT risk was highest among adolescent aged ≤19 years (12%) followed by young women aged 20-24 years (7.5%) and adult women aged ≥25 years (6.9%). Across these groups, more than 94% had ≥1 antenatal care visit by 21 weeks of gestation, more than 95% had ≥1 HIV test, and more than 98% knew their HIV status. Of known HIV-positive mothers, maternal antiretroviral medication coverage during pregnancy was 76.8% (95% confidence interval: 65.1-85.5), 83.8% (78.6-87.9), and 87.8% (84.6-90.4) among adolescent, young women, and adult mothers, respectively. Among HIV-positive mothers diagnosed prenatally, the adjusted odds ratio of no ARV use during pregnancy was increased among those who had no antenatal care attendance (adjusted odds ratio: 7.7 [3.7-16.0]), no HIV testing (7.3 [2.3-23.5]), no prepartum CD4 count testing (2.1 [1.3-3.4]), and maternal HIV identification during pregnancy (2.9 [1.8-4.8]). Age was not a risk factor. CONCLUSIONS: With similar coverage of prevention of MTCT services, the 18-month cumulative MTCT risk was higher among adolescents and young women, compared with adults. Additional research should examine the causes to develop targeted interventions. Published by Elsevier Inc.
Entities:
Keywords:
Adolescents; Mother-to-child HIV transmission (MTCT); Young women; Zimbabwe
Authors: Steffie Heemelaar; Nicole Habets; Ziche Makukula; Jos van Roosmalen; Thomas van den Akker Journal: Trop Med Int Health Date: 2014-12-22 Impact factor: 2.622
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