HIV-free Survival Among Breastfed Infants Born to HIV-positive Women in Northern Uganda: a Facility-based Retrospective Study

Overview

Journal Pan Afr Med J

Date 2021 Mar 3

PMID 33654517

Citations 2

Authors

Irene Aguti

Charles Kimbugwe

Patricia Apai

Siraji Munyaga

Richard Nyeko

Affiliations

Soon will be listed here.

Abstract

Introduction: the HIV-free survival rate is the gold-standard measure of the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting. However, data on HIV-free survival among the HIV-exposed infants followed up in most low-resource settings are lacking. We determined the HIV-free survival among breastfed infants in two tertiary facilities in a resource-poor setting in northern Uganda.

Methods: we conducted a retrospective cohort study in May 2019 and retrospectively reviewed records of HIV-exposed infants registered in 2014 through 2016 at two tertiary facilities in northern Uganda. We analyzed data using SPSS v16 software package. The chi-square and Student t-tests were used to compare factors among infant groups. Multivariate logistic regression analysis was used to determine factors independently associated with HIV-free survival. P-value <0.05 was considered for statistical significance.

Results: majority of the infants were males 55.6% (203/365) and 98.6% (360/365) received nevirapine prophylaxis. A total of 345 (94.5%) infants were exclusively breastfed, only 100/345 (29.0%) of whom were exclusively breastfed for at least 6 months, while the breastfeeding status of 44/345 (12.8 %) infants could not be ascertained. The overall HIV-free survival rate was 93.7% (342/365), while 2.7% (10/365) were HIV-infected and 3.6% (13/365) died. Infants´ age at enrolment in care (aOR 5.20, p=0.008) and treatment facility (aOR 3.76, p=0.027) were the independent determinants of HIV-free survival.

Conclusion: the HIV-free survival rate among the breastfed infants in the study setting marginally falls short of the recommended standard, thus calling for more efforts to improve survival.

Citing Articles

The progress of mother-to-child transmission of Human Immunodeficiency Virus (HIV) after Dolutegravir (DTG) optimization program: evidence from a multicenter cohort study in Ethiopia.

Gedefaw A, Tadesse B, Tadesse S, Kebede B, Hussen S, Hailu D BMC Public Health. 2024; 24(1):3367.

PMID: 39627710 PMC: 11613881. DOI: 10.1186/s12889-024-20761-w.

Feeding modalities, HIV transmission and its predictors among HIV-exposed infants visited Gamo and Gofa zones public health facilities, Southern Ethiopia: a retrospective follow up study.

Belete N, Megersa N, Hebo S, Animut M, Tariku E BMC Pediatr. 2024; 24(1):410.

PMID: 38926639 PMC: 11202369. DOI: 10.1186/s12887-024-04894-w.

References

Gill M, Hoffman H, Ndatimana D, Mugwaneza P, Guay L, Ndayisaba G . 24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda: The Kabeho Study. Medicine (Baltimore). 2018; 96(51):e9445. PMC: 5758279. DOI: 10.1097/MD.0000000000009445. View

Stringer J, Stinson K, Tih P, Giganti M, Ekouevi D, Creek T . Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries. PLoS Med. 2013; 10(5):e1001424. PMC: 3646218. DOI: 10.1371/journal.pmed.1001424. View

Taha T, Hoover D, Kumwenda N, Fiscus S, Kafulafula G, Nkhoma C . Late postnatal transmission of HIV-1 and associated factors. J Infect Dis. 2007; 196(1):10-4. DOI: 10.1086/518511. View

Berhan Z, Abebe F, Gedefaw M, Tesfa M, Assefa M, Tafere Y . Risk of HIV and associated factors among infants born to HIV positive women in Amhara region, Ethiopia: a facility based retrospective study. BMC Res Notes. 2014; 7:876. PMC: 4289399. DOI: 10.1186/1756-0500-7-876. View

Peltier C, Ndayisaba G, Lepage P, van Griensven J, Leroy V, Pharm C . Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS. 2009; 23(18):2415-23. PMC: 3305463. DOI: 10.1097/QAD.0b013e32832ec20d. View

