A Retrospective Study of Human Immunodeficiency Virus Transmission, Mortality and Loss to Follow-up Among Infants in the First 18 Months of Life in a Prevention of Mother-to-child Transmission Programme in an Urban Hospital in KwaZulu-Natal, South...

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2012 Sep 12

PMID 22963527

Citations 26

Authors

Terusha Chetty

Stephen Knight

Janet Giddy

Tamaryn L Crankshaw

Lisa M Butler

Marie-Louise Newell

Affiliations

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Abstract

Unlabelled:

Background: Follow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa.

Methods: We conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants' LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death.

Results: Of 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (≥ 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044).

Conclusion: This urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.

Citing Articles

Mortality and Loss to Follow-Up Among HIV-Exposed Infants After Option B Guideline Implementation in Amhara Regional State Referral Hospitals, Ethiopia.

Kassaw M, Abebe A, Abate B, Getu M, Kassie A Front Pediatr. 2021; 9:591963.

PMID: 34858894 PMC: 8631536. DOI: 10.3389/fped.2021.591963.

Retention in Care and Health Outcomes of HIV-Exposed Infants in a Prevention of Mother-to-Child Transmission of HIV (PMTCT) Cohort in Addis Ababa, Ethiopia.

Alamdo A, King E HIV AIDS (Auckl). 2021; 13:171-179.

PMID: 33603493 PMC: 7882432. DOI: 10.2147/HIV.S286347.

Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data.

Muyunda B, Musonda P, Mee P, Todd J, Michelo C Front Public Health. 2020; 7:401.

PMID: 32010656 PMC: 6978742. DOI: 10.3389/fpubh.2019.00401.

Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016.

Kigen H, Galgalo T, Githuku J, Odhiambo J, Lowther S, Langat B Pan Afr Med J. 2018; 30:178.

PMID: 30455807 PMC: 6235513. DOI: 10.11604/pamj.2018.30.178.15837.

12-month outcomes of HIV-infected infants identified at birth at one maternity site in Johannesburg, South Africa: an observational cohort study.

Technau K, Strehlau R, Patel F, Shiau S, Burke M, Conradie M Lancet HIV. 2018; 5(12):e706-e714.

PMID: 30416043 PMC: 6336389. DOI: 10.1016/S2352-3018(18)30251-0.

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