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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

Mean virus load (and 95% CL) of DREAM program pregnant patients at one of our centers over time. CL: Confidence Limits.
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ijerph-12-13224-f004: Mean virus load (and 95% CL) of DREAM program pregnant patients at one of our centers over time. CL: Confidence Limits.

Mentions: Our program saw a very significant increase over time in the total number of patients followed in Mozambique, both adult and pediatric, and the number of subjects prescribed cART as seen in Figure 2. The number of pregnancies monitored through our services also significantly increased over the years as seen in Figure 3. We documented in numerous publications a steady decrease over the years in HIV mother-to-child transmission rates among our patients, from 5% in earlier years to less than 2% at 12 months of age [15,17,18,19]. Our infant HIV-free survival at 18 months has been 92.5% or higher in multiple studies [15,16,17,18,19], a result of implementation of a WHO B type approach in our treatment protocols years before this practice became standard of care endorsed by the WHO. The implementation of cART to all pregnant women regardless of CD4 cell count highly impacted short-term and long-term maternal mortality rates in our postpartum population of women. Among 10,150 pregnancies of HIV-positive women followed at our centers, long term maternal mortality (up to four years post-delivery) was 2.3%, [31] which is significantly less than maternal mortality rates observed in sub-Saharan Africa, where maternal mortality can reach 500 deaths per 100,000 births or 1 in 39 [32]. Maternal mortality was particularly reduced in women who received long courses of antenatal cART in our cohorts, demonstrating that the benefits of cART for EMTCT extend way beyond transmission efforts but also reduce maternal deaths [31]. The implementation of widespread cART to our patients has also been associated with significant declines in population virus load parameters and immune reconstitution, with significant gains in CD4 cell count numbers and restoration of immune function [23,25]. As Figure 4 illustrates, mean virus load values of pregnant patients followed in our clinics has steadily decreased over the years, likely a reflection of widespread use of cART in our patient population.


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)

Mean virus load (and 95% CL) of DREAM program pregnant patients at one of our centers over time. CL: Confidence Limits.
© Copyright Policy
Related In: Results  -  Collection

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

ijerph-12-13224-f004: Mean virus load (and 95% CL) of DREAM program pregnant patients at one of our centers over time. CL: Confidence Limits.
Mentions: Our program saw a very significant increase over time in the total number of patients followed in Mozambique, both adult and pediatric, and the number of subjects prescribed cART as seen in Figure 2. The number of pregnancies monitored through our services also significantly increased over the years as seen in Figure 3. We documented in numerous publications a steady decrease over the years in HIV mother-to-child transmission rates among our patients, from 5% in earlier years to less than 2% at 12 months of age [15,17,18,19]. Our infant HIV-free survival at 18 months has been 92.5% or higher in multiple studies [15,16,17,18,19], a result of implementation of a WHO B type approach in our treatment protocols years before this practice became standard of care endorsed by the WHO. The implementation of cART to all pregnant women regardless of CD4 cell count highly impacted short-term and long-term maternal mortality rates in our postpartum population of women. Among 10,150 pregnancies of HIV-positive women followed at our centers, long term maternal mortality (up to four years post-delivery) was 2.3%, [31] which is significantly less than maternal mortality rates observed in sub-Saharan Africa, where maternal mortality can reach 500 deaths per 100,000 births or 1 in 39 [32]. Maternal mortality was particularly reduced in women who received long courses of antenatal cART in our cohorts, demonstrating that the benefits of cART for EMTCT extend way beyond transmission efforts but also reduce maternal deaths [31]. The implementation of widespread cART to our patients has also been associated with significant declines in population virus load parameters and immune reconstitution, with significant gains in CD4 cell count numbers and restoration of immune function [23,25]. As Figure 4 illustrates, mean virus load values of pregnant patients followed in our clinics has steadily decreased over the years, likely a reflection of widespread use of cART in our patient population.

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