OBJECTIVES: 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. PATIENTS AND METHODS: The Kento-Mwana project (2005-2008) provided counselling, serological and biomolecular 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. RESULTS: 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 = 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P = 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P = 0.092) were associated with better compliance. CONCLUSIONS: 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.
Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo / F. Bisio, G. Masini, E. Vacca, A. Calzi, F. Cardinale, B. Bruzzone, P. Bruzzi, C. Viscoli, K. Kento Mwana, J. Nkouendolo, J. Moutou, H. Banguissa, L. Nicolini, E. Schenone, E. Repetto, C. Montaldo, S. Ferrando, E. Righi, C. Dentone, S. Farinella, F. Vitale, M. Izzo, A. Mularoni, M. Mikulska, L. Di Stefano, E. Malfatto, C. Bernardini, F. Ginocchio, G. Secondo, E. Delfino, E. Nicco, R. Prinapori, A. Parisini, L. De Hoffer, A. Mesini, S. Grignolo, L. Taramasso, D. Giacobbe, F. Artom, S. Dini, A. Beltrame, S. Ratto, F. Mbongou, L. Miguel, A. Nzagou, P. Mayembo, D. Ibata, A. Ventura, N. Nigro, C. Andrei, G. Icardi. - In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - ISSN 0305-7453. - 68:8(2013 Aug), pp. 1862-1871.
|Titolo:||Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo|
|Parole Chiave:||Attrition; Drop-out; Lost to follow-up; Mother-to-child transmission; PMTCT; Congo; Female; HIV Infections; Humans; Infant; Infant; Newborn; Infectious Disease Transmission; Vertical; Male; Patient Acceptance of Health Care; Patient Compliance; Pregnancy; Pregnancy Complications; Infectious; Prospective Studies; Health Services Research; Pharmacology; Pharmacology (medical); Infectious Diseases|
|Settore Scientifico Disciplinare:||Settore MED/17 - Malattie Infettive|
|Data di pubblicazione:||ago-2013|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/jac/dkt102|
|Appare nelle tipologie:||01 - Articolo su periodico|