Study Justification:
– The study aimed to assess whether providing combination antiretroviral therapy (cART) to HIV-infected mothers would reduce loss to follow-up (LTFU) of their HIV-exposed infants in Kinshasa, DR Congo.
– Programs to prevent mother-to-child HIV transmission often face challenges with LTFU of HIV-exposed infants, which hinders the effectiveness of interventions.
– Understanding the impact of maternal cART on infant retention is crucial for improving the clinical and population-level outcomes of prevention of mother-to-child HIV transmission interventions.
Study Highlights:
– A cohort of mother-infant pairs was constructed using routinely collected clinical data.
– Maternal cART eligibility was determined based on national guidelines.
– Infants were considered LTFU if they had 3 failed tracking attempts after a missed visit or if more than 6 months had passed since their last clinic visit.
– Statistical methods accounted for competing risks, such as death.
– A total of 1318 infants were enrolled at a median age of 2.6 weeks, with 24% of mothers receiving cART at that time.
– Overall, 5% of infants never returned to care after enrollment, and 18% were LTFU by 18 months.
– Infants whose mothers initiated cART by infant enrollment had an 18-month cumulative incidence of LTFU of 8%, compared to 20% among infants whose mothers were not yet on cART.
– Adjusted for baseline factors, infants whose mothers were not on cART were over twice as likely to be LTFU, with a subdistribution hazard ratio of 2.75.
– The association between maternal cART and reduced LTFU remained strong regardless of maternal CD4 count at infant enrollment.
Recommendations for Lay Reader and Policy Maker:
– Increasing access to cART for pregnant women could improve the retention of HIV-exposed infants.
– This would enhance the effectiveness of prevention of mother-to-child HIV transmission interventions and early access to cART for HIV-infected infants.
– Policy makers should prioritize efforts to expand access to cART for pregnant women, ensuring that national guidelines are followed and that resources are allocated accordingly.
– Lay readers should be aware of the importance of maternal cART in improving the long-term health outcomes of HIV-exposed infants and the overall impact on reducing mother-to-child HIV transmission.
Key Role Players:
– Ministry of Health: Responsible for implementing policies and guidelines related to HIV prevention and treatment, including access to cART for pregnant women.
– Healthcare Providers: Involved in the identification, counseling, and provision of cART to HIV-infected pregnant women.
– Community Health Workers: Play a crucial role in tracking and following up with HIV-exposed infants to ensure their retention in care.
– Non-Governmental Organizations (NGOs): Provide support and resources for HIV prevention and treatment programs, including initiatives targeting pregnant women and infants.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on cART administration and monitoring.
– Procurement and distribution of antiretroviral drugs for pregnant women.
– Development and implementation of tracking systems for HIV-exposed infants.
– Community outreach and engagement activities to improve awareness and adherence to cART among pregnant women.
– Monitoring and evaluation of the program’s impact on infant retention and mother-to-child HIV transmission rates.