Nigerian Journal of Paediatrics

2PMTCT Programme reduced vertical transmission of HIV in Abuja Nigeria

Niger J Paediatr 2016; 43 (3):166 – 169

ORIGINAL

Oyesakin AB

PMTCT Programme reduced

Akinsulie A

Oniyangi O

vertical transmission of HIV in

Audu LI

Abuja, Nigeria

Ogunfowokan O

DOI:http://dx.doi.org/10.4314/njp.v43i3.2

Accepted: 16th April 2016

Abstract : Objective: To deter-

PMTCT programme and the trans-

mine the rate of mother to child

mission rates obtained were com-

Ogunfowokan O (

)

transmission of HIV following the

pared.

Department of Family Medicine,

introduction of PMTCT program

Result: An overall HIV vertical

National Hospital Abuja,

PMB 425 Garki Abuja, Nigeria.

in Abuja.

transmission rate of 6.4% (23/359)

Email:gloryogunfowokan@yahoo.com

Method: A prospective study of

was found. A lower rate of 1.6%

355 seropositive mothers and their

(5/311) was obtained for those

Oyesakin AB, Oniyangi O, Audu LI

newborns was conducted at the

whose mothers fully accessed

Department of Paediatrics,

National Hospital Abuja and

PMTCT programme as opposed to

National Hospital Abuja Nigeria

Asokoro District Hospital Abuja

15.0% (3/20) for those whose

over a 12 months’ period follow-

mothers had incomplete participa-

Akinsulie A

ing ethical approval. Using DNA

tion and 53.6%(15/28) for those

Department of Haematology /

PCR the HIV status of all the ex-

whose mothers did not participate.

Oncology, Lagos University Teaching

Hospital,

posed babies delivered over the

Conclusion: Full participation in

Lagos, Nigeria.

period was determined by taking

PMTCT programme significantly

their peripheral blood at 6 weeks

reduced mother to child transmis-

of age. This was repeated 6 weeks

sion of HIV.

post cessation of breast feeding

for breastfed babies.. Further-

Keywords: Paediatric HIV/ AIDS,

more, the babies were categorized

MTCT,

PMTCT,

DNA-PCR,

based on the extent of participa-

Abuja, Nigeria

tion of their mothers in the

Introduction

-20% ⁶ . However, with some preventive interventions, a

lower rate of 16.2% was reported in Jos and 6.8% in

Abuja

Human Immunodeficiency Virus (HIV)/Acquired im-

munodeficiency syndrome (AIDS) is a significant threat

to the health of families worldwide. Paediatric AIDS has

Prevention of mother-to-child (PMTCT) of HIV pro-

become the cause of increasing childhood morbidity and

gramme as a tool for reducing paediatric burden of HIV

mortality . Women of child bearing age in Africa are

infection became a reality in 1994 when the result of the

Paediatric Clinical Trial Group (PACTG) protocol 076

particularly vulnerable to HIV infection and this has led

to an increase in paediatric HIV through mother to child

in the United States showed that maternal ARVs, opti-

transmission of HIV .

mal obstetric practice, appropriate infant feeding option

Mother to child transmission, (MTCT) also referred to

and infant ARVs could reduce the rate of transmission

from mother to child by two-thirds. Implementation of

as vertical transmission, is the predominant mode of

acquisition of HIV in children and can be reduced by the

the PMTCT programme in Nigeria commenced in July

PMTCT programme. In Nigeria the risk of MTCT is

2002 in six sites and had scaled up to six hundred and

forty (640) sites across the six geo-political zones by

high because of the high prevalence of HIV among

women of reproductive age (4.8%), high fertility rate

2008. It has been integrated into routine antenatal ser-

(5.6%), prolonged breast feeding associated with mixed

vices offered in the country. There is however paucity of

feeding and poor access to effective interventions aimed

data on the formal evaluation of the outcome of the

at preventing MTCT.

PMTCT programme and contributory factors to MTCT

in Abuja Municipal Area Council. There is a need to

Prior to the use of antiretroviral therapy, the rate of

assess the extent of participation of HIV positive moth-

MTCT of HIV in developed countries was 15-30%

ers in PMTCT program in Abuja and the outcome of

while it was about 45% in resource limited countries,

these interventions. The information from this study will

including Nigeria This difference was attributed to

be useful in making recommendation that may guide in

breast feeding which increased the risk of MTCT by 5%

further development of policy guidelines for the

167

PMTCT program in the Federal Capital Territory in par-

those who had no interventions were categorized as nil.

ticular and Nigeria as a whole. This will hopefully re-

Data were analyzed using the SPSS 18 and P value

duce the burden of paediatric HIV infection and AIDS in

< 0.05 was taken as significant

the population and reduce the rate of child morbidity and

mortality.

