Academic journal article Bulletin of the World Health Organization

Operational Issues in Preventing Mother-to-Child Transmission of HIV-1 in Abidjan, Cote d'Ivoire, 1998-99

Academic journal article Bulletin of the World Health Organization

Operational Issues in Preventing Mother-to-Child Transmission of HIV-1 in Abidjan, Cote d'Ivoire, 1998-99

Article excerpt

Voir page 645 le resume en francais. En la pagina 646 figura un resumen en espanol.

Introduction

Clinical trials have demonstrated that reductions of 37-50% in mother-to-child transmission of human immunodeficiency type 1 virus (HIV-1) can be achieved through a short course of zidovudine (AZT) (1-3) or nevirapine (4). Subsequently such interventions have been implemented as public health programmes in developing countries (5) and in several African countries pilot programmes began in 1999 (6).

In Abidjan, Cote d'Ivoire, the DITRAME ANRS 049a trial achieved 37% and 30% reductions in mother-to-child transmission of HIV-1 at the ages of 6 and 15 months, respectively, following a short maternal regimen of AZT, compared with a placebo, in a breastfed population (1, 7). Building on this result, investigators of the project, UNICEF and the National AIDS Control Programme in Cote d'Ivoire jointly developed and implemented a six-month public health project beginning on 1 October 1998 to provide, on a routine basis, the following services free of charge: universal proposal of HIV screening to pregnant women; HIV serotesting of all pregnant women who agreed; provision of pretest and post-test information and counselling; and a short course of zidovudine and alternatives to breastfeeding for pregnant women infected with HIV-1.

Methods

In October 1998 the UNICEF Interim Project initiated the organization of the above services in the four facilities where the DITRAME research programme had been taking place: the Yopougon Teaching Hospital, a public sector health centre, and two community-based health centres. The field team comprised five experienced counsellors, two midwives, and two physicians who complemented the regular personnel of these clinics during the research phase.

The HIV serotest was proposed to each pregnant woman during an individual pretest interview lasting 10-15 min at the first antenatal consultation, after clinical examination in a private room. A blood sample was taken by the person who conducted this interview and an identification number was assigned to each patient so that the entire process would remain anonymous. No restrictions were placed on the age or gestational age of the participants. Two enzyme-linked imunosorbent assays (ELISA) (Murex ICE[TM], Murex Biotech Ltd, Dartford, England; and Vironostika[TM], Organon-Teknika Inc, Scarborough, Ontario, Canada) were used to test to all the sera in the Centre de Diagnostic et de Recherches sur le SIDA (CeDReS) laboratory in Abidjan. In accordance with the recommendations of the National AIDS Control Programme, tests distinguishing between HIV-1 and HIV-2 were not employed. Positive results were disclosed to the women who returned to the clinic two weeks later, when a new sample was taken for repeat testing in order to avoid labelling and laboratory errors.

The result of her HIV test was explained to each participating mother at individual post-test counselling sessions by the person who had proposed and performed it. On average, each post-test session lasted 10 min for uninfected women and 30 min for HIV-positive women. Uninfected women were given further counselling on prevention of HIV infection and were encouraged to bring their partners for free testing. They were then provided with routine antenatal services. Each HIV-positive woman also received general preventive counselling and was advised to inform her partner, who, if he consented, was tested under similar conditions. Furthermore, specific counselling was given to each HIV-positive woman on the means available for reducing the risk of infecting her child, on support groups for people living with HIV, and on locations where she could obtain care, assistance, and counselling. An appointment was made for her to meet the project team within a week to discuss the prescription of AZT and the choice of feeding methods. The only criterion for excluding the prescription of AZT was a haemoglobin level below 7g/dl. …

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