Mother-to-child HIV transmission in resource poor settings: how to improve coverage?

Objectives: To review coverage of the current nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Mombasa, Kenya, and to reflect on alternative models to reduce mother-to-child transmission (MTCT) of HIV. Methods: At the antenatal clinic, health information is provided, followed by pre-test HIV voluntary counselling and testing (VCT). Because many women deliver at home, HIV-infected women are provided with a tablet of 200 mg nevirapine for themselves, and with 0.6 ml (6 mg) nevirapine in a luer lock syringe for the baby. Data on coverage are provided from antenatal records and delivery registers. Results: Out of 3564 first-visit pregnant women receiving health education, 2516 were counselled (71%) and 2483 were tested (97%); 348 were HIV positive (14%), and 106 women took nevirapine in labour, resulting in an overall coverage rate of 20%. In the same period, approximately 6000 women gave birth in CPGH, of whom 21% had attended a facility with VCT services. Assuming an overall HIV prevalence of 14%, 840 mother-infant pairs could have received a preventative intervention with a hospital policy of antepartum as well as intrapartum testing and treatment in place. Conclusion: The coverage of perinatal MTCT was low as a result of a variety of programme elements requiring urgent improvement at different levels. Alternative models, including intrapartum testing, should be considered as a safety net for women without access to VCT before delivery, and recommendations for nevirapine should be considered in the light of home deliveries

Uptake of the HIVNET012 regimen in a real-live situation

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Placental inflammation and perinatal outcome

Objective: To examine the role of placental inflammation in adverse obstetrical outcome (AOO). Methods: Analysis of perinatal data of 701 randomly selected mothers of singleton infants, Mombasa, Kenya. Results: There were 661 (94.3%) live infants and 40 (5.7%) stillbirths. Out of the live born infants, 78 (12.4%) had a low birth weight (LBW \u3c 2500 g); 33 of them were preterm and 41 small for gestational age (SGA). The incidence of neonatal sepsis and post partum endometritis was 3.6 and 19.8%, respectively. The perinatal death rate was estimated to be 7.3% (51/701). The prevalence of acute placental inflammation was 19.6%. Acute placental inflammation was independently associated with preterm low birth weight (ARR=3.8, 95% CI=1.7–8.9, P\u3c0.01), stillbirth (ARR=2.3, 95% CI=1.1–5.0, P=0.03) and perinatal death (ARR=2.8, 95% CI=1.4–5.4, P\u3c0.01). Women with acute placental inflammation had a two-fold higher risk for AOO (32.6 versus 15.2%, respectively, ARR=2.5, 95% CI=1.3–4.8, P\u3c0.01). Other risk factors for AOO were bad obstetrical history, low haemoglobin level and leucocytosis. Conclusions: The incidence of adverse obstetrical outcome defined as low birth weight, low Apgar score, perinatal mortality and post partum endometritis, was high in this population. Acute placental inflammation was associated with preterm birth, stillbirth and perinatal death. More research is needed to study the role of infection in adverse obstetrical outcome, and to design interventions to decrease infectious morbidity and mortality in pregnancy

Correlation between maternal and infant HIV infection and low birth weight: a study in Mombasa, Kenya

This article aimed to examine the association between maternal and infant HIV infection and low birth weight (LBW <2500 grams). Datafrom 8563 singleton liveborns in Mombasa, Kenya, were analysed. Maternal HIV infection was found in 14·1% of the women and 9·6% of neonates had a birth weight of <2500 grams. In multivariate analysis, maternal HIV infection was independently associated with LBW (RR=1·46, 95% CI=1·20-1·79, P =0·0002). Maternal age, primiparity, sex of the baby, religion, syphilis infection, anaemia and previous history of stillbirth were also independently associated with LBW (RR: 1·32, 2·19, 1·44, 1·56, 1·61, 1·31 and 1·69, respectively). The rate of intra-uterine HIV transmission was 5·1% and 20·1% of the exposed infants were infected during the intrapartum period. Intrapartum infected infants had a relative risk of LBW of 1·95 (95% CI=1·18-2·87, P <0·01) compared to uninfected children, whereas the birth weight of infants infected in utero was not different from uninfected infants (RR=1·18, 95% CI=0·56-2·60, P=0·630). HIV infected mothers are more likely to have small babies, even after controlling for possible confounding factors. Low birth weight babies were more at risk for peripartum HIV transmission, but further research is needed to study mechanisms of transmission in relation to birth weight

Placental malaria and perinatal transmission of human immunodeficiency virus type 1

Prevalence of placental malaria in human immunodeficiency virus (HIV) type 1–infected and –uninfected women and the effect of placental malaria on genital shedding and perinatal transmission of HIV-1 were examined. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1–infected women and 277 of HIV-1–uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1–infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-

Correlation between maternal and infant HIV infection and low birth weight: a study in Mombasa, Kenya

This article aimed to examine the association between maternal and infant HIV infection and low birth weight (LBW \u3c2500 grams). Datafrom 8563 singleton liveborns in Mombasa, Kenya, were analysed. Maternal HIV infection was found in 14·1% of the women and 9·6% of neonates had a birth weight of \u3c2500 grams. In multivariate analysis, maternal HIV infection was independently associated with LBW (RR=1·46, 95% CI=1·20-1·79, P =0·0002). Maternal age, primiparity, sex of the baby, religion, syphilis infection, anaemia and previous history of stillbirth were also independently associated with LBW (RR: 1·32, 2·19, 1·44, 1·56, 1·61, 1·31 and 1·69, respectively). The rate of intra-uterine HIV transmission was 5·1% and 20·1% of the exposed infants were infected during the intrapartum period. Intrapartum infected infants had a relative risk of LBW of 1·95 (95% CI=1·18-2·87, P \u3c0·01) compared to uninfected children, whereas the birth weight of infants infected in utero was not different from uninfected infants (RR=1·18, 95% CI=0·56-2·60, P=0·630). HIV infected mothers are more likely to have small babies, even after controlling for possible confounding factors. Low birth weight babies were more at risk for peripartum HIV transmission, but further research is needed to study mechanisms of transmission in relation to birth weight

Placental malaria and perinatal transmission of human immunodeficiency virus type 1

Prevalence of placental malaria in human immunodeficiency virus (HIV) type 1–infected and –uninfected women and the effect of placental malaria on genital shedding and perinatal transmission of HIV-1 were examined. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1–infected women and 277 of HIV-1–uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1–infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-