title: Low rates of mother-to-child HIV transmission in a routine programmatic setting in Lilongwe, Malawi.
abstract: BACKGROUND
  The Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery. We evaluated the impact of antiretroviral (ARV) regimen and maternal CD4+ count on HIV transmission within the Tingathe program in Lilongwe, Malawi.
  
  
  METHODS
  We reviewed clinical records of 1088 mother-infant pairs enrolled from March 2009 to March 2011 who completed follow-up to first DNA PCR. Eligibility for antiretroviral treatment (ART) was determined by CD4+ cell count (CD4+) for women not yet on ART. ART-eligible women initiated stavudine-lamivudine-nevirapine. Early ART was defined as ART for ≥14 weeks prior to delivery. For women ineligible for ART, optimal ARV prophylaxis was maternal AZT ≥6 weeks+sdNVP, and infant sdNVP+AZT for 1 week. HIV transmission rates were determined for ARV regimens, and factors associated with vertical transmission were identified using bivariate logistic regression.
  
  
  RESULTS
  Transmission rate at first PCR was 4.1%. Pairs receiving suboptimal ARV prophylaxis were more likely to transmit HIV (10.3%, 95% CI, 5.5-18.1%). ART was associated with reduced transmission (1.4%, 95% CI, 0.6-3.0%), with early ART associated with decreased transmission (no transmission), compared to all other treatment groups (p = 0.001). No association was detected between transmission and CD4+ categories (p = 0.337), trimester of pregnancy at enrollment (p = 0.100), or maternal age (p = 0.164).
  
  
  CONCLUSIONS
  Low rates of MTCT of HIV are possible in resource-constrained settings under routine programmatic conditions. No transmissions were observed among women on ART for more than 14 weeks prior to delivery.
authors.affiliation: Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States of America. mhkim@bcm.edu
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kim
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Chiao
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.forename: Avni
authors.initials: A
authors.lastname: Bhalakia
authors.forename: Debora
authors.initials: D
authors.lastname: Nanthuru
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003150:Community Health Workers; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D008295:Malawi / Q000453:epidemiology; D011247:Pregnancy; D011292:Premedication; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents