Prevention & Care of Pediatric HIV Infection in Ouagadougou, Burkina Faso: Knowledge, Attitudes & Practices of the Caregivers

Background

The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso.

Methods

We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows:

those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment.

Results

A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done.

Conclusions

This study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care.

Caregivers’ knowledge, attitudes and perceptions in Ouagadougou, Burkina Faso, 2011

	Total N = 37 100 %	Group 1 N = 11 100 %	Group 2 N = 4 100 %	Group 3 N = 5 100 %	Group 4 N = 17 100 %	Groups 1 + 2 + 3 N = 20 100 %	P-value (Group 1 + 2 + 3 vs Group 4)
Caregiver’s knowledge of existing interventions to prevent MTCT of HIV
Yes	30 (81)	7 (64)	4 (100)	3 (60)	16 (94)	14 (70)	0.16
No	1 (3)	0 (0)	0 (0)	1 (20)	0 (0)	1 (5)
No response	6 (16)	4 (36)	0 (0)	1 (20)	1 (6)	5 (25)
Caregiver’s knowledge regarding existing methods of infant HIV diagnosis
Yes	32 (86)	8 (73)	4 (100)	5 (100)	15 (88)	17 (85)	0.77
No	5 (14)	3 (27)	0 (0)	0 (0)	2 (12)	3 (15)
Caregiver’s knowledge regarding existing treatment of HIV-infected infants
Yes	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)		Not applicable
No	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Caregiver’s attitude regarding the practice of their child systematic HIV testing
For	31 (84)	11 (100)	3 (75)	4 (80)	13 (76)	18 (90)	0.26
Against	6 (16)	0 (0)	1 (25)	1 (20)	4 (24)	2 (10)
Caregiver’s attitude regarding the antiretroviral treatment of HIV-infected children
For	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)	20 (100)	Not applicable
Against	0 (0)	0 (0)	0 (0)	0 (0.0)	0 (0.0)	0 (0)
Parent’s consent needed for child HIV-test
Yes	24 (65)	8 (73)	3 (75)	4 (80)	9 (53)	15 (75)	0.16
No	13 (35)	3 (27)	1 (25)	1 (20)	8 (47)	5 (25)
Parent’s consent needed for child treatment
Yes	11 (30)	6 (55)	0 (0)	1 (20)	4 (24)	7 (35)	0.25
No	24 (65)	4 (36)	3 (75)	4 (80)	13 (76)	11 (55)
No response	2 (5)	1 (9)	1 (25)	0 (0)	0 (0)	2 (10)

Group 1: caregivers of HIV-infected child currently treated with antiretroviral therapy

Group 2: caregivers of HIV-infected child not yet initiated on antiretroviral therapy

Group 3: caregivers waiting for their child’s HIV post-test result

Group 4: caregivers attending paediatric ward, with an unknown HIV child status

Vs versus

Full article at:   http://goo.gl/1Dwg43

By:  Malik Coulibaly, Elisabeth Thio, Caroline Yonaba, Sylvie Ouédraogo, Nicolas Meda, Fla Kouéta, Désiré Lucien Dahourou, Angèle Kalmogho, Mady Gansonré, Diarra Yé, Ludovic Kam, Valériane Leroy, and for the MONOD Study Group*

Projet MONOD, ANRS 12206, Centre de Recherche Internationale pour la Santé, 09 BP 168 Ouagadougou, Burkina Faso

Centre Muraz, Bobo Dioulasso, Burkina Faso

CHU Charles De Gaules, Service de Pédiatrie médicale, Ouagadougou, Burkina Faso

CHU Yalgado Ouédraogo, Service de Pédiatrie, Ouagadougou, Burkina Faso

Inserm U1219, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France

Inserm U1027 Université Paul Sabatier, Toulouse 3, Toulouse, France

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Early Diagnosis of HIV-1 in Infants: The Prevention of Mother-To-Child Transmission Program in Equatorial Guinea

BACKGROUND:

Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program.

METHODS:

A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay.

RESULTS:

Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5).

CONCLUSIONS:

The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection.

