289047
Identifying risk factors for vertical HIV transmission from a prevention of mother-to-child transmission (PMTCT) program evaluation in bamako, Mali
Yssouf Kone, M.D.,
GAIA Vaccine Foundation, Community Health Center, ASACOMSI, Mékin-Sikoro, Bamako, Mali
Youssouf Traoré, M.D.,
Department of Obstetrics and Gynecology, Gabriel Touré Hospital, Bamako, Mali, Bamako, Mali
Flabou Bougoudogo,
National Institute of Public Health Research, Bamako, Mali, Bamako, Mali
BACKGROUND: In Mali, Prevention of Mother-to-Child Transmission (PMTCT) is not yet available in community health centers (CSCOMs), the lowest tier of the public health system. We therefore (1) established a PMTCT program in a CSCOM located in Bamako, Mali, (2) identified risk factors associated with vertical HIV transmission among HIV-positive women and their children attending the clinic, and (3) evaluated whether the PMTCT intervention was successful at the five-year point. METHODS AND RESULTS: A PMTCT program was established within a CSCOM in collaboration with the local department of health. Structured interviews were conducted with women enrolled in the PMTCT program to assess risk factors for HIV transmission and program participation five years after the program was initiated. Significant reductions in odds of transmission were seen when antiretroviral (ARV) treatment was provided during pregnancy (OR=14.4, 95%CI: 2.20-90.6, p=0.0048) or to infants immediately after birth (OR=11.3, 95%CI: 1.86-90.6, p=0.0070). Breastfeeding with concomitant ARV treatment was also shown to significantly reduce the risk of HIV transmission (p=0.0340), though breastfeeding without ARV treatment significantly increased the odds of transmission (OR=5.7, 95%CI: 1.15-28.3, p=0.0447). CONCLUSIONS: Prevention of mother-to-child transmission can be achieved in low-resource settings. This evaluation of a PMTCT program based in an infirmary-style (CSCOM) clinic in Mékin-Sikoro, a peri-urban slum located in Bamako, suggests PMTCT interventions are feasible and can be successful in such contexts. Expansion of PMTCT programs to more CSCOMs in West Africa may limit vertical HIV transmission in the region and could reduce the prevalence of HIV among children.
Learning Areas:
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Learning Objectives:
Demonstrate the feasibility of establishing a Prevention of Mother-to-Child HIV Transmission (PMTCT) program in an infirmary-style clinic (CSCOM) in the low-resource setting of Bamako, Mali.
Identify risk factors associated with vertical HIV transmission among HIV-positive women and their children in the context of this PMTCT program.
Evaluate whether the PMTCT intervention was successful at the five-year point.
Discuss the potential for limiting vertical HIV transmission and reducing the HIV prevalence among children by expanding PMTCT programs to more CSCOMs in West Africa.
Keyword(s): HIV/AIDS, Prevention
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been a GAIA Vaccine Foundation researcher both at the bench and in the field since graduating from Brown University in 2010. My published work has focused on epitope validation for HIV vaccine design; knowledge, attitudes, and practices in the context of HIV and HPV; and vaccine acceptability in Bamako, Mali. Among my scientific interests is the identification of maternal-child transmission risk factors to improve Prevention of Mother-to-Child Transmission (PMTCT) programs in West Africa.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