Results

General Characteristics of the mothers

Subjects and Methods

A total of 355 HIV positive mothers and their newborns

A prospective study was undertaken in the National

were recruited. There were four sets of twin resulting in

Hospital Abuja and Asokoro District Hospital both lo-

a total of 359 babies. Of the 355 HIV positive mothers,

cated in Abuja municipal Area council from July 2009

121(37.2%) were delivered at the National Hospital

to July 2010. Ethical approval was obtained from the

Abuja, 80(22.5%) at Asokoro District Hospital and 154

ethical boards of both hospitals and the study was con-

(43.4%) were referred from other hospitals. Table 1

ducted in accordance with the declaration of Helsinki.

summarizes the background information of the mothers.

The subjects were the HIV positive mothers and their

Their mean age was 27years.

subsequent infants (inborns) delivered at the study cen-

tres. On enrolment, after obtaining an informed consent,

Table 1: General and obstetric characteristics of the mothers

the Biodata of mother including (age, marital status,

Characteristics

number (%)

religion, social class and husbands’ HIV status) were

Age

obtained at 36 weeks gestation. At delivery relevant

<20

2 (0.5)

20-34

201(56.6)

information relating to the baby such as (sex, mode of

>35

152 (42.8)

delivery, birth weight, mode of feeding, use of post ex-

Marital Status

posure ART prophylaxis) were also obtained and docu-

Married

342 (96.2)

mented.

Separated

5 (1.4)

Single

5(1.4)

Inborn babies were seen at 6 weeks of age on appoint-

Widow

3(0.9)

ment for 1 clinic visit at the paediatric outpatient clinics

Socio – economic status

(POPD) of the study centres. Dried Blood Specimen

Upper

59(16.6)

(DBS) were taken from the exposed babies for DNA-

Middle

234(65.9)

Lower

62(17.5)

PCR test and 4weeks appointment given for a 2 clinic

Parity

visit during which time the result of the test was dis-

118 (33.2)

closed to the mother/ parents and those who were on

114(32.1)

breast milk substitute who tested negative to DNA-PCR

77 (21.7)

test were discharged to well babies’ clinic. Those who

46(13)

tested positive were referred to paediatric HIV clinic for

Mode of delivery

treatment. However, those who tested negative and were

SVD

219(61.7)

still breast feeding were given appointment for a 3

ELCS

116 (32.7))

clinic visit to repeat DNA-PCR test 6 weeks post cessa-

EMCS

20 (5.6)

PROM

tion of breastfeeding and 4

clinic appointment was

Yes

48 (20.8)

given for disclosure of the results and referral appropri-

183(79)

ately.

Place of Delivery

NHA

130 (36.6)

For the out born babies referred to the study centres,

ADH

78(22. 0)

recruitment was done at the POPD clinic at age 6-12

Others

147(41.4)

weeks and the clinic visits scheduled as those of the in-

borns.

General Characteristics of Babies

The PMTCT protocol adopted for this study was in ac-

Of the 359 babies, 199(55.4%) were males while 160

cordance with the National Guideline on PMTCT which

(44.6%) were females giving a male to female ratio of

consisted of HIV counseling and testing, maternal

1.2:1 as shown in Table 2. Three hundred and forty-six

ARVs, modified obstetric practice, appropriate infant

were born term (96.4%) while13(3.6%) were preterm.

feeding option and neonatal ARV prophylaxis at the

There were four sets of twins one pair was conceived by

time in which this study was conducted.

in-vitro fertilization. Three hundred and twenty-six ba-

bies had sufficiently satisfactory conditions to be dis-

The subjects were eventually categorized into three

charged to their mothers but 33(9.2%) required hospi-

groups based on the extent of the participation of the

talization. The reason for the hospitalization were pre-

mothers in the PMTCT protocol. Those who were re-

maturity in 13(39.4%), neonatal jaundice 8(24.2%), neo-

cruited from the ANC and followed up to the point of

natal sepsis 7(21.2%) and perinatal asphyxia 5(15.2%).

diagnosis were categorized as total, those who missed

any stage of the protocol were categorized as partial and

168

Table 2: General characteristics of babies

tions and the circumstances under which the study was

Variables

n (%)

conducted. For instance, Odaibo et al found a transmis-

Sex

sion rate of 45 % in Ibadan, from a study on MTCT rate

Male

199 (55.4)

in Nigeria among HIV infected pregnant women before

Female

160 (44.6)

Gestational age (wk)

ARV intervention. None of the positive mothers had

Term (37- 42))

346 (96.4)

any preventive intervention.

