Menu
Menu
Menu
Menu
Introduction While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria’s final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and thei≥r correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. Methods This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18–24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. Results After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. Conclusion The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months’ exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.
This retrospective cross-sectional study focused on HEI seen at public and private healthcare facilities across nine states and the Federal Capital Territory in Nigeria, namely, Benue, Delta, Ekiti, Kano, Katsina, Nasarawa, Ogun, Ondo and Osun. HIV services at healthcare facilities in these states were supported by the Institute of Human Virology Nigeria (IHVN) with PEPFAR funding. IHVN is a large local non-governmental organization that provides public health services including for malaria, tuberculosis, and HIV, to healthcare facilities in Nigeria [16]. The primary, secondary and tertiary facilities supported by IHVN and included in the analysis were located across the spectrum of rural and urban settings, with primary facilities located largely in rural areas, secondary facilities in both rural and urban areas, and tertiary facilities concentrated in urban areas. Additionally, tertiary facilities also serve as referral centers at which patients from within and outside the state access higher-level care. We reviewed available records of infants born between October 30, 2014 and April 30, 2015 who had final outcome results available by October 30, 2016. This birth cohort attained 18 to 24 months of age by October 30, 2016. We prioritized data analysis for this birth cohort of HEI because 2014 was the first year of implementation for a newly-implemented longitudinal birth cohort register that linked the mother-infant pair in the PMTCT program. HIV positive final outcome refers to the status of HEIs identified as HIV-infected after testing positive for HIV antibodies at ≥18 months of age and/or 6 weeks after cessation of breastfeeding [17]. In 2014/2015, national guidelines recommended that all HEI were to be tested for HIV by DNA PCR using dried blood samples, for early infant diagnosis (EID) between 6 weeks and 2 months of age, and at 6 weeks after breastfeeding [17]. Infants older than 9 months could first be screened with rapid antibody testing, and if positive, undergo PCR testing for confirmation [17]. There was no birth testing nor mandatory repeat PCR testing recommendation after first DNA PCR for HEI in 2014/2015 [17]. HEI testing negative at first DNA PCR were tested for final outcome by rapid antibody testing between 18 and 24 months of age [17, 18]. The delay period of final outcome testing to up to 24 months is to reduce the possibility of false positives from maternal antibodies which may occur in younger children. Only HEI with an available DNA PCR result at ≤6 weeks of birth and an HIV rapid test result at ≥18 months of age were eligible for inclusion. All HEI who had a positive DNA PCR test collected between 6 weeks and less than 18 months of age were excluded from final outcome analysis. In addition to HEI HIV test data, socio-demographic and clinical parameters were collected on infants and their HIV-positive mothers. Site-level data clerks de-identified data from IHVN’s electronic HIV program database and from hard-copy program registers at supported facilities in the nine states and the Federal Capital Territory. State-level Monitoring and Evaluation program officers collated site data and submitted it to the Central Strategic Information Unit in secured, encrypted Excel files for analysis. After abstraction and cleaning, relevant data from mother-infant pairs meeting the eligibility criteria were migrated into Stata 14 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). Descriptive analysis was performed, after which bi-variate analysis using Chi-square, Fisher’s exact and likelihood ratios were conducted to test for associations between HEI final outcomes and maternal-infant characteristics. Explanatory variables significant at p<0.05 from bi-variate analysis were inputted into a model for multivariate logistic regression to establish predictors of HIV infant positivity at 18–24 months of age. The binary dependent variable was HEI who were positive or negative after HIV rapid testing at ≥18 months. Independent variables were divided into two main domains: maternal data including age and marital, education and employment status at antenatal care clinic booking, facility type attended, place of delivery, and receipt of ART; and infant data including gender, birth weight, DNA PCR result, and infant feeding practice. The study was approved by the Nigerian National Health Research Ethics Committee (NHREC/01/01/2007-01/03/2021D) for secondary analysis of routine data collected by the Institute of Human Virology Nigeria’s HIV program. The data reviewed and presented in this study were collected as part of routine HIV program activities.
N/A
