HIV infant diagnosis follow shows challenges to successful program

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mmwrfeb2114uncroIn Botswana, where in 2011 more than 30 percent of pregnant women were estimated to have HIV,  rates of mother to child transmission of HIV have dropped in the last decade from as high as 40 percent, to less than 4 percent. Between 2005 and 2012, of more than 10,000 infants exposed to HIV, more than 7,000 were tested, and 202 were diagnosed with the virus.

By 2013, 82 of those children were alive and receiving antiretroviral treatment. Of the rest, 79 children had died. The outcomes for the others, 41 children are uncertain; they were “lost to follow-up” had transferred to another health service setting, or their mothers had turned down antiretroviral treatment.

That is the sobering news from one of the most successful programs to prevent mother-to-child HIV transmission in sub-Saharan Africa, according to a report in the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report released Thursday.

It is a successful program because outcomes could be much worse. More than 95 percent of pregnant women in Botswana register for prenatal care, almost all are offered services to prevent mother-to-child HIV transmission, and infants born to women who have the virus are tested early.

But the challenges highlighted by the outcomes for the 202 children followed include familiar ones, including difficulty getting to clinics, long wait times once there and fear on the part of mothers of having their own HIV infection known. Lack of coordination across services led to waits between testing, post-test counseling, and starting antiretroviral treatment. The report recommends a comprehensive strategy to improve outcomes following infant HIV diagnoses, including strengthening referral systems to reduce waits, and addressing educational, structural and cultural obstacles.

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