title: Reducing mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria.
abstract: BACKGROUND
  Early diagnosis of HIV in infants provides a critical opportunity to strengthen follow-up of HIV-exposed children and assure early access to antiretroviral (ARV) treatment for infected children. This study describes findings from an Early Infant Diagnosis (EID) program and the effectiveness of a prevention of mother-to-child transmission (PMTCT) intervention in six health facilities in Cross-River and Akwa-Ibom states, south-south Nigeria.
  
  
  METHODS
  This was a retrospective study. Records of 702 perinatally exposed babies aged six weeks to 18 months who had a DNA PCR test between November 2007 and July 2009 were reviewed. Details of the ARV regimen received to prevent mother-to-child transmission (MTCT), breastfeeding choices, HIV test results, turn around time (TAT) for results and post test ART enrolment status of the babies were analysed.
  
  
  RESULTS
  Two-thirds of mother-baby pairs received ARVs and 560 (80%) babies had ever been breastfed. Transmission rates for mother-baby pairs who received ARVs for PMTCT was 4.8% (CI 1.3, 8.3) at zero to six weeks of age compared to 19.5% (CI 3.0, 35.5) when neither baby nor mother received an intervention. Regardless of intervention, the transmission rates for babies aged six weeks to six months who had mixed feeding was 25.6% (CI 29.5, 47.1) whereas the transmission rates for those who were exclusively breastfed was 11.8% (CI 5.4, 18.1). Vertical transmission of HIV was eight times (AOR 7.8, CI: 4.52-13.19) more likely in the sub-group of mother-baby pairs who did not receive ARVS compared with mother-baby pairs that did receive ARVs. The median TAT for test results was 47 days (IQR: 35-58). A follow-up of 125 HIV positive babies found that 31 (25%) were enrolled into a paediatric ART program, nine (7%) were known to have died before the return of their DNA PCR results, and 85 (67%) could not be traced and were presumed to be lost-to-follow-up.
  
  
  CONCLUSIONS
  Reduction of MTCT of HIV is possible with effective PMTCT interventions, including improved access to ARVs for PMTCT and appropriate infant feeding practices. Loss to follow up of HIV exposed infants is a challenge and requires strategies to enhance retention.
authors.affiliation: FHI 360, Nigeria, Plot 1073 J,S Tarka Street, Area 3 Garki Abuja. eanoje@ghain.org
authors.forename: Chukwuemeka
authors.initials: C
authors.lastname: Anoje
authors.forename: Bolatito
authors.initials: B
authors.lastname: Aiyenigba
authors.forename: Chiho
authors.initials: C
authors.lastname: Suzuki
authors.forename: Titilope
authors.initials: T
authors.lastname: Badru
authors.forename: Kesiena
authors.initials: K
authors.lastname: Akpoigbe
authors.forename: Michael
authors.initials: M
authors.lastname: Odo
authors.forename: Solomon
authors.initials: S
authors.lastname: Odafe
authors.forename: Oluwasanmi
authors.initials: O
authors.lastname: Adedokun
authors.forename: Kwasi
authors.initials: K
authors.lastname: Torpey
authors.forename: Otto N
authors.initials: ON
authors.lastname: Chabikuli
mesh_terms: D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D009549:Nigeria; D012189:Retrospective Studies; D018570:Risk Assessment; D040242:Risk Reduction Behavior