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Impact of maternal HIV treatment on under-5 child mortality in rural, high HIV prevalence South Africa
Presented by James Ndirangu (South Africa).
J. Ndirangu1, R. Bland1,2, M.-L. Newell1,3
1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa, 2Division of Developmental Medicine, Glasgow University Medical Faculty, Glasgow, United Kingdom, 3Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, United Kingdom
Background: To assess the effect of maternal HIV treatment on under-5 child mortality in a largely rural population with high HIV prevalence.
Methods: All births, January 2000-January 2007, to women enrolled in the Africa Centre Demographic Information System (ACDIS) were included. Since 2003, an annual population-based HIV surveillance, nested within ACDIS, documented the HIV status of consenting resident women aged 15-49 years. Maternal antiretroviral treatment (ART) information came from an HIV Treatment and Care Programme, initiated in 2004, providing services at 6 local primary healthcare clinics in the demographic surveillance area; this independent data was linked to the surveillance data. Therefore some women have ART but no HIV surveillance data. Under-5 mortality rates (U5MR) were computed as deaths per 1000 live-births per year. Maternal ART effect on U5MR was assessed in a Cox regression, stratified by maternal HIV status at delivery, adjusting for factors known to be associated with mortality.
Results: 9,372 mothers delivered 12,027 children, of whom 938 (7.8%) died before age 5. 266 (2.8%) of all mothers initiated ART within 5 years post-delivery: 64 (12.8%) of 500 HIV-positive, 102 (1.9%) of 5,237 HIV-unknown and 77 (3.8%) of 2,022 HIV-ambiguous (unknown at birth but negative before pregnancy or positive beyond delivery) mothers. Under-5 mortality declined by 55% between 2001 and 2006, from 99.7 to 44.5 deaths per thousand live-births; 32% in children of HIV-positive, 64% in HIV-unknown and 58% in HIV-ambiguous mothers. Mortality was independently associated with maternal ART among HIV-positive mothers (aHR 0.32, 0.09-1.02; p=0.055) and HIV-unknown mothers (0.18, 0.04-0.72; p=0.015); no deaths were observed in children whose mothers initiated ART but had ambiguous HIV status.
Conclusions: These findings highlight the importance of maternal HIV treatment with direct benefits of improved survival among all their children under-5 years. Urgency in scaling-up HIV treatment programmes is necessary if MDG4 is to be realised.
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