Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

Anays Murillo; Mary Bachman DeSilva; Lora L Sabin; Nafisa Halim; Harriet Chemusto; Philip Aroda; Julia Gasuza; Davidson H Hamer; Anna Larson Williams; Barbara Mukasa; Lisa J Messersmith; Rachael Bonawitz

doi:10.21106/ijma.380

Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

Int J MCH AIDS. 2020;9(3):320-329. doi: 10.21106/ijma.380. Epub 2020 Jul 29.

Authors

Affiliations

¹ Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA.
² University of New England, 716 Stevens Ave, Portland, ME, 04103 USA.
³ Mildmay Uganda, Lweza Kampala-Entebbe Road, Kampala, Uganda.
⁴ Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118 USA.
⁵ Section of Hospital Medicine, Department of Pediatrics, Saint Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA, 19134 USA.
⁶ Department of Pediatrics, Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA, 19129 USA.

Abstract

Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing.

Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data.

Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV.

Conclusion and global health implications: We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era.

Keywords: Antiretroviral therapy prophylaxis; Early infant diagnosis; HIV; HIV-exposed infants; Nevirapine; Prevention of maternal to child transmission of HIV.