By Kuda Pembere
Point of care testing in children helped Zimbabwe reduce Mother to child Transmission (MTCT), infant mortality and morbidity over the past two decades, Professor Lynn Zijenah an immunologist says.
Nationally, MTCT in the early 2000s amidst the absence of HIV interventions was more than 30 percent till it dropped to 8 percent according to latest figures.
Presenting a research at the Cepheid Booth at the ICASA 2023 conference, Prof Zijenah said in the research where 500 HIV positive pregnant women were enrolled they MTCT rate was 1.55 percent/
“At the end of the 24 months follow up study in 2020, the retention rate was more than 95 percent. All the infants received nevirapine in the first six weeks of life. All except one set of twins were exclusively breast fed in the first six months of life.
“The MTCT rate was 1.55 percent. The current national MTCT rate in Zimbabwe is 8 percent. Of the seven HIV-infected, four infants were infected in-utero, one infant was infected intrapartum and two infants were infected post partum.
“In the first 24 months of life in-utero transmission was the major rout of MTCT. POC testing should thus be commenced at birth. The majority of transmitters that is 86 percent were in their third trimester and had been on cART for less than six months,” she said.
During the rime when HIV interventions were unavailable, the infant mortality rate was as high as 20 percent for Harare.
“The maternal and infant mortality rates were 0.21 percent and 1.78 percent respectively. In the early 2000s in the absence of any intervention, we reported an MTCT rate of 30.7 percent and an infant mortality rate of 19.6 percent, in the first two years of life among HIV infected infants in Harare.
“Thus POC testing not only contributed to drastic reduction of MTCT but also maternal and infant mortality as well as increased rate retention in care,” she said.
Zimbabwe started the Option B Plus initiative which sees HIV negative infants on nevirapine prohylaxis for the first six weeks of life following point of care diagnosis using Cepheid GeneXpert qualitative assays.
“Strategies for preventing MTCT have evolved dramatically over the years since the late 1980s. The latest WHO recommendation of 2013 is the Option B plus which includes provision of children ART to HIV-infected pregnant women regardless of CD4 cell count, or WHO clinical stage, prophylaxis of infants with daily Nevirapine for the first six weeks of life, exclusive breast feeding during the first six months of life, early infant diagnosis and commencement of pediatric ART to the HIV infected infants,” Prof Zijenah said. “The Zimbabwe ministry of health and child care adopted Option B plus for prevention of MTCT in 2014. Under the National PMTCT program, dried blood spots were sent from PMTCT centers nationwide to the three centralized laboratories for EID of HIV infection starting at 4 to 6 weeks postnatally. In 2017, we conducted a study at Mabvuku Polyclinic, primary health centre in Harare with the aim of optimizing Option B plus. We enrolled 500 HIV infected pregnant women at various stages of gestation who had registered for Antenatal services and their newly born babies. We had the GeneXpert machine installed at Mabvuku Polyclinic laboratory.”
She added, “We employed the POC GeneXpert HIV-1 Quantitative assay to quantify maternal VL at enrolment into the study and every six months thereafter up to 24 months. The women with a VL of more than 1 000 copies per milligram in two consecutive tests were reffered to the clinic for extensive adherence counselling before decision to switch to other pediatric ART if suspected of having developed resistance to their current pediatric ART regimen.”
To avoid the death of HIV infected babies before the age of two years, she said it is critical for these babies to be tested at birth, which is what the Zimbabwean government is doing.
“Mother to child transmission of HIV which can occur in-utero, intrapartum, and post partum mainly through breast feeding is the major source of HIV infection in children. In the absence of any intervention, MTCT rates range from 15 to 45 percent.
“However, with combination ART for children, combined with other effective interventions, MTCT rates can be reduced to below 5 percent. In the absence of any interventions, to reduce MTCT, one third of HIV infected infants die before their first birthday, and more than 50 percent die before their second birthday,” Prof Zijenah said.
