Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey
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In Swaziland, no data are available on the rates of HIV infection and HIV-free survival among children at the end of the breastfeeding period. We performed a national crosssectional community survey of children born 18–24 months prior to the study, in randomly selected constituencies in all 4 administrative regions of Swaziland, from April to June 2015. Mother-to-child transmission (MTCT) of HIV and HIV-free survival rates were calculated for all HIV-exposed children. The overall HIV-free survival rate at 18–24 months was 95.9% (95% CI 94.1–97.2). The estimated proportion of HIV infected children among known HIV-exposed children was 3.6% (95% CI 2.4–5.2). Older maternal age, delivering at a health facility, and receiving antenatal antiretroviral drugs were independently associated with reduced risk for child infection or death. The Swaziland program for prevention of MTCT achieved high HIV-free survival (95.9%) and low MTCT (3.6%) rates at 18–24 months of age when Option A (infant prophylaxis) of the WHO 2010 guidelines was implemented.
KeywordsPrevention of mother-to-child transmission (PMTCT) of HIV HIV-free survival Mother-to-child transmission (MTCT) of HIV
We would like to thank Samkelo Dladla—the Study Coordinator; Nelisiwe Masilela—the Field Coordinator; and Sandile Mchunu—the Data Management Officer for the great work in coordinating the study and ensuring timely completion. We would also like to thank all the study team (regional team leaders, data collectors, HIV testing counselors, and drivers) for ensuring timely and quality data collection. We also thank Epiphanie Nyirabahizi who conducted the initial and preliminary data analysis for the study. We also acknowledge all the mothers, caregivers and children who agreed to participate in this study. We wish to acknowledge support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712.
The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of USAID, PEPFAR or the US Government.
CC designed study, wrote the protocol, oversaw study implementation, assisted in data analysis and wrote the manuscript. RM conducted data analysis. SM, MM, MMG, GM, GW and LG helped in designing study, developing the protocol, data analysis and writing the manuscript. KK helped in designing study, developing the protocol, supervising study implementation, data analysis and writing the manuscript. KL helped in writing of the manuscript. All authors read and approved the final manuscript.
This study was made possible through funding from PEPFAR through USAID under the Eliminating Paediatric AIDS in Swaziland (EPAS) Project Cooperative Agreement #674-A-00-11-00009-00.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
The study was reviewed and approved by the Swaziland Scientific and Ethics Committee at the Ministry of Health, and the institutional review board of George Washington University, Washington, DC, USA. The mother or the primary caregiver provided verbal informed consent, which was documented by the interviewer in study records.
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