Adherence and effectiveness of guidelines for prevention of mother to child transmission of HIV at Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Abstract

Degree Project Thesis, Programme in Medicine. TITLE: Adherence and effectiveness of guidelines for prevention of mother to child transmission of HIV at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Background Mother-to-child transmission (MTCT) is the second most common mode of HIV transmission after heterosexual contact. The estimated rate of MTCT without any interventions is 25-40% but with the adequate prevention including HIV-testing, antiviral treatment and breastfeeding advices the MTCT could be less than 1%. Aim To identify factors that influence MTCT of HIV. Method An observation study was performed on the adherence among consecutive HIV-positive mothers to the current guidelines on prevention of MTCT of HIV. Results In total 98 HIV-positive mothers with children born between 1998 and 2014 were included in the study, 26 of the mothers had a HIV-positive child, 43 had a HIV-negative child, 20 had children with unknown HIV-status and 9 were excluded due to insufficient data. The transmission rate of HIV during 2014 was 14%. The mothers with HIV-positive children had a lower CD4-count than the mothers with HIV-negative children (p=0.003). The mothers who were diagnosed after delivery had a higher prevalence of infected children in comparison to those who were diagnosed before the pregnancy (p<0.004). A tendency towards that the mothers with HIV-positive children received treatment to a lesser extent than those with HIV-negative children was seen (p=0.07). The children who acquired the infection also received treatment to a lesser extent then the negative children (p<0.001). Nevirapine prophylactic treatment to the child had the strongest impact on the MTCT and reduced the transmission rate with one fifth. It was also seen that exclusive breastfeeding for six months reduce the transmission rate with 43%. Discussion and conclusion: This study showed that the rate of MTCT of HIV is strongly correlated on the extent of the adherence to the guidelines of prevention. The prevention programs of MTCT in the western world today are very effective and to halter the MTCT in developing countries the programs must be available and accepted by all pregnant women with a high compliance.

Keywords: HIV, prevention, pregnancy, resource limited settings