A Review to Identify the Gaps in Prevention of Mother to Child Transmission of HIV Services in Nigeria

Background: Nigeria has the second largest burden of maternal to child transmission of HIV (MTCT) in the world at a rate of 30% and has the largest burden of paediatric HIV infection globally at the rate of 10%. Effective prevention of mother to child transmission of HIV (PMTCT) can drastically reduce the paediatric HIV infection to 2%. However, recent evidence reveals yawning gaps in the PMTCT services in Nigeria, where out of estimated 9.2 million pregnancies, only about 3 million received HIV counselling and testing (HCT). This review is to unravel the unmet needs for PMTCT of HIV services in Nigeria. Methods: Keywords from objectives of review are MTCT and PMTCT which were used to search for related literatures through online libraries of national and international journals; Medline and PubMed including google. 62 related literatures/studies were initially generated and then narrowed down to 19 literatures were selected which met the inclusion criteria- less than 10 year and related to objective of review. Findings: There are unmet needs for PMTCT of HIV services in Nigeria due to challenges like low HCT/PMTCT service uptake (35.5%), low HCT/PMTCT service delivery facilities (27%), low ANC (58%) and low (35%) delivery in formal health setting. Conclusion: PMTCT target in Nigeria has not been met. Regular training of existing health workforce including the TBAs and the adoption of the recommendations for an HIV-free generation will bridge the HCT / PMTCT of HIV services gap identified in this review.

Mother-to-child HIV transmissions in Israel, 1985–2011

SUMMARYMother-to-child transmission (MTCT) is the leading cause of paediatric HIV-infection in Israel. This study aimed to assess MTCT rates and analyse temporal changes in relation to highly active antiretroviral therapy (HAART) introduction in 1996. This historical prospective study included all HIV-infected women who delivered in Israel between 1988 and 2011. Demographic, clinical, laboratory and therapy characteristics were compared between HIV-infected newborns with all others, and between infants born before and after 1996. Of all 796 infants born in Israel to HIV-infected women, 25 (3·1%) were infected. MTCT rates decreased significantly after HAART introduction compared with infants who were born before 1996 (16·3%vs. 1·7%). Mothers who infected vertically were more likely to be younger, Ethiopian-born, delivered trans-vaginally, not treated with HAART during pregnancy/labour and delivered before 1996 compared with mothers who did not transmit the HIV to their neonates. Newborns who did not receive antiretroviral therapy postpartum were more commonly HIV-infected and their mortality rate was higher. In conclusion, HAART during pregnancy/labour decreased MTCT significantly. Most MTCT in Israel was recorded among Ethiopian migrants, yet, in decreasing rates. Continuous efforts should be employed to encourage early HIV testing and allow effective HAART to pregnant women who belong to a key risk-group.