Purchase full article [In Spanish] at:  http://goo.gl/cP1e56

By:  Prieto-Tato LM1, Vargas A2, Álvarez P3, Avedillo P4, Nzi E5, Abad C4, Guillén S6, Fernández-McPhee C3, Ramos JT7, Holguín Á3, Rojo P4, Obiang J8.

• 1Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España. Electronic address: lmprieto.hugf@salud.madrid.org.
• 2Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, RICET, Madrid, España.
• 3Laboratorio de Epidemiología Molecular VIH-1, Departamento de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, IRYCIS y CIBERESP, Madrid, España.
• 4Departamento de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España.
• 5Servicio de Análisis Clínicos, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial.
• 6Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España.
• 7Servicio de Pediatría, Hospital Universitario Clínico San Carlos, Madrid, España.
• 8Servicio de Pediatría, Hospital Regional de Bata Dr. Damian Roku, Bata, Guinea Ecuatorial. 

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Performance of Roche CAP/CTM HIV-1 Qualitative Test Version 2.0 Using Dried Blood Spots for Early Infant Diagnosis

In the context of early infant diagnosis (EID) decentralization in sub-Saharan Africa, dried blood spot (DBS) is now widely used for HIV proviral DNA detection in resource-limited settings. 

A new version of CAP/CTM (version 2) has been introduced, recently by Roche Diagnosis as a new real-time PCR assay to replace previous technologies on qualitative detection of HIV-1 DNA using whole blood and DBS samples. 

The objective of this study was to evaluate CAP/CTM version 2 compared to CAP/CTM version 1 and Amplicor on DBS. A total of 261 DBS were collected from children aged 4 weeks to 17 months born from HIV-seropositive mothers and tested by the three techniques. CAP/CTM version 2 showed 100% of agreement with Amplicor including 74 positive results and 187 negative results. CAP/CTM version 2 versus CAP/CTM version 1 as well as CAP/CTM version 1 versus Amplicor showed two discordant results giving a sensitivity of 98.6%, specificity of 99.5%, positive predictive value of 98.6% and negative predictive value of 99.5%. 

The concordance was 99.12% (95% of confidence interval) giving a Kappa coefficient of 0.97 (p<0.001). These findings confirmed the expected good performance of CAP/CTM version 2 for HIV-1 EID.

Purchase full article at:   http://goo.gl/gpzTkR

By:   Gueye SB¹, Diop-Ndiaye H², Diallo MM³, Ly O⁴, Sow-Ndoye A⁵, Diagne-Gueye ND⁶, Kébé-Fall K⁷, Diop F⁸, Gaye-Diallo A⁹, Belec L¹⁰, Mboup S¹¹, Touré-Kane C¹².

¹Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: sbgueye@yahoo.fr.

²Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: halimatoudiop@yahoo.fr.

³Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: malickdiari@yahoo.fr.

⁴Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: omarlyster@gmail.com.

⁵Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: sowaicha@yahoo.fr.

⁶Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: diabou.diagne@yahoo.fr.

⁷Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: didi_sn@yahoo.fr.

⁸Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: fatyraza@hotmail.fr.

⁹Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: ayougayediallo@gmail.com.

¹⁰Laboratoire de Virologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital, Européen Georges Pompidou / Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: prbelecl@yahoo.fr.

¹¹Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: virus@orange.sn.

¹²Laboratoire de Bactériologie-Virologie CHU Aristide Le Dantec, Université Cheikh, Anta Diop, Dakar, Senegal. Electronic address: ctourekane@yahoo.co.uk.

  

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Use of peers, community lay persons and Village Health Team (VHT) members improves six-week postnatal clinic (PNC) follow-up and Early Infant HIV Diagnosis (EID) in urban and rural health units in Uganda: A one-year implementation study

Background

Effective Prevention of Mother to child Transmission of HIV (PMTCT) relies heavily on follow-up of HIV-infected women and infants from antenatal, through postnatal, to the end of the breastfeeding period. In Uganda, postnatal (PNC) follow-up remains below 50 % creating a missed opportunity for linkage to comprehensive HIV care and early infant diagnosis (EID). We evaluated the use of HIV infected peer mothers (peers), community lay persons and Village health team (VHT) members to improve PNC follow up and EID in urban and rural health units.

