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. 2020;9(3):320-329.
doi: 10.21106/ijma.380. Epub 2020 Jul 29.

Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

Anays Murillo  1 , Mary Bachman DeSilva  2 , Lora L Sabin  1 , Nafisa Halim  1 , Harriet Chemusto  3 , Philip Aroda  3 , Julia Gasuza  3 , Davidson H Hamer  1   4 , Anna Larson Williams  1 , Barbara Mukasa  3 , Lisa J Messersmith  1 , Rachael Bonawitz  1   5   6
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Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

Anays Murillo et al. Int J MCH AIDS. 2020.

Abstract

Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing.

Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data.

Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV.

Conclusion and global health implications: We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era.

Keywords: Antiretroviral therapy prophylaxis; Early infant diagnosis; HIV; HIV-exposed infants; Nevirapine; Prevention of maternal to child transmission of HIV.

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Conflict of interest statement

Conflicts of Interest: No conflicts of interest for any authors to disclose.

Figures

Figure 1
Figure 1
Retention of Wise Infant (WIN) participants. Of the 121 mother-infant dyads eligible for the WIN study, 97 dyads enrolled. LTFU = lost to follow-up; EID = early infant diagnosis of HIV
Figure 2
Figure 2
Proportions of study participants and their respective place of delivery, receipt of NVP, and time to HIV testing. Legend: Intervention ◻ Control ◼
Figure 3
Figure 3
Kaplan-Meier analysis of time to EID testing compared by randomization status. Given p-value is the significance between the infants in the control arm versus those in the intervention arm.
See this image and copyright information in PMC

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