Oluwayemi I, Olatunya S, Ogundare E . PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014. Int J MCH AIDS. 2016; 3(2):168-73. PMC: 5005991. View

Chouraya C, Machekano R, Mthethwa S, Lindan K, Mirira M, Kudiabor K . Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey. AIDS Behav. 2018; 22(Suppl 1):105-113. PMC: 6045958. DOI: 10.1007/s10461-018-2121-6. View

Buzdugan R, Kang Dufour M, McCoy S, Watadzaushe C, Dirawo J, Mushavi A . Option A improved HIV-free infant survival and mother to child HIV transmission at 9-18 months in Zimbabwe. AIDS. 2016; 30(10):1655-62. PMC: 4889511. DOI: 10.1097/QAD.0000000000001111. View

Jackson J, Musoke P, Fleming T, Guay L, Bagenda D, Allen M . Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet. 2003; 362(9387):859-68. DOI: 10.1016/S0140-6736(03)14341-3. View

10.

Kagaayi J, H Gray R, Brahmbhatt H, Kigozi G, Nalugoda F, Wabwire-Mangen F . Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda. PLoS One. 2008; 3(12):e3877. PMC: 2588542. DOI: 10.1371/journal.pone.0003877. View

11.

Gill M, Hoffman H, Bobrow E, Mugwaneza P, Ndatimana D, Ndayisaba G . Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study. PLoS One. 2016; 11(12):e0168671. PMC: 5179044. DOI: 10.1371/journal.pone.0168671. View

12.

Hoffman R, Black V, Technau K, van der Merwe K, Currier J, Coovadia A . Effects of highly active antiretroviral therapy duration and regimen on risk for mother-to-child transmission of HIV in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2010; 54(1):35-41. PMC: 2880466. DOI: 10.1097/QAI.0b013e3181cf9979. View

13.

van den Bosch W, Huygen F, van den Hoogen H, van Weel C . Morbidity in early childhood: differences between girls and boys under 10 years old. Br J Gen Pract. 1992; 42(362):366-9. PMC: 1372113. View

14.

Ben O, Yusuf T . PCR pattern of HIV-exposed infants in a tertiary hospital. Pan Afr Med J. 2015; 18:345. PMC: 4282809. DOI: 10.11604/pamj.2014.18.345.3713. View

15.

Huntington S, Thorne C, Newell M, Anderson J, Taylor G, Pillay D . The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy. AIDS. 2015; 29(17):2269-78. PMC: 4631122. DOI: 10.1097/QAD.0000000000000826. View

16.

Chikhungu L, Bispo S, Rollins N, Siegfried N, Newell M . HIV-free survival at 12-24 months in breastfed infants of HIV-infected women on antiretroviral treatment. Trop Med Int Health. 2016; 21(7):820-8. PMC: 5096069. DOI: 10.1111/tmi.12710. View

17.

Shapiro R, Kitch D, Ogwu A, Hughes M, Lockman S, Powis K . HIV transmission and 24-month survival in a randomized trial of HAART to prevent MTCT during pregnancy and breastfeeding in Botswana. AIDS. 2013; 27(12):1911-20. PMC: 3987116. DOI: 10.1097/qad.0b013e32836158b0. View

18.

Doro Altan A, Taafo F, Fopa F, Buonomo E, Marazzi M, Nielsen-Saines K . An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort. Pan Afr Med J. 2016; 23:72. PMC: 4862786. DOI: 10.11604/pamj.2016.23.72.7958. View

19.

Ivers L, Appleton S, Wang B, Jerome J, Cullen K, Fawzi M . HIV-free survival and morbidity among formula-fed infants in a prevention of mother-to-child transmission of HIV program in rural Haiti. AIDS Res Ther. 2011; 8(1):37. PMC: 3220628. DOI: 10.1186/1742-6405-8-37. View

20.

Gissler M, Jarvelin M, Louhiala P, Hemminki E . Boys have more health problems in childhood than girls: follow-up of the 1987 Finnish birth cohort. Acta Paediatr. 1999; 88(3):310-4. DOI: 10.1080/08035259950170088. View