The evolving pediatric HIV epidemic in rural southern Zambia: the beneficial impact of advances in prevention and treatment at a district hospital from 2007 to 2019

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Sutcliffe, Catherine G. ; Moyo, Nkumbula ; Hamahuwa, Mutinta ; Mutanga, Jane N. ; van Dijk, Janneke H. ; Hamangaba, Francis ; Schue, Jessica L. ; Thuma, Philip E. ; Moss, William J.
• Description:
  Background:
  
  Remarkable progress has been made in expanding access to services addressing the pediatric HIV epidemic, including programs to prevent mother-to-child transmission, early diagnosis, and treatment for children living with HIV. Few long-term data are available from rural sub-Saharan Africa to assess implementation and impact of national guidelines.
  
  Methods:
  
  Results from three cross-sectional studies and one cohort study conducted at Macha Hospital in Southern Province, Zambia from 2007-2019 were summarized. For infant diagnosis, maternal antiretroviral treatment, infant test results, and turnaround times for results were evaluated by year. For pediatric HIV care, the number and age of children initiating care and treatment, and treatment outcomes within 12 months were evaluated by year.
  
  Results:
  
  Receipt of maternal combination antiretroviral treatment increased from 51.6% in 2010-2012 to 93.4% in 2019, and the proportion of infants testing positive decreased from 12.4% to 4.0%. Turnaround times for results returning to clinic varied but were shorter when labs consistently used a text messaging system. The proportion of mothers receiving results was higher when a text message intervention was piloted. The number of children living with HIV enrolled into care and the proportion initiating treatment with severe immunosuppression and dying within 12 months decreased over time.
  
  Conclusions:
  
  These studies demonstrate the long-term beneficial impact of implementing a strong HIV prevention and treatment program. While expansion and decentralization brought challenges, the program succeeded in decreasing the rate of mother-to-child transmission and ensuring that children living with HIV benefit from access to life-saving treatment.
  
  
• Subjects:
  Anti-Retroviral Agents Antiretroviral Therapy Article Child Cohort Studies Cross-Sectional Studies Early Infant Diagnosis Female HIV HIV Infections Hospitals, District Humans Infant Infectious Disease Transmission, Vertical Pediatrics Sub-Saharan Africa Zambia

  More +
• Source:
  Pediatr Infect Dis J. 42(6):489-495
• Pubmed ID:
  36795584
• Pubmed Central ID:
  PMC10360039
• Document Type:
  Journal Article
• Funding:
  R01 AI116324/AI/NIAID NIH HHSUnited States/ ; U2G PS001930/PS/NCHHSTP CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Place as Subject:
  Zambia
• Volume:
  42
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:926c16c07c2c7b439336fbe84cc1fc75c978ff68679ac27fea7419de79901604
• Download URL:
  https://stacks.cdc.gov/view/cdc/131201/cdc_131201_DS1.pdf
• File Type:
  [PDF - 492.92 KB ]