Vertical transmission of HIV in the era of universal antiretroviral therapy in Zvimba district, Zimbabwe 2016-2017

  • Viral hepatitis and HIV
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Background:
Despite implementing the elimination of mother to child transmission (eMTCT) of HIV strategies in Zimbabwe, MTCT (vertical transmission) of HIV remains a public health challenge in some parts of the country. Zvimba dis- trict recorded MTCT rate of 7%, above the national target of 5%. We determined factors associated with vertical transmission of HIV among HIV positive mother-baby pairs in Zvimba from 2016-2017
Methods:
We conducted a 1:2 unmatched case-control study with a random sample of 51 cases and 102 controls. A case was a mother-baby pair whose mother was HIV infected during pregnancy or breastfeeding and baby tested HIV positive post-weaning. Controls were mother-baby pairs with HIV infected mothers during pregnancy or breastfeeding and HIV negative babies post-weaning. We collected data on demographics, maternal, child, and health system factors associated with HIV vertical transmission. We generated frequencies, proportions, means, odds ratio (OR) and their corresponding 95% confidence intervals ( CI). Independent factors were determined by step-wise logistic regression analysis.
Results:
:Among the cases, 71% (36/51) were residing at commercial farms compared to 48% (49/102) of controls. In 55% (28/51) of cases, diagnosis of HIV was made during breastfeeding compared to 2% (2/102) in controls. Independent risk factors were: primiparous mother [aOR=1.9, 95%CI (1.41-8.20)] and defaulting Anti-Retroviral Therapy (ART) for ≥ 1 month during pregnancy [aOR=15.57, 95%CI (2.69-90.12)]. Independent protective factors were: knowl- edge of HIV status during pregnancy [aOR=0.17, 95%CI (0.04-0.82)], family support on ART [aOR=0.11, 95%CI (0.01- 0.88)], attending ≥4 antenatal care visits [aOR=0.17, 95%CI (0.05-0.58)], and sexual partner on ART during pregnancy [aOR=0.34, 95%CI (0.18-0.87)].
Conclusion
Mothers who defaulted ART had a higher risk of transmitting HIV to their infants. Access to antenatal care and ear- lier awareness of HIV status reduced chances of vertical transmission. Primiparous women need special attention regarding eMTCT services and commercial farms must also be targeted.

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