LBPEC21
Share
 
Title
Multi-country evaluation of survival and HIV-free survival among children under 3 years of age of women living with HIV in eight sub-Saharan African countries: Results from population-based HIV impact assessments
Presenter
Eugenie Poirot
Authors
S. Saito1, K. Yuengling1, S. Jonnalagadda2, J. Galbraith3, W. Kirungi4, M. Eliya5, Z. Minisi6, N. Hamunime7, J. Mushi8, A. Rwebembera9, A. Mushavi10, E.J. Dziuban11, E. Gonese12, P. Rwehumbiza13, K. Hageman13, C. Ryan14, E. Poirot1, H. Patel2, E. Kim15, E.J. Abrams1, S. Modi2
Institutions
1ICAP at Columbia University, New York, United States, 2Centers for Disease Control and Prevention (CDC), Atlanta, United States, 3Centers for Disease Control and Prevention (CDC) - Uganda, Kampala, Uganda, 4Uganda Ministry of Health, Kampala, Uganda, 5Malawi Ministry of Health, Lilongwe, Malawi, 6Eswatini Ministry of Health, Mbabane, Eswatini, 7Namibia Ministry of Health and Social Services, Windhoek, Namibia, 8Ministry of Health, Community Development, Gender, Elderly and Children, The National AIDS Control Program (NACP), Dar Es Salaam, Tanzania, United Republic of, 9Tanzania National AIDS Council, Dar Es Salaam, Tanzania, United Republic of, 10Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 11Centers for Disease Control and Prevention (CDC) - Namibia, Windhoek, Namibia, 12Centers for Disease Control and Prevention (CDC) - Zimbabwe, Harare, Zimbabwe, 13Centers for Disease Control and Prevention (CDC) - Tanzania, Dar Es Salaam, Tanzania, United Republic of, 14Centers for Disease Control and Prevention (CDC) - Eswatini, Mbabane, Eswatini, 15Centers for Disease Control and Prevention (CDC) - Malawi, Lilongwe, Malawi

Background: We used population-based household survey data to estimate survival and HIV-free survival through age 3 years in children of women living with HIV (CoWLHIV), accounting for maternal antiretroviral treatment (ART) status, in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe.
Methods: Maternal HIV status and ART use during last pregnancy in the past 3 years, HIV status of their children, current age of living children, and age of death of deceased children were determined through maternal interviews. A sub-sample of children underwent HIV testing using rapid test and Geenius? HIV-1/2 confirmatory assay (≥18 months) and virologic testing (< 18 months). We performed Kaplan-Meier analyses to estimate probability of survival and HIV-free survival at 3 years. Children were censored at HIV diagnosis, death or 3 years of age.
Results: Of the 16,006 children, 2,373 were CoWLHIV. Among CoWLHIV, 2138 were HIV-uninfected, 127 were HIV-infected, and 108 had died before 3 years. Survival probability at 3 years was similar among CoWLHIV and children of HIV-uninfected women (Figure 1). HIV-free survival at 3 years was 85% (CI: 83%-87%) among CoWLHIV and highest among children of mothers who were on ART at first antenatal visit compared to children of mothers who had initiated or who did not take ART during pregnancy (Figure 2).
Conclusions: The findings demonstrate the impact of maternal ART in improving survival among CoWLHIV in Africa, particularly with ART initiation before pregnancy. Elimination of MTCT requires programs to close the gap in maternal HIV diagnosis and ART coverage.


Figure 1. Child survival Up to 3 years of Age by HIV Status of Mothers (n = 16,006)
[Figure 1. Child survival Up to 3 years of Age by HIV Status of Mothers (n = 16,006)]




Figure 2. HIV-Free Survival among CoWLHIV, by Maternal ARV Use during Pregnancy (n = 2,370)
[Figure 2. HIV-Free Survival among CoWLHIV, by Maternal ARV Use during Pregnancy (n = 2,370)]

Download the e-Poster