An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort

  • Anna Maria Doro Altan
  • Francis Taafo
  • François Fopa
  • Ersilia Buonomo
  • Maria Cristina Marazzi
  • Karin Nielsen-Saines
  • Stefano Orlando
  • Paola Scarcella
  • Fausto Ciccacci
  • Sandro Mancinelli
  • Massimo Magnano San Lio
  • Leonardo Palombi

Abstract

Introduction: Scaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon. Methods: HIV-positive pregnant women attending the DREAM Centre of Dschang, Cameroon for prenatal care were enrolled in a prospective cohort study, and received ART until the end of breastfeeding or indefinitely if their CD4 count was <350mm3. Infants were evaluated for HIV infection at 1, 6 and 12 months of age. Results: A total of 298 women were enrolled. Among them, 152 were already on established ART. Women were followed until 6 months after delivery with a retention rate of 92.6%. Eight women died. Those with a CD4 count <350 cells/mm3 during pregnancy had the highest mortality risk (RR 2.53; 95% CL= 1.86-3.44). The HIV  transmission rate was 1.2% at 12 months with an HIV free survival of 91%. In the proportional Cox regression analysis, the following factors were positively associated with infant mortality: maternal CD4< 350 cells/mm3, no breastfeeding in the first 6 months of life, weight-for-age z score < -2. Conclusion: Results confirm the feasibility and effectiveness of the implementation of Option B, with very low rates of HIV MTC  transmission, and potential benefits to the health of mothers and infants with earlier initiation of ART. Breastfeeding again demonstrates to be highly beneficial for the growth and survival of HIV exposed children.

Pan African Medical Journal 2016; 23

Author Biographies

Anna Maria Doro Altan
DREAM programme, Community of Sant’Egidio, Rome, Italy
Francis Taafo
DREAM Center, Dschang, Cameroon
François Fopa
DREAM Center, Dschang, Cameroon
Ersilia Buonomo
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
Maria Cristina Marazzi
University LUMSA, Rome, Italy
Karin Nielsen-Saines
Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, California
Stefano Orlando
DREAM programme, Community of Sant’Egidio, Rome, Italy
Paola Scarcella
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
Fausto Ciccacci
DREAM programme, Community of Sant’Egidio, Rome, Italy
Sandro Mancinelli
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
Massimo Magnano San Lio
DREAM programme, Community of Sant’Egidio, Rome, Italy
Leonardo Palombi
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
Published
2016-07-02
Section
Articles

Journal Identifiers


eISSN: 1937-8688