Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey
- 141 Downloads
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.
- 1.Joint United Nations Programme on HIV/AIDS (UNAIDS). Fact sheet 2015. http://www.unaids.org/en/resources/campaigns/HowAIDSchangedeverything/factsheet. Accessed 25 May 2016.
- 2.Joint United Nations Programme on HIV/AIDS (UNAIDS). 2015 progress report on the global plan towards the elimination of new HIV infections among children and keeping their mothers alive. http://www.unaids.org/sites/default/files/media_asset/JC2774_2015ProgressReport_GlobalPlan_en.pdf. Accessed 30 June 2016.
- 3.World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection—recommendations for a public health approach—second edition, 2016. Geneva, Switzerland: World Health Organization. http://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed 16 Aug 2016.
- 4.World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach. http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf. Accessed 20 May 2016.
- 5.World Health Organization. A short guide on methods: measuring the impact of national PMTCT programmes towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. http://apps.who.int/iris/bitstream/10665/75478/1/9789241504362_eng.pdf. Accessed 20 May 2016.
- 8.Joint United Nations Programme on HIV/AIDS (UNAIDS). 2016. http://aidsinfo.unaids.org/. Accessed 20 June 2016.
- 9.Swaziland Ministry of Health. 2010 ANC sentinel surveillance. Mbabane: Ministry of Health; 2010.Google Scholar
- 10.Buzdugan R, McCoy SI, Watadzaushe C, et al. Evaluating the impact of Zimbabwe’s prevention of mother-to-child HIV transmission program: population-level estimates of HIV-free infant survival pre-Option A. PLoS ONE. 2015. https://doi.org/10.1371/journal.pone.0134571.PubMedPubMedCentralCrossRefGoogle Scholar
- 12.Goga A. Highest risk of mother-to-child transmission of HIV or death in the first 6 months postpartum: results from 18 month follow-up of an HIV-exposed cohort, South Africa. 21st International AIDS Conference, Durban, 2016, abstract TUAE0106.Google Scholar
- 15.Central Statistical Office. Swaziland multiple indicator cluster survey 2014. Mbabane: Key Findings; 2015.Google Scholar
- 16.Swaziland Ministry of Health. Evaluation of the effectiveness of the national prevention of mother to child transmission of HIV (PMTCT) Programme at 6–8 weeks post-partum in Swaziland. Mbabane: Swaziland; 2012.Google Scholar
- 18.Swaziland Ministry of Health. Swaziland HIV Estimates and Projections Report. 2015. Mbabane.Google Scholar
- 20.Omer SB. Six week extended dose nevirapine (SWEN) study team. Twelve-month follow-up of 6 week extended dose nevirapine randomized controlled trials: differential impact of extended-dose nevirapine on mother-to-child transmission and infant death by maternal CD4 cell count. AIDS. 2011;25(6):767–76. https://doi.org/10.1097/QAD.0b013e328344c12a.CrossRefPubMedGoogle Scholar