A community-based, household survey to determine mother to child HIV transmission rates and HIV-free survival in Swaziland
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) renewed efforts to virtually eliminate mother-to-child HIV transmission (MTCT) with a target of reducing the mother-to-child transmission rate to 5% or less among breastfeeding populations by breastfeeding cessation, and to 2% or less among non-breastfeeding populations. In Swaziland, although data are available on MTCT rates at six weeks, no study has been performed to determine MTCT and HIV-free survival through the end of breastfeeding.
Methods: The Elizabeth Glaser Pediatric AIDS Foundation performed a national, cross-sectional study of children born 18-24 months prior to the study launch among HIV-infected mothers to determine MTCT rates and HIV-free survival through a community survey in randomly selected constituencies in all four regions of Swaziland. At the time of this cohort''s birth, Swaziland had been implementing World Health Organization Option A for prevention of MTCT (PMTCT). We also evaluated the relationship between both maternal and child characteristics and child infection or death.
Results: Most HIV-positive mothers (91.8%) received antiretroviral prophylaxis for PMTCT or antiretroviral treatment during pregnancy. Among 724 known HIV-exposed children between 18 and 24 months, 26 children were HIV-positive and 694 were HIV-negative and alive. Four (all with unknown HIV status at time of death) HIV-exposed children died by 24 months of birth. The overall 18-24-month HIV-free survival among this cohort was 95.9% [95% CI: 94.1-97.2]. At 18-24 months, the estimated proportion of HIV-positive children among known HIV-exposed children was 3.6% [95% CI: 2.4-5.2]. Older maternal age, delivering in a health facility, high maternal CD4 count and receiving antenatal antiretroviral drugs were associated with reduced risk of child infection or death. Child hospitalization was associated with higher rates of child HIV infection or death.
Conclusions: The Swaziland PMTCT program under Option A was largely effective with a high HIV-free survival of 95.9% and low MTCT at 18-24 months of 3.6%. This would be expected to improve further under current Option B+ (universal maternal antiretroviral therapy).
C. Chouraya1, R. Machekano2, S. Mthethwa3, L. Krysia4, M. Mirira5, K. Kudiabor1, M. Gill2, G. Maphalala6, G. Woelk2, L. Guay2
1Elizabeth Glaser Paediatric AIDS Foundation, Mbabane, Swaziland, 2Elizabeth Glaser Paediatric AIDS Foundation, Washington, United States, 3Ministry of Health, Sexual Reporductive Health Unit, Mbabane, Swaziland, 4University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, United States, 5United States Agency for International Development, Mbabane, Swaziland, 6Ministry of Health, Health Laboratory Services, Mbabane, Swaziland