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. 2022 Jul 8;22(1):1312.
doi: 10.1186/s12889-022-13543-9.

Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence

Sheila Fernández-Luis #  1   2 , Maria Grazia Lain #  3 , Miquel Serna-Pascual  4 , Sara Domínguez-Rodríguez  4 , Louise Kuhn  5 , Afaaf Liberty  6 , Shaun Barnabas  7 , Elisa Lopez-Varela  8   9 , Kennedy Otwombe  6   10 , Siva Danaviah  11 , Eleni Nastouli  12 , Paolo Palma  13   14 , Nicola Cotugno  13   14 , Moira Spyer  12 , Viviana Giannuzzi  15 , Carlo Giaquinto  16 , Avy Violari  6 , Mark F Cotton  7 , Tacilta Nhampossa  8   17 , Nigel Klein  11   12 , Nastassja Ramsagar  6 , Anita Janse van Rensburg  7 , Osee Behuhuma  11 , Paula Vaz  18 , Almoustapha Issiaka Maiga  19 , Andrea Oletto  20 , Denise Naniche  8   9 , Paolo Rossi  21 , Pablo Rojo #  4 , Alfredo Tagarro #  4   22   23 ; EPIICAL Consortium
Collaborators, Affiliations

Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence

Sheila Fernández-Luis et al. BMC Public Health. .

Abstract

Background: The World Health Organization (WHO) risk assessment algorithm for vertical transmission of HIV (VT) assumes the availability of maternal viral load (VL) result at delivery and early viral control 4 weeks after initiating antiretroviral treatment (ART). However, in many low-and-middle-income countries, VL is often unavailable and mothers' ART adherence may be suboptimal. We evaluate the inclusion of the mothers' self-reported adherence into the established WHO-algorithm to identify infants eligible for enhanced post-natal prophylaxis when mothers' VL result is not available at delivery.

Methods: We used data from infants with perinatal HIV infection and their mothers enrolled from May-2018 to May-2020 in Mozambique, South Africa, and Mali. We retrospectively compared the performance of the WHO-algorithm with a modified algorithm which included mothers' adherence as an additional factor. Infants were considered at high risk if born from mothers without a VL result in the 4 weeks before delivery and with adherence <90%.

Results: At delivery, 143/184(78%) women with HIV knew their status and were on ART. Only 17(12%) obtained a VL result within 4 weeks before delivery, and 13/17(76%) of them had VL ≥1000 copies/ml. From 126 women on ART without a recent VL result, 99(79%) had been on ART for over 4 weeks. 45/99(45%) women reported suboptimal (< 90%) adherence. A total of 81/184(44%) infants were classified as high risk of VT as per the WHO-algorithm. The modified algorithm including self-adherence disclosure identified 126/184(68%) high risk infants.

Conclusions: In the absence of a VL result, mothers' self-reported adherence at delivery increases the number of identified infants eligible to receive enhanced post-natal prophylaxis.

Keywords: Enhanced post-natal prophylaxis; HIV-exposed infants; Mother-to-child transmission; Paediatric HIV; Prevention of mother-to-child transmission; Vertical transmission.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study profile among the mother-child pairs examined for eligibility in the EARTH cohort until May 1st, 2020. Percentages are calculated over the previous parent box. ART = antiretroviral treatment
Fig. 2
Fig. 2
Classification of infants into high or low risk of HIV vertical transmission according to the WHO algorithm and WHO modified algorithm. The additional question was added at the last step for mothers on ART ≥4 weeks before delivery with no VL test result (in red). The WHO algorithm is described in green as well as the final classification of high-risk infants. The additional risk factor included in the modified WHO algorithm is depicted in red as well as the final classification of high-risk infants. Percentages were calculated using as denominator the number of mothers from the preceding classification step. ART = Antiretroviral treatment; VL = Viral Load
See this image and copyright information in PMC

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