title: Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study.
abstract: OBJECTIVE
  To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.
  
  
  METHODS
  Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women, irrespective of immunological status, at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death.
  
  
  RESULTS
  In the first survey (2008-2009), 335 of 1778 women (18.8%) tested positive for HIV. In the second (2011), 390 of 2386 (16.3%) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95% confidence interval, CI: 0.63-0.76) in the first survey and 0.89 (95% CI: 0.83-0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33, 95% CI: 0.15-0.73). Maternal knowledge of HIV status, use of HIV tests and use of combination regimens during pregnancy increased between the surveys.
  
  
  CONCLUSIONS
  The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased.
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Campus Box 7570, 130 Farm Mason Road, Chapel Hill, NC 27599, United States of America (USA).
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.affiliation: Department of Medical Statistics, University of East Anglia, Norwich, England .
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.affiliation: Zambian Ministry of Health, Lusaka, Zambia .
authors.forename: Mwila K
authors.initials: MK
authors.lastname: Lembalemba
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia .
authors.forename: Namwinga T
authors.initials: NT
authors.lastname: Chintu
authors.affiliation: Vanderbilt University School of Medicine, Nashville, USA .
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Gartland
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia .
authors.forename: Saziso N
authors.initials: SN
authors.lastname: Mulenga
authors.affiliation: Zambian Ministry of Health, Lusaka, Zambia .
authors.forename: Maximillian
authors.initials: M
authors.lastname: Bweupe
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia .
authors.forename: Eleanor
authors.initials: E
authors.lastname: Turnbull
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Campus Box 7570, 130 Farm Mason Road, Chapel Hill, NC 27599, United States of America (USA).
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Campus Box 7570, 130 Farm Mason Road, Chapel Hill, NC 27599, United States of America (USA).
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015397:Program Evaluation; D012424:Rural Population; D015996:Survival Rate; D015024:Zambia / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents