Academic journal article Bulletin of the World Health Organization

Preventing Vertical Transmission of HIV in Kinshasa, Democratic Republic of the Congo: A Baseline Survey of 18 Antenatal Clinics

Academic journal article Bulletin of the World Health Organization

Preventing Vertical Transmission of HIV in Kinshasa, Democratic Republic of the Congo: A Baseline Survey of 18 Antenatal Clinics

Article excerpt

Introduction

At the end of 2005, an estimated 38.6 million people were living with human immunodeficiency virus (HIV). Nearly two-thirds of these were in sub-Saharan Africa (1,2) where countries struggling to respond to the crisis are simultaneously battling poverty, poor infrastructure, competing health needs and, in some cases, civil unrest. In 2004, women represented 57% of all cases of HIV in sub-Saharan Africa and made up nearly three-quarters of new infections in the 15-24 years age group in the region. (3)

Approximately 700 000 children younger than 15 years were newly infected with the virus in 2005. (1) Almost 90% of these newly infected children were born to HIV-infected mothers and acquired HIV during pregnancy, labour and delivery, or via breastfeeding. (1,3,4) Interventions to reduce the transmission of HIV from an infected mother to her infant include antiretroviral regimens, Caesarean delivery, and avoidance of breastfeeding. (5) Short-course antiretroviral regimens given during pregnancy and/or labour and delivery can reduce rates of mother-to-child-transmission by 37-50%. (6-10) Such interventions are becoming more common in developing countries and are often integrated within existing antenatal care services. The purpose of our study was to assess the existing content and delivery of essential antenatal services before implementation of prevention of mother-to-child transmission (PMTCT) roll-out in Kinshasa, Democratic Republic of the Congo (DRC).

The DRC is emerging from nearly a decade of civil war and ethnic strife that has disrupted civil society, undermined an already weakened infrastructure and decimated the country's standard of living. Between 1997 and 2001, annual per capita expenditures in health ranged from US$ 11-13. (11) Life expectancy fell from 52 years to 45 years between 1990 and 2001. (11) According to the World Bank, the gross national income per capita in the DRC was US$ 100 in 2003. (12)

The DRC was one of the first African countries to document HIV/ acquired immunodeficiency syndrome (AIDS) cases in the early 1980s. Between 1986 and 1989, HIV prevalence among pregnant women in urban areas ranged from 5.8% to 6.50/0. (13,14) Since then, HIV prevalence among women attending antenatal care in Kinshasa has fluctuated, from 5.7% in 1987 to 10.8% in 1992, 5.4% in 1999, and 3.0% in 2002. (15) In 2004, the HIV prevalence in the DRC population was estimated to be 4.2%. (15)

The current population of Kinshasa, capital of the DRC, is unknown. The last census, conducted in 1984, placed the capital's population at 4.3 million. (16) Since then, the city's population has grown as a result of high fertility rates and migration to urban centres prompted by the conflict and the search for economic opportunities. In 2000, Kinshasa's population was estimated to exceed six million people. (16,17) If we assume that the current number of Kinshasa residents is 6.3 million, and that 4% of the population are pregnant at any given time, (18) we can estimate that there are about 252 000 pregnancies in the city every year. Approximately 85% of pregnant women in Kinshasa had at least one antenatal visit in 2001. (18)

Assuming an HIV prevalence of 3% among pregnant women in Kinshasa, 7560 HIV-positive women are in need of antenatal care and PMTCT every year. The 2003 DRC national HIV strategic plan (19) identifies nine priority areas, including PMTCT. In May 2002, the University of North Carolina at Chapel Hill, Democratic Republic of the Congo Research Collaboration began a PMTCT programme in one large maternity unit in Kinshasa run by a nongovernmental organization; subsequently, we expanded to another nongovernmental maternity unit and to one public facility.

In the first year of services 20 670 pregnant women received counselling and 15 604 were tested for HIV. Of those who were tested, 424 HIV-positive women were identified, 114 women received nevirapine during labour, and 137 children were given nevirapine within 72 hours of delivery. …

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