title: An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort.
abstract: BACKGROUND
  Scaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon.
  
  
  METHODS
  HIV-positive pregnant women attending the DREAM Centre of Dschang, Cameroon for prenatal care were enrolled in a prospective cohort study, and received ART until the end of breastfeeding or indefinitely if their CD4 count was <350mm(3). Infants were evaluated for HIV infection at 1, 6 and 12 months of age.
  
  
  RESULTS
  A total of 298 women were enrolled. Among them, 152 were already on established ART. Women were followed until 6 months after delivery with a retention rate of 92.6%. Eight women died. Those with a CD4 count <350 cells/mm(3) during pregnancy had the highest mortality risk (RR 2.53; 95% CL= 1.86-3.44). The HIV transmission rate was 1.2% at 12 months with an HIV free survival of 91%. In the proportional Cox regression analysis, the following factors were positively associated with infant mortality: maternal CD4< 350 cells/mm(3), no breastfeeding in the first 6 months of life, weight-for-age z score<-2.
  
  
  CONCLUSIONS
  Results confirm the feasibility and effectiveness of the implementation of Option B, with very low rates of HIV MTC transmission, and potential benefits to the health of mothers and infants with earlier initiation of ART. Breastfeeding again demonstrates to be highly beneficial for the growth and survival of HIV exposed children.
authors.affiliation: DREAM programme, Community of Sant'Egidio, Rome, Italy.
authors.forename: Anna Maria Doro
authors.initials: AM
authors.lastname: Altan
authors.affiliation: DREAM Center, Dschang, Cameroon.
authors.forename: Francis
authors.initials: F
authors.lastname: Taafo
authors.affiliation: DREAM Center, Dschang, Cameroon.
authors.forename: François
authors.initials: F
authors.lastname: Fopa
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.affiliation: University LUMSA, Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.affiliation: Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, California.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
authors.affiliation: DREAM programme, Community of Sant'Egidio, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Orlando
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.affiliation: DREAM programme, Community of Sant'Egidio, Rome, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Ciccacci
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.affiliation: DREAM programme, Community of Sant'Egidio, Rome, Italy.
authors.forename: Massimo Magnano San
authors.initials: MM
authors.lastname: Lio
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Cameroon; HIV; Option B; breastfeeding; mother-to-child transmission (MTCT)