Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo

• Published in: Journal of antimicrobial chemotherapy 2013-08, Vol.68 (8), p.1862-1871
• Main Authors: Bisio, Francesca, Masini, Giulia, Blasi Vacca, Elisabetta, Calzi, Anna, Cardinale, Francesco, Bruzzone, Bianca, Bruzzi, Paolo, Viscoli, Claudio
• Format: Article
• Language: English
• Subjects: Congo; Disease prevention; Disease transmission; Effectiveness studies; Female; Health Services Research; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - prevention & control; HIV Infections - transmission; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Male; Patient Acceptance of Health Care; Patient Compliance - statistics & numerical data; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Prospective Studies
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkt102

To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance. The Kento-Mwana project (2005-2008) provided counselling, serological and biomolecular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance. The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P = 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P = 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P = 0.092) were associated with better compliance. Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.