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Elimination of Mother-To-Child Transmission of HIV Infection: The Drug Resource Enhancement against AIDS and Malnutrition Model.

Liotta G, Marazzi MC, Mothibi KE, Zimba I, Amangoua EE, Bonje EK, Bossiky BN, Robinson PA, Scarcella P, Musokotwane K, Palombi L, Germano P, Narciso P, de Luca A, Alumando E, Mamary SH, Magid NA, Guidotti G, Mancinelli S, Orlando S, Peroni M, Buonomo E, Nielsen-Saines K - Int J Environ Res Public Health (2015)

Bottom Line: Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%.Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies.A review of this model of care for HIV eMTCT is provided.

View Article: PubMed Central - PubMed

Affiliation: University of Tor Vergata, 18-00173 Rome, Italy. giuseppeliotta@hotmail.com.

ABSTRACT
The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%-88% while retention rates at 18-24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.

No MeSH data available.


Related in: MedlinePlus

Patients receiving care at DREAM centers in Mozambique over the years.
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ijerph-12-13224-f002: Patients receiving care at DREAM centers in Mozambique over the years.

Mentions: The DREAM program in Mozambique manages 10 heath care facilities in the country, both in urban and rural settings, with care provided to over 35,000 HIV-infected patients on cART (Figure 2 and Figure 3). The program is particularly focused on HIV EMTCT [15,16,17,18,19]. Growth of the program steadily increased from inception in 2002 to 35,000 patients followed in 2013, an indicator of successful program uptake by individuals in the country. The number of pregnancies in HIV-infected mothers followed at our centers has steadily risen over the years as seen in Figure 3, another marker of successful uptake. Our infant HIV-1 free survival at 12 months of age of HIV-exposed infants born to women receiving HIV care during pregnancy at DREAM centers is 92.5%, which is in stark contrast to infant HIV-free survival nationwide [15]. Given that in the absence of any HIV EMTCT intervention, a 30%–40% HIV transmission rate would be expected [6], MTCT rates of 2% or less in a breastfeeding population [15,16,17,18,19] are highly encouraging, particularly since most HIV EMTCT programs in Mozambique have demonstrated HIV mother-to-child transmission rates of 5%–10% or higher in recent years [20].


Elimination of Mother-To-Child Transmission of HIV Infection: The Drug Resource Enhancement against AIDS and Malnutrition Model.

Liotta G, Marazzi MC, Mothibi KE, Zimba I, Amangoua EE, Bonje EK, Bossiky BN, Robinson PA, Scarcella P, Musokotwane K, Palombi L, Germano P, Narciso P, de Luca A, Alumando E, Mamary SH, Magid NA, Guidotti G, Mancinelli S, Orlando S, Peroni M, Buonomo E, Nielsen-Saines K - Int J Environ Res Public Health (2015)

Patients receiving care at DREAM centers in Mozambique over the years.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4627027&req=5

ijerph-12-13224-f002: Patients receiving care at DREAM centers in Mozambique over the years.
Mentions: The DREAM program in Mozambique manages 10 heath care facilities in the country, both in urban and rural settings, with care provided to over 35,000 HIV-infected patients on cART (Figure 2 and Figure 3). The program is particularly focused on HIV EMTCT [15,16,17,18,19]. Growth of the program steadily increased from inception in 2002 to 35,000 patients followed in 2013, an indicator of successful program uptake by individuals in the country. The number of pregnancies in HIV-infected mothers followed at our centers has steadily risen over the years as seen in Figure 3, another marker of successful uptake. Our infant HIV-1 free survival at 12 months of age of HIV-exposed infants born to women receiving HIV care during pregnancy at DREAM centers is 92.5%, which is in stark contrast to infant HIV-free survival nationwide [15]. Given that in the absence of any HIV EMTCT intervention, a 30%–40% HIV transmission rate would be expected [6], MTCT rates of 2% or less in a breastfeeding population [15,16,17,18,19] are highly encouraging, particularly since most HIV EMTCT programs in Mozambique have demonstrated HIV mother-to-child transmission rates of 5%–10% or higher in recent years [20].

Bottom Line: Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%.Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies.A review of this model of care for HIV eMTCT is provided.

View Article: PubMed Central - PubMed

Affiliation: University of Tor Vergata, 18-00173 Rome, Italy. giuseppeliotta@hotmail.com.

ABSTRACT
The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%-88% while retention rates at 18-24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.

No MeSH data available.


Related in: MedlinePlus