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HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study

BACKGROUND: Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-...

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Autores principales: Breton, Guillaume, Diallo, Oumou Hawa, Cissé, Mohamed, Diallo, Néné Aissatou, Soumaoro, Sény Agnès, Camara, Yalikhatou, Montoyo, Alice, Rouzioux, Christine, Koita, Youssouf, Peytavin, Gilles, Tubiana, Roland, Frange, Pierre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616546/
https://www.ncbi.nlm.nih.gov/pubmed/36031792
http://dx.doi.org/10.1093/jac/dkac287
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author Breton, Guillaume
Diallo, Oumou Hawa
Cissé, Mohamed
Diallo, Oumou Hawa
Diallo, Néné Aissatou
Soumaoro, Sény Agnès
Camara, Yalikhatou
Montoyo, Alice
Rouzioux, Christine
Koita, Youssouf
Peytavin, Gilles
Tubiana, Roland
Frange, Pierre
author_facet Breton, Guillaume
Diallo, Oumou Hawa
Cissé, Mohamed
Diallo, Oumou Hawa
Diallo, Néné Aissatou
Soumaoro, Sény Agnès
Camara, Yalikhatou
Montoyo, Alice
Rouzioux, Christine
Koita, Youssouf
Peytavin, Gilles
Tubiana, Roland
Frange, Pierre
author_sort Breton, Guillaume
collection PubMed
description BACKGROUND: Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field. METHODS: The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea. RESULTS: 6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%–95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, ‘real’ high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers’ stigmatization (69% versus 31%, P < 0.01). CONCLUSIONS: Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers’ self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.
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spelling pubmed-96165462022-11-01 HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study Breton, Guillaume Diallo, Oumou Hawa Cissé, Mohamed Diallo, Oumou Hawa Diallo, Néné Aissatou Soumaoro, Sény Agnès Camara, Yalikhatou Montoyo, Alice Rouzioux, Christine Koita, Youssouf Peytavin, Gilles Tubiana, Roland Frange, Pierre J Antimicrob Chemother Original Research BACKGROUND: Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field. METHODS: The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea. RESULTS: 6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%–95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL < 400 copies/mL attributable to undisclosed HIV status and/or antiretroviral intake. Undisclosed HIV status was associated with self-stigmatization (85% versus 44%, P = 0.02). Based on the results of maternal pVL at delivery, ‘real’ high-risk infants were more frequently lost to follow-up (44% versus 8%, P < 0.01) in comparison with low-risk infants, and this was associated with mothers’ stigmatization (69% versus 31%, P < 0.01). CONCLUSIONS: Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers’ self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT. Oxford University Press 2022-08-29 /pmc/articles/PMC9616546/ /pubmed/36031792 http://dx.doi.org/10.1093/jac/dkac287 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.
spellingShingle Original Research
Breton, Guillaume
Diallo, Oumou Hawa
Cissé, Mohamed
Diallo, Oumou Hawa
Diallo, Néné Aissatou
Soumaoro, Sény Agnès
Camara, Yalikhatou
Montoyo, Alice
Rouzioux, Christine
Koita, Youssouf
Peytavin, Gilles
Tubiana, Roland
Frange, Pierre
HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title_full HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title_fullStr HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title_full_unstemmed HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title_short HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study
title_sort hiv stigma limits the effectiveness of pmtct in guinea: the anrs 12344-diavina study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616546/
https://www.ncbi.nlm.nih.gov/pubmed/36031792
http://dx.doi.org/10.1093/jac/dkac287
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