title: Progress in the prevention of mother to child transmission of HIV in three regions of Tanzania: a retrospective analysis.
abstract: BACKGROUND
  Mother to child transmission (MTCT) of HIV-1 remains an important problem in sub-Saharan Africa where most new pediatric HIV-1 infections occur. Early infant diagnosis of HIV-1 using dried blood spot (DBS) PCR among exposed infants provides an opportunity to assess current MTCT rates.
  
  
  METHODS
  We conducted a retrospective data analysis on mother-infant pairs from all PMTCT programs in three regions of northern Tanzania to determine MTCT rates from 2008-2010. Records of 3,016 mother-infant pairs were assessed to determine early transmission among HIV-exposed infants in the first 75 days of life.
  
  
  RESULTS
  Of 2,266 evaluable infants in our cohort, 143 had a positive DBS PCR result at ≤ 75 days of life, for an overall transmission rate of 6.3%. Transmission decreased substantially over the period of study as more effective regimens became available. Transmission rates were tightly correlated to maternal regimen: 14.9% (9.5, 20.3) of infants became infected when women received no therapy; 8.8% (6.9, 10.7) and 3.6% (2.4, 4.8) became infected when women received single-dose nevirapine (sdNVP) or combination prophylaxis, respectively; the lowest MTCT rates occurred when women were on HAART, with 2.1% transmission (0.3, 3.9). Treatment regimens changed dramatically over the study period, with an increase in combination prophylaxis and a decrease in the use of sdNVP. Uptake of DBS PCR more than tripled over the period of study for the three regions surveyed.
  
  
  CONCLUSIONS
  Our study demonstrates significant reductions in MTCT of HIV-1 in three regions of Tanzania coincident with increased use of more effective PMTCT interventions. The changes we demonstrate for the period of 2008-2010 occurred prior to major changes in WHO PMTCT guidelines.
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America ; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Buchanan
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Dorothy E
authors.initials: DE
authors.lastname: Dow
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Massambu
authors.affiliation: Kilimanjaro Christian Medical Centre Clinical Laboratory, Moshi, Tanzania.
authors.forename: Balthazar
authors.initials: B
authors.lastname: Nyombi
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Aisa
authors.initials: A
authors.lastname: Shayo
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Rahma
authors.initials: R
authors.lastname: Musoke
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America.
authors.forename: Sheng
authors.initials: S
authors.lastname: Feng
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America ; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
authors.forename: Werner
authors.initials: W
authors.lastname: Schimana
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D059788:Dried Blood Spot Testing; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine