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Evaluation of PMTCT Program Progress and Outcomes in Nigeria

Explore the expansion and outcomes of a PMTCT program in Nigeria from 2002 to 2008, focusing on interventions, services, variables, prophylaxis, and transmission risks associated with maternal and infant care. Detailed analysis reveals trends in HIV transmission rates, gender differences in viral load suppression, and key factors influencing program success.

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Evaluation of PMTCT Program Progress and Outcomes in Nigeria

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  1. APIN Plus/Harvard PEPFAREvaluation of PMTCT Program Phyllis Kanki Seema Meloni

  2. APIN Plus/Harvard PEPFAREvaluation of PMTCT Program • 4 sites developed through Gates funded APIN program 2002-2004 • Training of health care workers • Development of labs • PEPFAR provided ART to eligible mothers and infected infants • 2005- PEPFAR expanded to 9 PMTCT sites • 2006 - PEPFAR expands to 16 PMTCT sites • 2007 - PEPFAR expands to 32 PMTCT sites

  3. Program Overview • At present, conducting PMTCT activities at 29 sites and expanding to 36 by end of 2008 • PMTCT services: 174,000 cumulative • ARV prophylaxis: >5,000 cumulative

  4. Program Evaluation • Effort to document outcomes in APIN Plus/Harvard PEPFAR PMTCT program • Collaborative evaluation of data from 4 sites: NIMR, UCH, JUTH, LUTH • Data collected from charts and electronic databases

  5. Variables Mother • Entry point • Prophylaxis • Age • Highest level of education • CD4, VL • Type of delivery • Conditions • Site Infant • Gestational age • Prophylaxis • Feeding method • Sex • Plurality

  6. Most patients received some ANC Number of patients

  7. Revised Nigerian PMTCT Guidelines (2005) Entry 28-33 weeks ZDV NVP 1 wk ZDV NVP 1 wk ZDV Entry >34 weeks ZDV+3TC NVP 1 wk ZDV Entry at Labor NVP after delivery 6 weeks ZDV syrup PCR Mom Delivery NVP Baby Assess for ART eligibility

  8. Majority of deliveries at secondary and tertiary sites

  9. Most infants born by SVD and C/S primarily performed at tertiary sites Number of patients

  10. Maternal Prophylaxis • 84% of HAART-eligible and 12% of HAART-ineligible mothers were on HAART

  11. Variables Associated with Increased Risk of Transmission at 6 weeks

  12. Maternal prophylaxis • 3% of infants HIV+ at 6 weeks (80/2,395) P<0.001 Transmission Rate Maternal Prophylaxis

  13. Rupture of Membranes > 4 hours p=0.01 Transmission Rate Duration of membrane rupture

  14. Undetectable viral load prior to/at delivery p=0.002 Transmission Rate

  15. Variables not associated with transmission risk • Delivery mode • Delivery site • Mother’s age • Mother’s educational status • Episiotomy • CD4 count • Gestational age at delivery • Infant sex • Birth weight • Vaginal tear, excessive bleeding

  16. Variables Associated with Increased Risk of Transmission at 6 months

  17. Infant prophylaxis p=0.03 Transmission Rate

  18. Infant feeding* P<0.001 Transmission Rate • *Combines data for all those infected at 6 months, regardless of time of infection • When limit to only those infected after 6 week timepoint, association disappears

  19. Infant - gender* p=0,06 Transmission Rate • *Other groups have found associations with infant gender and transmission risk; our data indicate a slightly higher risk for girls

  20. Summary • Increased risk of transmission at 6-weeks for infants whose mothers: • No prophylaxis • None>NVP only>CBV+NVP>AZT+NVP>HAART • No ANC care • Detectable VL prior to/at delivery • Increased risk of transmission at 6 months for infants that received no prophylaxis

  21. Gender difference in viral load suppression Naïve patients or experienced patients with detectable VL at enrollment 6 months (n=11,076): Females - 60% Males - 58% (p=.008) 4292/7141 2262/3935 12 months (n=9061): Females - 63% Males - 60% (p=.002) 3748/5877 1923/3184

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