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HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
Guillaume Breton1,2, Oumou Hawa Diallo3, Mohamed Cissé4
1Solthis, Paris, France.
Insights
Implementing reinforced antiretroviral prophylaxis and early infant diagnosis (EID) for preventing mother-to-child HIV transmission (PMTCT) is feasible. However, maternal stigma impacts follow-up, necessitating improved PMTCT strategies and support.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Limited access to prevention of mother-to-child HIV transmission (PMTCT) programs in West and Central Africa impacts nearly half of globally HIV-infected children.
- The World Health Organization (WHO) recommends enhanced antiretroviral prophylaxis for high-risk infants, but field implementation requires further study.
Purpose of the Study:
- To evaluate the feasibility of combining early infant diagnosis (EID) with reinforced antiretroviral prophylaxis for high-risk infants in Guinea.
- To assess the effectiveness of PMTCT strategies in a resource-limited setting.
Main Methods:
- Prospective ANRS 12344-DIAVINA study conducted at Ignace Deen Hospital, Conakry, Guinea.
- Inclusion of 56 infants born to 51 high-risk mothers identified via interviews.
- Initiation of reinforced antiretroviral prophylaxis and infant EID at birth; retrospective maternal plasma viral load (pVL) measurement.
Main Results:
- Reinforced antiretroviral prophylaxis initiated in 86% of infants; 35% received iron supplementation for anemia.
- 52% of mothers had a viral load <400 copies/mL, often due to undisclosed HIV status or antiretroviral intake.
- Undisclosed HIV status and maternal stigmatization were linked to higher rates of loss to follow-up among high-risk infants (44% vs. 8%).
Conclusions:
- Combined EID and reinforced antiretroviral prophylaxis at birth are feasible for PMTCT.
- Maternal plasma viral load near delivery is crucial for accurate risk assessment, as self-reported status is unreliable.
- Addressing maternal stigmatization is essential to improve PMTCT program engagement and outcomes.
Background:
Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field.
Methods:
The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea.
Results:
6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%-95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, 'real' high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers' stigmatization (69% versus 31%, P < 0.01).
Conclusions:
Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers' self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.
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