Efficacy of Prevention of Mother to Child Transmission

Efficacy of Prevention of Mother to Child Transmission (PMTCT) of HIV in Rivers State, Nigeria By IBINABO ANITA PORBENI, MD, MSPH Co- Authors: Dr. Emmanuel Keku (MD, MA, MSPH, PHD) Ms. Jackie Lloyd (MS) Dr. Richard Dicker (MD, MS) Dr. William Sawyer (PHD) Dr. Cecilia Hegamin. Younger (PHD)

HIV in Nigeria; Prevalence of 4. 6%, Rivers State, 7. 3% from http: //www. livingtongues. org/dcs/Baan. pdf http: //www. prisonpastor. com/images/the_new_map_of_nigeria. jpg &

Background and Literature Review Ø Rivers state chosen because of high Prevalence of 7. 3% compared with National prevalence of 4. 6% and presence of facilities that carry out PMTCT interventions Ø Evidence shows that effective large scale Prevention of Mother to Child Transmission (PMTCT) of HIV programs can be implemented in settings with limited resources Ø That 15% of new HIV infections each year are caused by mother-to-child-transmission (MTCT) also called Vertical transmission Ø Eliminating HIV infection in infants and young children will accelerate global prevention initiatives United Nations General Assembly Special Session (UNGASS) 2001

Objectives To clearly outline the different interventions being carried out Ø To see if the interventions are really reducing vertical transmission of HIV/AIDS Ø Ø To see if there any significant differences between interventions Ø To ascertain if the outcomes of interventions are comparable to those being carried out in more developed countries in terms of reducing transmission to as little as 2%. Ø To make recommendations on possible improvements of interventions if applicable and elucidate areas of further study

Research Question Ø Do the interventions carried out under Prevention of Mother to Child transmission of HIV (PMTCT) in any way reduce the incidence of vertical transmission of HIV 1 to children in Rivers State and if they do which interventions are the most effective?

Hypothesis I Ø Hypothesis I H 0 The HIV status of children born to women living with HIV is solely due to chance whether they had any intervention or not outcome is the same. HA The HIV status of children born to women living with HIV is dependent on their having been given some form of ARV Prophylaxis Ø Hypothesis II H 0 The HIV status of children born to women living with HIV is independent of the type and time of ARV prophylaxis given HA The HIV status of children born to women living with HIV is dependent on the type and time of ARV Prophylaxis initiated

Hypothesis III Ø H 0 The HIV status of children born to women living with HIV is independent of the mothers HIV treatment history Ø HA The HIV status of children born to women living with HIV is dependent on if the mother has been on HAART before pregnancy or if she had any ARV Prophylaxis.

Methods and Population Quasi experimental study with Participants drawn from Program reports and Hospital registers. Women were contacted through their HIV support groups consent sought. Ø The study population is the pregnant women living with HIV and the children born from the pregnancy that went through PMTCT interventions or had access to PMTCT services in three local government areas in Rivers State. Ø

Results: Study Participants at each site Study site Eligible participants Enrolled participants Braithwaite Memorial Specialist Hospital (BMSH) Port Harcourt 308 85(69. 7%) College of Health Sciences and Technology Demonstration Clinic, Nkpolu 59 6 (4. 9%) General Hospital Omoku 55 29 (24. 6%)

Demographics; age of mothers in years and infants in weeks Mean age distribution Median age distribution Modal age 28. 4 28. 5 28 (17. 1%) Range Standard deviation Variance 22 -37 years 3. 164 10. 012 Mean age of children Median Mode 16. 76 17 6 (28. 6%) Range Standard deviation Variance 3 (0. 8%)- 104 (1. 7%) 19. 43 377. 61

Major interventions Intervention for Mother Intervention for baby Count HAART and SDNVP SD-NVP/ AZT 20 (16. 7%) SD-NVP/ AZT 7 (5. 8%) AZT/3 TC/SD-NVP/AZT 21 (17. 5%) - SD-NVP/AZT 7 (5. 8%)

Effect of Interventions on vertical transmission Classification Count Transmission rate Any intervention 60 (50%) 3 (5% ) CL (1. 3%-13%) No intervention 60 (50%) 13 (21. 7%) CL (12. 6%33. 4%)

Effect of different interventions on vertical transmission 60. 00% Comparison of different interventions and no interventions Rate of infection 50. 00% 40. 00% 30. 00% 20. 00% Comparison of different interventions and no interventions Rate of infection 10. 00% ns T tio AZ en rv ixe d No in te ne d an m AZ T/ 3 TC AZ an d Di ffe re nt No ne an d No DNV T/ S SD T/ AZ d an P ne P P -N V VP -N SD -N V -N SD TC / T/ 3 AZ HA A RT /S DNV VP P an an d d AZ AZ T/ T/ S SD D- No NV ne P 0. 00%

Comparing studies- No intervention Data Source Transmission rate in Non Breast Fed infants Transmission rate in Breast Fed infants No intervention De Cock review, 15%-30% 2000 25%-45% 20%-45% Study findings 29. 4% 21. 7% 11. 5%

Discussion- Highlights Higher rates of transmission amongst lower age groups (p value 0. 000047) More female children were positive 19. 7% as compared with males 7% (RR 2. 8, 95% CI 0. 9 -8. 4 and p value 0. 052). Ø Hypothesis I ü No intervention arm had infants 4. 3 times more likely to be HIV positive than those who had any form of pharmaceutical intervention, (P- value 0. 007)

Discussion: Hypothesis testing; I and II Hypothesis II Ø No significant difference between women who had HAART which Ø predates pregnancy and interventions given within pregnancy and at delivery and after, (P value 0. 21). HAART and SD-NVP for both and AZT had comparable outcomes. Sample size may play a role. Ø Hypothesis III: Ø There was a significant difference between woman who had interventions HAART and short course ARV even if their children had none and women who had none even if their children had, (pvalue 0. 0018). Ø A woman’s treatment history has a lot to do with HIV transmission outcome in her child.

Conclusion and Recommendations Ø PMTCT works and should be offered in every area where ANC is carried out. Ø Even the simplest intervention significantly reduces vertical transmission and should be provided. Ø More research is needed in this area, especially regarding effect of couple counseling and support groups on participant retention in PMTCT programs.

Contact Details Ibinabo Anita Porbeni- poribi @sgu. edu, ibporbeni@yahoo. com, 6097167359 Emmanuel Keku, ekeku@sgu. edu

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