Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo

Francesca Bisio, Giulia Masini, Elisabetta Blasi Vacca, Anna Calzi, Francesco Cardinale, Bianca Bruzzone, Paolo Bruzzi, Claudio Viscoli, K. Kento-Mwana, Jean Pierre Nkouendolo, Joseph Moutou, Hubert Banguissa, Laura Nicolini, Eva Schenone, Ernestina Repetto, Chiara Montaldo, Sara Ferrando, Elda Righi, Chiara Dentone, Sara Tita FarinellaFrancesco Vitale, Manuela Izzo, Alessandra Mularoni, Malgorzata Mikulska, Letizia Di Stefano, Emanuele Malfatto, Claudia Bernardini, Francesca Ginocchio, Giovanni Secondo, Emanuele Delfino, Elena Nicco, Roberta Prinapori, Andrea Parisini, Laura De Hoffer, Alessio Mesini, Sara Grignolo, Lucia Taramasso, Daniele Roberto Giacobbe, Francesco Artom, Simone Dini, Andrea Beltrame, Sandra Ratto, Franc Astyanax Mayinda Mbongou, Landry Martial Miguel, Abdon Claude Nzagou, Patrice Mayembo, Daniel Ibata, Agostina Ventura, Nicola Nigro, Cristina Andrei, Giancarlo Icardi

Research output: Contribution to journalArticle

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 languageEnglish
Article numberdkt102
Pages (from-to)1862-1871
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume68
Issue number8
DOIs
Publication statusPublished - Aug 2013

Keywords

  • Attrition
  • Drop-out
  • Lost to follow-up
  • Mother-to-child transmission
  • PMTCT

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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  • Cite this

    Bisio, F., Masini, G., Vacca, E. B., Calzi, A., Cardinale, F., Bruzzone, B., Bruzzi, P., Viscoli, C., Kento-Mwana, K., Nkouendolo, J. P., Moutou, J., Banguissa, H., Nicolini, L., Schenone, E., Repetto, E., Montaldo, C., Ferrando, S., Righi, E., Dentone, C., ... Icardi, G. (2013). Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo. Journal of Antimicrobial Chemotherapy, 68(8), 1862-1871. [dkt102]. https://doi.org/10.1093/jac/dkt102