Date Published: May 21, 2019
Publisher: Public Library of Science
Author(s): Sokhna Bousso Gueye, Halimatou Diop-Ndiaye, Ousmane Diouf, Aissatou Sow-Ndoye, Fatoumata Touré, Ndèye Fatou Ngom-Faye, Diabou Diagne-Gueye, Khady Mbow-Ndiaye, Papa Amadou Niang Diallo, Aïssatou Gaye-Diallo, Souleymane Mboup, Cheikh Tidiane Ndour, Cheikh Saad-Bouh Boye, Coumba Touré-Kane, Julie AE Nelson.
To improve the care and treatment of HIV-exposed children, early infant diagnosis (EID) using dried blood spot (DBS) sampling has been performed in Senegal since 2007, making molecular diagnosis accessible for patients living in decentralized settings. This study aimed to determine the evolution of the HIV transmission rate in children from 2008 to 2015 and to analyze associated factors, particularly the mother’s treatment status and/or child’s prophylaxis status and the feeding mode.
The data were analyzed using EID reports from the reference laboratory. Information related to sociodemographic characteristics, HIV profiles, the mother’s treatment status, the child’s prophylaxis status, and the feeding mode was included. Descriptive statistics were calculated, and bivariate and multivariate logistic regression analyses were performed.
During the study period, a total of 5418 samples (5020 DBS and 398 buffy coat) from 168 primary prevention of HIV mother-to-child transmission (PMTCT) intervention sites in Senegal were tested. The samples were collected from 4443 children with a median age of 8 weeks (1–140 weeks) and a sex ratio (M/F) of 1.1 (2309/2095). One-third (35.2%; N = 1564) of the children were tested before 6 weeks of age. Twenty percent (N = 885) underwent molecular diagnostic testing more than once. An increased number of mothers receiving treatment (57.4%; N = 2550) and children receiving prophylaxis (52.1%; N = 2315) for protection against HIV infection during breastfeeding was found over the study period. The transmission rate decreased from 14.8% (95% confidence interval (CI): 11.4–18.3) in 2008 to 4.1% (95% CI: 2.5–7.5) in 2015 (p < 0.001). However, multivariate logistic regression analysis revealed that independent predictors of HIV mother-to-child transmission included lack of mother’s treatment (adjusted odd ratio (aOR) = 3.8, 95% CI: 1.9–7.7; p˂0.001), lack of child’s prophylaxis (aOR = 7.8, 95% CI: 1.7–35.7; p = 0.009), infant age at diagnosis (aOR = 2.2, 95% CI: 1.1–4.3 for ≤6 weeks versus 12–24 weeks; p = 0.025) and protective effect of breastfeeding on ART against formula feeding (aOR = 0.4, 95% CI: 0.2, 0.7; p = 0.005). This study demonstrates the effectiveness of PMTCT interventions in Senegal but indicates also that increased efforts should be continued to reduce the MTCT rate to less than 2%.
Pediatric HIV infection remains a significant public health issue; 2.6 million children, 2.3 million of whom were in sub-Saharan Africa (SSA), were infected worldwide in 2014 . To reduce HIV mother-to-child transmission (MTCT), different strategies have been recommended by the World Health Organization (WHO).
The international community has responded to the launch of the Global Plan to eliminate HIV MTCT by 2015 . More pregnant women have been and will be screened for HIV, and more HIV-exposed infants have been and will be tested for HIV infection. The pediatric risk of HIV infection could be reduced to less than 5% by 2015 through PMTCT interventions . The goal of this study was to evaluate the Senegalese national PMTCT program after the increases in both the PMTCT services implemented in primary health care facilities and the accessibility of EID due to the use of DBS sampling from 2008 to 2015.
This report indicated the effectiveness of PMTCT in Senegal, showing that the MTCT rate decreased to less than 5% between 2008 and 2015. This decrease could be due to the greater and earlier access to EID allowed by DBS sampling combined with an increase in PMTCT services. Task shifting to integrate primary health care centers, the adoption of Option B+ for pregnant women, the improved coverage of antiretroviral prophylaxis for babies, and the use of breastfeeding on ART were probably the key factors underlying the improved organization of maternal and infant health care services. However, due to the possible further postpartum infection of uninfected newborns via breastfeeding, efforts must be strengthened—especially towards improving the adherence of mothers to treatment and children to prophylaxis, enhancing counseling and monitoring infant feeding in order to achieve the goal of an MTCT rate of less than 2% by 2020 for a generation without AIDS in 2030.