Achievements and Challenges in the Prevention of Mother-to-Child Transmission of HIV-A Retrospective Cohort Study from a Rural Hospital in Northern Tanzania

Abstract

Despite the goal of eliminating new human immunodeficiency virus (HIV) infections in children, mother-to-child transmission is still common in resource-poor countries. The aims of this study were to assess the occurrence of mother-to-child transmission of HIV (MTCT) by age 18 months, risk factors for transmission, and the implementation of the national prevention of MTCT (PMTCT) program in a rural hospital in Tanzania. Data were collated from various medical registers and records. We included 172 children and 167 HIV-infected mothers. Among 88 children (51%) with adequate information, 9 (10.2%) were infected. Increased risk of MTCT was associated with late testing of the child (>2 months) [OR = 9.5 (95% CI: 1.8-49.4)], absence of antiretroviral therapy during pregnancy [OR = 9.7 (95% CI: 2.1-46.1)], and maternal CD4 cell count <200 cells/mm³ [OR = 15.3 (95% CI: 2.1-111)]. We were unable to determine the occurrence of MTCT transmission in 84 children (49%). The results from this study highlight that there is an urgent need for enhanced efforts to improve follow-up of HIV-exposed children, to improve documentation in registries and records, and to facilitate ease of linkage between these.

Keywords: HIV-exposed infants; Tanzania; antiretroviral therapy; pregnancy; prevention of mother-to-child transmission of HIV (PMTCT).

Figure 1

Flow chart of inclusion of mothers and children. PMTCT: Prevention of mother-to-child transmission of human immunodeficiency virus (HIV).

Figure 2

Linkage of data for mothers and their children between RCHS, CTC and labor ward. Abbreviations: RCHS: Reproductive and Child Health Service; CTC: Care and Treatment Clinic; HEID: HIV Early Infant Diagnosis.