title: Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007-2013).
abstract: OBJECTIVE
  Guidelines for prevention of mother-to-child transmission of HIV have developed rapidly, yet little is known about how outcomes of HIV-exposed infants have changed over time. We describe HIV-exposed infant outcomes in Kinshasa, Democratic Republic of Congo, between 2007 and 2013.
  
  
  METHODS
  Cohort study of mother-infant pairs enrolled in family-centered comprehensive HIV care.
  
  
  METHODS
  Accounting for competing risks, we estimated the cumulative incidences of early infant diagnosis, HIV transmission, death, loss to follow-up, and combination antiretroviral therapy (cART) initiation for infants enrolled in three periods (2007-2008, 2009-2010, and 2011-2012).
  
  
  RESULTS
  1707 HIV-exposed infants enrolled at a median age of 2.6 weeks. Among infants whose mothers had recently enrolled into HIV care (N = 1411), access to EID by age two months increased from 28% (95% confidence limits [CL]: 24,34%) among infants enrolled in 2007-2008 to 63% (95% CL: 59,68%) among infants enrolled in 2011-2012 (Gray's p-value <0.01). The 18-month cumulative incidence of HIV declined from 16% (95% CL: 11,22%) for infants enrolled in 2007-2008 to 11% (95% CL: 8,16%) for infants enrolled in 2011-2012 (Gray's p-value = 0.19). The 18-month cumulative incidence of death also declined, from 8% (95% CL: 5,12%) to 3% (95% CL: 2,5%) (Gray's p-value = 0.02). LTFU did not improve, with 18-month cumulative incidences of 19% (95% CL: 15,23%) for infants enrolled in 2007-2008 and 22% (95% CL: 18,26%) for infants enrolled in 2011-2012 (Gray's p-value = 0.06). Among HIV-infected infants, the 24-month cumulative incidence of cART increased from 61% (95% CL: 43,75%) to 97% (95% CL: 82,100%) (Gray's p-value <0.01); the median age at cART decreased from 17.9 to 9.3 months. Outcomes were better for infants whose mothers enrolled before pregnancy.
  
  
  CONCLUSIONS
  We observed encouraging improvements, but continued efforts are needed.
authors.affiliation: aThe University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, North Carolina, USA bKinshasa School of Public Health, Kinshasa, Democratic Republic of Congo cThe University of North Carolina at Chapel Hill, School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Feinstein
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.forename: Jean Lambert
authors.initials: JL
authors.lastname: Chalachala
authors.forename: Vitus
authors.initials: V
authors.lastname: Okitolonda
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents