title: Effectiveness of a prevention of mother-to-child HIV transmission programme in an urban hospital in Angola.
abstract: BACKGROUND
  Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007-2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa.
  
  
  RESULTS
  Data for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07-1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31-20.15, p = 0.019).
  
  
  CONCLUSIONS
  Among the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.
authors.affiliation: Infectious Diseases Laboratory, Hospital Divina Providencia, Luanda, Angola. cristinaelle@hotmail.it
authors.forename: Cristina
authors.initials: C
authors.lastname: Lussiana
authors.forename: Sofia Vanda Lôa
authors.initials: SV
authors.lastname: Clemente
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghelardi
authors.forename: Magda
authors.initials: M
authors.lastname: Lonardi
authors.forename: Ivan Alejandro
authors.initials: IA
authors.lastname: Pulido Tarquino
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
mesh_terms: D000328:Adult; D000810:Angola / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000635:transmission*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009035:Mothers; D015999:Multivariate Analysis; D018743:Perinatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D015215:Zidovudine / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine