title: Early Initiation of ARV During Pregnancy to Move towards Virtual Elimination of Mother-to-Child-Transmission of HIV-1 in Yunnan, China.
abstract: OBJECTIVE
  To identify factors associated with mother-to-child-transmission and late access to prevention of maternal to child transmission (PMTCT) services among HIV-infected women; and risk factors for infant mortality among HIV-exposed infants in order to assess the feasibility of virtual elimination of vertical transmission and pediatric HIV in this setting.
  
  
  METHODS
  Observational study evaluating the impact of a provincial PMTCT program.
  
  
  METHODS
  The intervention was implemented in 26 counties of Yunnan Province, China at municipal and tertiary health care settings. Log linear regression models with generalized estimating equations were used to identify unadjusted and adjusted correlates for late ARV intervention and MTCT. Cox proportional hazard models with robust sandwich estimation were applied to examine correlates of infant mortality.
  
  
  RESULTS
  Mother-to-child- transmission rate of HIV was controlled to 2%, with late initiation of maternal ARV showing a strong association with vertical transmission and infant mortality. Risk factors for late initiation of maternal ARV were age, ethnicity, education, and having a husband not tested for HIV. Mortality rate among HIV-exposed infants was 2.9/100 person-years. In addition to late initiation of maternal ARV, ethnicity, low birth weight and preterm birth were associated with infant mortality.
  
  
  CONCLUSIONS
  This PMTCT program in Yunnan achieved low rates of MTCT. However the infant mortality rate in this cohort of HIV-exposed children was almost three times the provincial rate. Virtual elimination of MTCT of HIV is an achievable goal in China, but more attention needs to be paid to HIV-free survival.
authors.affiliation: Aaron Diamond AIDS Research Center, New York, New York, United States of America.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Meyers
authors.affiliation: Aaron Diamond AIDS Research Center, New York, New York, United States of America.
authors.forename: Haoyu
authors.initials: H
authors.lastname: Qian
authors.affiliation: Aaron Diamond AIDS Research Center, New York, New York, United States of America.
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Yunnan AIDS Care Center, Kunming, Yunnan, China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Lao
authors.affiliation: Yunnan AIDS Care Center, Kunming, Yunnan, China.
authors.forename: Qingling
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Yunnan AIDS Care Center, Kunming, Yunnan, China.
authors.forename: Xingqi
authors.initials: X
authors.lastname: Dong
authors.affiliation: Yunnan AIDS Care Center, Kunming, Yunnan, China.
authors.forename: Huiqin
authors.initials: H
authors.lastname: Li
authors.affiliation: Linxiang Maternal and Child Hospital, Lincang, Yunnan, China.
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Mangshi Maternal and Child Hospital, Dehong, Yunnan, China.
authors.forename: Chengqin
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Yunnan AIDS Care Center, Kunming, Yunnan, China; Yunnan AIDS Initiative, Kunming, Yunnan, China.
authors.forename: Zengquan
authors.initials: Z
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001942:Breast Feeding / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D000075202:Contraindications; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008431:Maternal-Fetal Exchange / Q000187:drug effects; D009035:Mothers; D011247:Pregnancy; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents