HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study

Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transm...

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Published in:	Journal of antimicrobial chemotherapy Vol. 77; no. 11; pp. 3093 - 3101
Main Authors:	Breton, Guillaume, Diallo, Oumou Hawa, Cissé, Mohamed, Diallo, Néné Aissatou, Soumaoro, Sény Agnès, Camara, Yalikhatou, Montoyo, Alice, Rouzioux, Christine, Koita, Youssouf, Peytavin, Gilles, Tubiana, Roland, Frange, Pierre
Format:	Journal Article
Language:	English
Published:	England Oxford University Press (OUP) 28-10-2022 Oxford University Press
Subjects:	Anti-Retroviral Agents - therapeutic use Female Guinea HIV Infections - drug therapy HIV Infections - prevention & control Humans Infant Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Life Sciences Original Research Pregnancy Pregnancy Complications, Infectious - drug therapy Prospective Studies Retrospective Studies Guinea
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Summary:	Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field. The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea. 6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%-95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, 'real' high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers' stigmatization (69% versus 31%, P < 0.01). Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers' self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Members are listed in the Acknowledgements section.
ISSN:	0305-7453 1460-2091 1460-2091
DOI:	10.1093/jac/dkac287