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The Impact of Maternal Highly Active Antiretroviral Therapy and Short-Course Combination Antiretrovirals for Prevention of Mother-to-Child Transmission on Early Infant Infection Rates at the Mulago National Referral Hospital in Kampala, Uganda, January 2007 to May 2009

Namukwaya, Zikulah MBChB, MPH***; Mudiope, Peter MBChB, MSc*††; Kekitiinwa, Adeodata MMed†‡; Musoke, Philippa MBChB*†; Matovu, Joyce MA Psychology***; Kayma, Sarah NO***; Salmond, William MA§; Bitarakwate, Edward MMed, MPH§; Mubiru, Michael BSc, Dip Med Stat*††; Maganda, Albert MSc Statistics‡‡‡; Galla, Moses MCO‡§§; Byamugisha, Josaphat MMed, PhD; Fowler, Mary Glenn MD, MPH*¶‖‖

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2011 - Volume 56 - Issue 1 - p 69-75
doi: 10.1097/QAI.0b013e3181fdb4a8
Epidemiology and Prevention

Background: Early HIV infant diagnosis and treatment have been shown to dramatically improve survival in infants. Despite these findings, infants accessing HIV diagnosis and treatment remain low in Uganda. We describe the antiretroviral (ARV) drugs given in the Mulago Hospital prevention of mother-to-child transmission (PMTCT) program from January 2007 to May 2009 and its impact on early infant HIV infection rates.

Methods: Pregnant women identified as HIV infected in the Mulago antenatal clinics received one of the following regimens: short-course ARV prophylaxis plus single-dose nevirapine (sdNVP) in labor, highly active antiretroviral therapy (HAART), or sdNVP if they presented in labor. Infants received sdNVP and zidovudine (ZDV) for 1 week. Infants HIV diagnosis was done from 6 weeks after delivery.

Results: 62.3% of HIV-infected women received combination ARVs, including HAART. Early infection rates were highest among infants with no maternal ARV [36.4; 95% confidence interval (CI): 17.2 to 59.3] or only sdNVP (11.2; 95% CI: 8.1 to 14.8). Similar rates were observed for the group that took short-course ARVs, ZDV/sdNVP (4.6; 95% CI: 3.2 to 6.4), and ZDV/lamivudine/sdNVP (4.9; 95% CI: 3.1 to 7.2) and lowest rates for those that took HAART (1.7: 95% CI: 0.8 to 2.8). Overall infection rate was 5.0% (95% CI: 4.1 to 5.9).

Conclusions: Findings indicate low rates of infant infection for mothers receiving combination ARVs. These findings demonstrate that provision of combination ARV for PMTCT is feasible and effective in busy referral hospital's PMTCT programs in resource-limited settings.

From the *Makerere University Johns Hopkins Research Collaboration, Mulago Hospital, Uganda; †Department of Pediatrics and Child Health, Makerere University College of Health Sciences; ‡Baylor College of Medicine Children's Foundation-Uganda, Mulago Hospital; §Elizabeth Glaser Pediatric AIDS Foundation, Kampala Uganda; ∥Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences; ¶Johns Hopkins Medical Institutes, Baltimore MD; **Division of Prevention of Mother to Child HIV Transmission; ††Division of Data Management and Analysis; ‡‡Data Management Section; §§Mulago Hospital, Post Natal Clinic; and ∥∥Department of Pathology.

Received for publication June 22, 2010; accepted September 21, 2010.

The authors have no funding or conflicts of interest to disclose.

Correspondence to: Zikulah Namukwaya, MBChB, MPH, Makerere University Johns Hopkins Research Collaboration, Mulago Hospital, Box Office 23491, Kampala, Uganda (e-mail

© 2011 Lippincott Williams & Wilkins, Inc.