Declining Rate of Infection with Maternal Human Immunodeficiency Virus at Delivery Units in North-Central Nigeria

Godwin E. Imade, Atiene. S. Sagay, Jonah Musa, Amaka N. Ocheke, David S. Adeniyi, Monica Idighri, Rosemary Powl, Ayuba Sendeht, Jerry P. Ogwuche, Michael Elujoba, Chris O. Egbodo, Tinuade Oyebode, Patrick H. Daru, Oche Agbaji, Ishaya C. Pam, Seema T. Meloni, Prosper Okonkwo, Phyllis J. Kanki

Abstract

HIV testing during labour and delivery provides a critical opportunity for administering appropriate interventions to prevent mother-to-child-transmission (PMTCT). We studied current HIV rates and infection trend among women tested during delivery following scale-up of  PMTCT and antiretroviral therapy (ART) programs in Jos, north central Nigeria. Between March 2010 and January 2012, provider-initiated HIV testing and counselling was offered in early labour. Women were recruited from a government tertiary health centre, a faith-based hospital, and a private health centre. Those who previously tested HIV negative during antenatal care (ANC) and those who presented at the labour ward with unknown HIV status were tested. A total of 944 subjects (727 re-tested for HIV infection and 217 with unknown HIV status) were enrolled and tested during labour. The HIV incidence and sero-conversion rates during pregnancy among women who repeated HIV testing at delivery was 1.7 per 100 person-years of observation (pyo) and 0.6% (4/727), respectively, while the rate among those who tested for the first time in labour was 1.8% (4/217). Women who accessed ANC were older and had achieved a higher educational status than those who did not access ANC. A 3- to 5-fold decline in HIV incidence and prevalence rates was detected among women tested at delivery when compared to data from a report in 2004. It is not certain whether the decline in maternal HIV infection is due to the major state-wide scale-up of PMTCT and HIV treatment programs. A broader and purposefully designed evaluation study would be required to verify observed occurrence. Afr J Reprod Health 2013 (Special Edition); 17[4]: 138-145).

 

Keywords: HIV, PMTCT, incidence, Labour/delivery, Nigeria

 

 

Résumé

 

Le dépistage du VIH pendant l'accouchement offre une occasion cruciale pour la gestion des interventions appropriées pour prévenir la transmission de la mère - à - l’enfant (PTME). Nous avons étudié les taux actuels de VIH  et les tendances de l'infection chez les femmes qui ont subi l’analyse pendant l'accouchement suite à l'intensification des programmes de la PTME et le traitement antirétroviral ( ART ) à Jos , dans le centre nord du Nigeria PTME et . Entre mars  2010 et janvier 2012 à l'initiative des dispensateurs le conseil et du dépistage ont été offerts en début de travail. Les femmes ont été recrutées dans un centre de santé tertiaire gouvernemental, un hôpital confessionnel  et un centre de santé privé. Celles  qui  séronégatives lors des soins prénatals (SP) et celle qui se sont présentées à la salle de travail avec la condition du VIH  inconnu ont des analyses. Un total de 944 sujets (727 ont répété l’analyse du dépistage du VIH et 217 avec l’état sérologique inconnu) ont été recrutées et ont subi l’analyse  pendant le travail. L’incidence du VIH et des taux de séroconversion pendant la grossesse chez les femmes qui répétaient le dépistage du VIH à l'accouchement était de 1,7 pour 100 personnes- années d'observation (pyo) et 0,6 % (4/ 727), respectivement, tandis que le taux de celles qui ont subi l’analyse pour la première fois pendant le travail  était de 1,8 % (4/ 217). Les femmes qui ont eu accès au SP étaient plus âgées et avaient atteint un niveau d'éducation plus élevé que celles qui n'ont pas eu accès  au SP.  Une baisse d’entre 3 et 5 fois de l'incidence du VIH et des taux de prévalence a été détectée chez les femmes qui ont subi l’analyse à l’accouche ment par rapport aux données d'un rapport en 2004. Il n'est pas certain que le déclin de l'infection maternelle du VIH est dû aux grands programmes d’intensification et du traitement  de la PTME et du VIH. Une plus grande étude d'évaluation qui a été conçue délibérément serait nécessaire pour vérifier les faits observés. Afr J Reprod Health 2013 (Edition Spéciale); 17[4]: 138-145).

 

Motsclés: VIH, la PTME, le travail /accouchement, Nigeria 

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