What will it take to eliminate pediatric HIV Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: a model-based analysis.Reportar como inadecuado

What will it take to eliminate pediatric HIV Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: a model-based analysis. - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

* Corresponding author 1 Department of Infectious Disease Boston 2 HIV-AIDS Unit 3 Epidémiologie et Biostatistique Bordeaux 4 Elizabeth Glaser Pediatric AIDS Foundation 5 Division of General Medicine 6 Organization of Public Health Interventions and Development 7 Center for AIDS Research Cambridge 8 Division of Infectious Disease 9 Ministry of Health and Child Welfare 10 Department of Health Policy and Management

Abstract : BACKGROUND: The World Health Organization WHO has called for the -virtual elimination- of pediatric HIV: a mother-to-child HIV transmission MTCT risk of less than 5%. We investigated uptake of prevention of MTCT PMTCT services, infant feeding recommendations, and specific drug regimens necessary to achieve this goal in Zimbabwe. METHODS AND FINDINGS: We used a computer model to simulate a cohort of HIV-infected, pregnant-breastfeeding women mean age, 24 y; mean CD4, 451-µl; breastfeeding duration, 12 mo. Three PMTCT regimens were evaluated: 1 single-dose nevirapine sdNVP, 2 WHO 2010 guidelines-Option A- zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral therapy for women with advanced disease, and 3 WHO -Option B- pregnancy-breastfeeding-limited combination antiretroviral drug regimens without advanced disease; lifelong antiretroviral therapy with advanced disease. We examined four levels of PMTCT uptake proportion of pregnant women accessing and adhering to PMTCT services: reported rates in 2008 and 2009 36% and 56%, respectively and target goals in 2008 and 2009 80% and 95%, respectively. The primary model outcome was MTCT risk at weaning. The 2008 sdNVP-based National PMTCT Program led to a projected 12-mo MTCT risk of 20.3%. Improved uptake in 2009 reduced projected risk to 18.0%. If sdNVP were replaced by more effective regimens, with 2009 56% uptake, estimated MTCT risk would be 14.4% Option A or 13.4% Option B. Even with 95% uptake of Option A or B, projected transmission risks 6.1%-7.7% would exceed the WHO goal of less than 5%. Only if the lowest published transmission risks were used for each drug regimen, or breastfeeding duration were shortened, would MTCT risks at 95% uptake fall below 5%. CONCLUSIONS: Implementation of the WHO PMTCT guidelines must be accompanied by efforts to improve access to PMTCT services, retain women in care, and support medication adherence throughout pregnancy and breastfeeding, to approach the -virtual elimination- of pediatric HIV in Zimbabwe. Please see later in the article for the Editors- Summary.

Autor: Andrea Ciaranello - Freddy Perez - Jo Keatinge - Ji-Eun Park - Barbara Engelsmann - Matthews Maruva - Rochelle Walensky - Franço

Fuente: https://hal.archives-ouvertes.fr/


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