Outcomes of HIV exposed infants before and after implementing Option B+ prevention of mother to child HIV transmission guidelines in Mulago Hospital, Uganda: A retrospective cohort study
Background: To assess the impact of Option B+ on the 18- month’s outcomes of HIV-exposed infants (HEI), we compared the cumulative incidence of HIV infection, loss to follow-up (LTFU) and death in HEI before and after implementing Option B+. We also compared combination antiretroviral therapy (cART) initiation proportions among HIV-infected infants and determined factors associated with mother to child HIV transmission during Option B+. Methods: We retrospectively analysed routine data from HEI at Mulago Hospital, Uganda. We compared estimated cumulative incidence of HIV infection, LTFU and death for HEI born from July 2010–June 2011 (Option A cohort) and July 2013-June 2014 (Option B+ cohort), accounting for competing risks. We used Fisher’s exact test to compare cART initiation proportions between the two cohorts. Competing risks regression model by Fine and Gray (1999) was adopted to determine predictors of MTCT during Option B+. Results: There were 2203(Option A) and 1571(Option B+) HEI enrolled at median age of 6.3 weeks. The 18-month cumulative incidence of HIV infection were similarly low when comparing Option A to Option B cohorts, 5.1% (95% CI: 4.3%, 6.2%) Vs 4.3% (95% CI: 3.3%, 5.5%) respectively p=0.2. LTFU were similar, Option A: 30.3% (95%CI: 28.4%, 32.3%) Vs. Option B+ 28.4% (95%CI: 26.2, 30.7) p=0.06. Cumulative incidence death during Option A was 0.9 % (95% CI: 0.5%, 1.5%) Vs. 1.4% (95% CI: 0.8%, 2.2%) during Option B+ (p=0.3). cART initiation proportion was higher during Option B+ [88% (51/58) vs. 74% (72/97); p=0.04]. Mothers or infants not receiving ARVs for PMTCT were associated with MTCT, Adjusted Hazard Ratio: 16.3(95%CI: 7.6, 34.6) and 2.3(95%CI: 1.03, 4.95) respectively. Conclusion: Outcomes of HIV-exposed infants at 18-months of life before and after implementing Option B+ were similar; however, the cART initiation in HIV-infected infants was better. Mothers or infants not receiving ARV’s predicted MTCT during Option B+. LTFU remains high and should be addressed.
Elyanu, Peter James, "Outcomes of HIV exposed infants before and after implementing Option B+ prevention of mother to child HIV transmission guidelines in Mulago Hospital, Uganda: A retrospective cohort study" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10131758.