title: Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo.
abstract: OBJECTIVE
  To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance.
  
  
  METHODS
  The Kento-Mwana project (2005-2008) provided counselling, serological and biomolecular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance.
  
  
  RESULTS
  The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P = 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P = 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P = 0.092) were associated with better compliance.
  
  
  CONCLUSIONS
  Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.
authors.affiliation: Infectious Diseases Unit, University of Genoa and IRCCS AOU San Martino-IST, Largo R. Benzi, 10, 16132 Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bisio
authors.forename: Giulia
authors.initials: G
authors.lastname: Masini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Blasi Vacca
authors.forename: Anna
authors.initials: A
authors.lastname: Calzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.forename: Bianca
authors.initials: B
authors.lastname: Bruzzone
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D003223:Congo; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies
keywords: PMTCT; attrition; drop-out; lost to follow-up; mother-to-child transmission