XVIII International AIDS Conference

Abstract

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Prevention of mother-to-child transmission of HIV (PMTCT) in Central Haiti: HIV-free survival at 18 months of age in a cohort of HIV-exposed infants enrolled in the partners In health / Zanmi Lasante (PIH/ZL) program

L. Ivers1, S. Appleton1, K. Cullen1, G. Jerome2, B. Wang3, M. Smith Fawzi1,4

1Partners In Health, Boston, United States, 2Zanmi Lasante Sociomedical Complex, Cange, Haiti, 3Massachusetts General Hospital, Boston, United States, 4Harvard Medical School, Department of Global Health and Social Medicine, Boston, United States

Background: PIH/ZL has one of the longest track records of providing care for PMTCT in the developing world, initiating services in 1995 after AZT was known to reduce vertical transmission of HIV. PIH/ZL offers comprehensive care, including ART during pregnancy, AZT and co-trimoxazole for the infant after birth, and free infant formula accompanied with community health worker support to ensure safe feeding practices.
Methods: An observational study was performed, examining HIV transmission, death, and HIV-free survival at 18 months among infants enrolled in the PIH/ZL PMTCT program. Among 351 pregnant women/infants who came to receive care at PIH/ZL, 91 presented after delivery and 260 presented during or prior to delivery. Twins were excluded from the analysis resulting in an effective sample size of n=254.
Results: Among HIV-exposed infants in the PIH/ZL program, 91% of infants at 18 months survived and were free from HIV infection, 3.5% were HIV-positive, and 6.7% had died at 18 months. For those mothers who had exclusively bottle fed, transmission of HIV was 3.2%. Protective factors for HIV-free survival included exclusive bottle feeding and longer duration of ART during pregnancy (starting at 4 weeks before delivery or earlier).
Conclusions: Although this population was in a severe resource-poor setting, with only 52% having an improved water source and 41% having an improved latrine, the rate of mortality at 18 months was much lower than Haiti overall. This finding may be related to the additional support that women received through the community health worker (accompagnateur) program at PIH/ZL, which offered support for directly observed therapy of ART during pregnancy and safe bottle feeding after delivery. The results also demonstrate that a key bottleneck to program success is the problem of identifying HIV-positive pregnant women before delivery and earlier in their pregnancy to prevent HIV transmission among their infants.


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