Methods

Study participants were HIV-infected women recruited from antenatal clinics at three urban clinics (Mulago, Rubaga and Mengo hospitals) and one rural health centre (Mpigi Health centre IV) between January and September 2010. The women were followed through delivery and the mother-infant pairs for the 6-week postnatal visit and up to 14 weeks for EID. Peers, community lay persons and VHT members were identified and trained in basic PMTCT and reproductive health (RH). They were then assigned to study clinic to support and follow study participants, their partners and infants through provision of health education, counseling, home visits, and phone call reminders. Six week PNC attendance was measured as a proportion of mother-infant pairs that returned for the 6-week postnatal follow up visit (5–8 weeks) while EID was measured as the proportion of HIV-exposed live birth that had an HIV test done by 14 weeks of age. Data at baseline (one year before the intervention) was compared with that during the one year study period among study participants and HIV infected women and their HIV-exposed infants in the whole clinic population.

Results

A total of 558 HIV-infected pregnant women were recruited for the study, 47 mother-infant pairs were censured before 6 weeks due to stillbirth (14), infant death < 6 weeks (23), death of participant (04) and loss to follow up before delivery (6). 401/511 (78.5 %) of mother-infant pairs returned to the study clinics at six-week, while 441/511 (86.3 %) infants were tested for HIV infection by 14 weeks of age. The baseline six-week PNC follow up was 37.7 % and increased during the study period to 78.5 % and 39.1 % among study participants and whole clinic population respectively, an incremental difference of 39.4 % (P < 0.001). EID increased from a baseline of 53.6 % to 86.3 % and 65.8 % among study and whole clinic population respectively during the study period, an incremental difference of 20.5 % (P < 0.001).

Conclusions

Use of peers, community lay persons and VHT members led to a significant increase in six-week postnatal follow up of HIV infected women and EID among HIV exposed infants in the four study clinics. Our study supports the use of peers to improve early postnatal follow up and EID and should be implemented in other health units to support the PMTCT cascade.

Below:  Enrollments, Live deliveries and 6 weeks PNC attendance among study participants

Full article at:  http://goo.gl/bwdFzb

By:   Zikulah Namukwaya^1*, Linda Barlow-Mosha¹, Peter Mudiope¹, Adeodata Kekitiinwa²³,Joyce Namale Matovu¹, Ezra Musingye¹, Jane Ntongo Ssebaggala¹, Teopista Nakyanzi¹,Jubilee John Abwooli⁴, Dorothy Mirembe¹, Juliane Etima¹, Edward Bitarakwate⁵, Mary Glenn Fowler¹, Philippa Martha Musoke¹³ and Peer-senga study Group at Mulago, Mengo, Rubaga and Mpigi Health Units

¹Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Kampala, Uganda

²Baylor College of Medicine Children’s Foundation, Kampala, Uganda

³Makerere University College of Health Sciences, Pediatrics and Child Health, Kampala, Uganda

⁴Mpigi Health Centre IV, Mpigi, Uganda

⁵Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda

 

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Disclosure, Stigma of HIV Positive Child & Access to Early Infant Diagnosis in the Rural Communities of OR Tambo District, South Africa: A Qualitative Exploration of Maternal Perspective

Below:  Cascade of early infant diagnosis (EID) Services

The participants have fairly good knowledge of mother-to-child transmission of HIV and the risks during pregnancy, delivery and breastfeeding. The majority of participants were confident of the protection offered by anti-retroviral drugs provided during pregnancy, however, lack knowledge of optimal time for early infant diagnosis of HIV. Reasons for not accessing EID included fear of finding out that their child is HIV positive, feelings of guilt and/or shame and embarrassment with respect to raising an HIV infected infant. Personal experiences of HIV diagnosis and HAART were associated with participants’ attitudes and beliefs toward care-seeking behaviours. Stigma resulting from their own disclosure to others reduced their likelihood of recommending EID to other members of their communities.

Despite the good knowledge of mothers about infant HIV infection and the availability of treatment, the knowledge of the optimal time for early infant diagnosis is lacking. Fear of infant HIV diagnosis and stigma are challenges for universal coverage of early infant diagnosis in these rural communities. Hence, community education and intensive counselling of pregnant women about early infant diagnosis are urgently needed.

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