Preterm (< 37)

13(3.6)

Mode of feeding

However, a higher rate of transmission of 70.4 % and

BMS

254(70.8)

68.3 % respectively were reported in university of Benin

EBF

93(25.9)

Teaching Hospital

and Abuja

during the era of

Mixed

12(3.3)

PMTCT programme. This was attributed to late detec-

tion of HIV in pregnancy and lack of full participation in

Rate of mother to child transmission of HIV

the preventive interventions.

Sadoh et al

Benin reported 70.4% and 8.4% respectively in the non-

At six weeks of age, all the 359 babies had PCR DNA

PMTCT cohorts group who discovered their positive

test. 22(6.1%) were positive (8 from BMS group, 14

HIV status after delivery and had partial intervention

from breast feeding group) while 337(93.9%) were

and the PMTCT cohorts group who were diagnosed

negative (246 from BMS group, 91from breast feeding

from prenatal period and had full preventive intervention

group). A second DNA PCR test was conducted for 91

respectively. This is closely related to the transmission

infants that were exclusively breast fed or had mixed

rates of 68.6% and 6.7% respectively obtained for those

feeding, who tested negative to the first test. One child

with no participation and those with full participation,

additionally was identified as being HIV positive among

reported by Okechukwu et al in Gwagwalada Abuja.

this group of infants who received mixed feeding.

It is noteworthy that the overall rates of transmission

Therefore, the total number of HIV infected children

quoted in the previous studies for those that were diag-

was 23 giving a mother to child transmission rate of

nosed early and had full participation in PMTCT

8,11

, are

(23/339) 6.4% as displayed in table 3.

close to the overall rate of 6.4% obtained in this study.

This, therefore clearly suggests a positive impact of the

Table 3: Outcome of MTCT of HIV

current intervention on PMTCT.

DNA – PCR Result

n(%)

Negative

336(93.5)

On further analysis, the rate of 1.6% of MTCT found in

Positive

23(6.5)*

this study for those who fully participated in the

Total

359(100)

PMTCT programme was significantly lower (p < 0.001).

This is comparable to < 2% reported in the industrial-

*95% CI = 5.47% - 6.52%

ized countries where their PMTCT package involves

Relationship between participation in the PMTCT

HIV counseling and testing, antiretroviral prophylaxis,

package and rate of vertical transmission of HIV

routine elective caesarian section and complete avoid-

ance of breastfeeding. However in the current study

There was a significant association between participa-

elective caesarian section was not a routine neither was

tion in all the interventions involved in the preventive

breast feeding completely avoided. This suggests an

package and HIV transmission. The rate of HIV trans-

important role of ARVS.

mission from mother to child was low (1.6%) for the

mothers who participated fully in the programme from

the prenatal period to delivery, compared to those who

Conclusions

participated partially (15.0%) or did not participate at all

(53.6%) as seen in Table 4.

The rate of mother to child transmission of HIV in

Abuja Municipal Area Council especially among those

Table 4: Relationship between DNA-PCR of Infant and

who fully participated in the PMTCT programme was

Participation in PMTCT

less than 2%. This is close to what obtains in the indus-

Participation in PMTCT

DNA-PCR

trialized countries, despite some differences in the line

Negative

Positive

Total

of interventions. Therefore, full participation in the

Full

306(98.4%)

5(1.6%)*

311(100%)

PMTCT programme is the major key for the reduction

Partial

17(85.0%)

3 (15.0%)

20 (100%)

of mother to child transmission to a negligible level.

Nil

13(46.4%)

15(53.6%)

28(100%)

Fishers Exact χ for 2 by 3 table = 85.884, p < 0.001

* 95% CI = 1.58% - 1.62%

Author’s contribution

Oyesakin AB: conceived, designed, conducted and ana-

lysed the data and also wrote the manuscript.

Discussion

Oniyangi O and Audu LI: designed, and wrote the

manuscript.

This rate of MTCT was lower than those reported in

Ogunfowokan O: designed, analysed and wrote the

previous study in Nigeria. Though the study was simi-

manuscript.

larly hospital based, the higher rate of transmission can

Conflict of interest: None

be attributed to the difference in the levels of interven-

Funding: None

169

Acknowledgement

Mr Kayode is greatly appreciated for his contribution in

the DNA-PCR test for the HIV exposed babies. Dr

Emodi is also acknowledged for the supervision of this

work.

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