title: Field effectiveness of combination antiretroviral prophylaxis for the prevention of mother-to-child HIV transmission in rural Zambia.
abstract: OBJECTIVE
  To evaluate the effectiveness of maternal combination antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV (PMTCT) in a program setting.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nine primary care clinics in rural Zambia.
  
  
  METHODS
  Two hundred and eighty-four HIV-infected pregnant women at at least 28 weeks gestation initiating PMTCT services between April 2009 and January 2011 and their newborn infants.
  
  
  METHODS
  In four 'intervention' sites, PMTCT comprised universal combination antiretroviral prophylaxis (i.e. irrespective of CD4 cell count) from pregnancy until the cessation of breastfeeding. In five 'control' sites, women received antenatal zidovudine and peripartum nevirapine, the standard of care at the time. Prophylaxis during breastfeeding was not available in control sites.
  
  
  METHODS
  Cumulative infant HIV infection and death at 12 months postpartum.
  
  
  RESULTS
  At 12 month postpartum, one of 104 (1.0%) infants born to mothers at the intervention sites were HIV-infected, compared with 14 of 116 (12.1%) receiving care in the control sites [relative risk (RR): 12.6, 95% CI: 2.2-73.1; P = 0.005]. When we considered the composite outcome of HIV infection or death, similar trends were observed in the overall study population (RR: 3.4, 95% CI: 1.6-7.6; P = 0.002) and in a sub-analysis of women with CD4 cell count more than 350 cells/μl (RR: 3.2; 95% CI: 1.1-9.6; P = 0.04).
  
  
  CONCLUSIONS
  When compared with PMTCT services based on antenatal zidovudine and peripartum nevirapine, the provision of maternal combination prophylaxis imparted measurable health benefits to HIV-exposed infants. Implementation research is needed to further tailor and optimize these strategies for similar field settings.
authors: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors: Matthew G
authors: MG
authors: Gartland
authors: Namwinga T
authors: NT
authors: Chintu
authors: Michelle S
authors: MS
authors: Li
authors: Mwila K
authors: MK
authors: Lembalemba
authors: Saziso N
authors: SN
authors: Mulenga
authors: Maximillian
authors: M
authors: Bweupe
authors: Patrick
authors: P
authors: Musonda
authors: Elizabeth M
authors: EM
authors: Stringer
authors: Jeffrey S A
authors: JS
authors: Stringer
authors: Benjamin H
authors: BH
authors: Chi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D055815:Young Adult; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents