Abstract
To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance. The Kento-Mwana project (2005-2008) provided counselling, serological and biomole-cular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance. The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P 1/4 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P 1/4 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P 1/4 0.092) were associated with better compliance. Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.
| Original language | English |
|---|---|
| Article number | dkt102 |
| Pages (from-to) | 1862-1871 |
| Number of pages | 10 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 68 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2013 |
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Keywords
- Attrition
- Drop-out
- Lost to follow-up
- Mother-to-child transmission
- PMTCT
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
Cite this
Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo. / Bisio, Francesca; Masini, Giulia; Vacca, Elisabetta Blasi; Calzi, Anna; Cardinale, Francesco; Bruzzone, Bianca; Bruzzi, Paolo; Viscoli, Claudio; Kento-Mwana, K.; Nkouendolo, Jean Pierre; Moutou, Joseph; Banguissa, Hubert; Nicolini, Laura; Schenone, Eva; Repetto, Ernestina; Montaldo, Chiara; Ferrando, Sara; Righi, Elda; Dentone, Chiara; Farinella, Sara Tita; Vitale, Francesco; Izzo, Manuela; Mularoni, Alessandra; Mikulska, Malgorzata; Di Stefano, Letizia; Malfatto, Emanuele; Bernardini, Claudia; Ginocchio, Francesca; Secondo, Giovanni; Delfino, Emanuele; Nicco, Elena; Prinapori, Roberta; Parisini, Andrea; De Hoffer, Laura; Mesini, Alessio; Grignolo, Sara; Taramasso, Lucia; Giacobbe, Daniele Roberto; Artom, Francesco; Dini, Simone; Beltrame, Andrea; Ratto, Sandra; Mbongou, Franc Astyanax Mayinda; Miguel, Landry Martial; Nzagou, Abdon Claude; Mayembo, Patrice; Ibata, Daniel; Ventura, Agostina; Nigro, Nicola; Andrei, Cristina; Icardi, Giancarlo.
In: Journal of Antimicrobial Chemotherapy, Vol. 68, No. 8, dkt102, 08.2013, p. 1862-1871.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo
AU - Bisio, Francesca
AU - Masini, Giulia
AU - Vacca, Elisabetta Blasi
AU - Calzi, Anna
AU - Cardinale, Francesco
AU - Bruzzone, Bianca
AU - Bruzzi, Paolo
AU - Viscoli, Claudio
AU - Kento-Mwana, K.
AU - Nkouendolo, Jean Pierre
AU - Moutou, Joseph
AU - Banguissa, Hubert
AU - Nicolini, Laura
AU - Schenone, Eva
AU - Repetto, Ernestina
AU - Montaldo, Chiara
AU - Ferrando, Sara
AU - Righi, Elda
AU - Dentone, Chiara
AU - Farinella, Sara Tita
AU - Vitale, Francesco
AU - Izzo, Manuela
AU - Mularoni, Alessandra
AU - Mikulska, Malgorzata
AU - Di Stefano, Letizia
AU - Malfatto, Emanuele
AU - Bernardini, Claudia
AU - Ginocchio, Francesca
AU - Secondo, Giovanni
AU - Delfino, Emanuele
AU - Nicco, Elena
AU - Prinapori, Roberta
AU - Parisini, Andrea
AU - De Hoffer, Laura
AU - Mesini, Alessio
AU - Grignolo, Sara
AU - Taramasso, Lucia
AU - Giacobbe, Daniele Roberto
AU - Artom, Francesco
AU - Dini, Simone
AU - Beltrame, Andrea
AU - Ratto, Sandra
AU - Mbongou, Franc Astyanax Mayinda
AU - Miguel, Landry Martial
AU - Nzagou, Abdon Claude
AU - Mayembo, Patrice
AU - Ibata, Daniel
AU - Ventura, Agostina
AU - Nigro, Nicola
AU - Andrei, Cristina
AU - Icardi, Giancarlo
PY - 2013/8
Y1 - 2013/8
N2 - To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance. The Kento-Mwana project (2005-2008) provided counselling, serological and biomole-cular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance. The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P 1/4 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P 1/4 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P 1/4 0.092) were associated with better compliance. Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.
AB - To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance. The Kento-Mwana project (2005-2008) provided counselling, serological and biomole-cular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance. The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P 1/4 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P 1/4 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P 1/4 0.092) were associated with better compliance. Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.
KW - Attrition
KW - Drop-out
KW - Lost to follow-up
KW - Mother-to-child transmission
KW - PMTCT
UR - http://www.scopus.com/inward/record.url?scp=84880742314&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84880742314&partnerID=8YFLogxK
U2 - 10.1093/jac/dkt102
DO - 10.1093/jac/dkt102
M3 - Article
C2 - 23587655
AN - SCOPUS:84880742314
VL - 68
SP - 1862
EP - 1871
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
SN - 0305-7453
IS - 8
M1 - dkt102
ER -