Short course zidovudine and nevirapine for prevention of mother to child transmission of HIV in Uganda: A propensity score application.

摘要

Randomized clinical trials have demonstrated efficacy of short course anti retroviral therapy in the peripartum period for reduction of HIV transmission from mother to child by up to 50%. In the year 1999, the Ugandan Ministry of Health, and other partners initiated a pilot project to administer short course zidovudine (AZT) and nevirapine (NVP) to HIV positive pregnant women.; The overarching goal of this study was to evaluate the effectiveness of the prevention of mother to child transmission (PMTCT) intervention program in reducing vertical transmission of HIV in Uganda. Specifically, to determine the characteristics associated with acceptance of HIV test among pregnant women attending ANC clinics in Uganda, to determine factors associated with infant feeding choices by HIV positive pregnant women in the context of free formula and breast-feeding cultural norms, and to determine the effectiveness of short course NVP versus AZT for PMTCT of HIV. We analyzed data from four pilot sites; Lacor, Mengo, Mulago and Nsambya hospitals. To compare the effectiveness of AZT versus NVP, we performed a propensity score method analysis adjusting for propensity to receive AZT and other known risk factors of vertical transmission of HIV.; Between January 2000--November 2002, 20,972(67%) of the 31,953 women who received pre test counseling at the four hospitals accepted HIV testing. Age, education level, past HIV test, and single marital status were associated with test acceptance. Of the 1,593 women enrolled in the pilot program, 67% chose to breastfeed even when free infant formula was provided. Education level, partner's knowledge of the HIV status, presence of HIV related event, and past antiretroviral drugs use predicted formula feeding. In this pilot program, NVP and AZT were effective in reducing transmission of HIV from mother to child at 13.3% and 13.6%, respectively. At Nsambya hospital, risk of HIV transmission tended to be higher among women who received AZT versus NVP after adjusting for propensity score, infant feeding, method of delivery, and stage of HIV disease (odds ratio 2.02, 95%CI, 0.77--5.25).; In the context of high prevalence of HIV, acceptability of HIV testing was inadequate at 67%. In Uganda, provision of free formula did not guarantee formula feeding. In the field setting, short course AZT and NVP were effective in preventing MTCT of HIV.