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Uptake of interventions, outcomes and challenges in caring for HIV-exposed infants in Kingston, Jamaica.
West Indian Med J 2004; 53(5):308-14WI

Abstract

BACKGROUND

In a few Caribbean islands, prevention of mother-to-child transmission (pMTCT) of HIV with zidovudine prophylaxis has reduced transmission rates from 27 - 44% to 5.5 - 9 %.

OBJECTIVES

To highlight the uptake of interventions, preliminary outcomes and challenges in caring for HIV-exposed infants in a pMTCT HIVprogramme in a resource-limited setting.

METHOD

A cohort of HIV-infected pregnant women were identified at the leading maternity centres in Greater Kingston through HIV counselling and testing and enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme. Antiretroviralprophylaxis with zidovudine or nevirapine was given to the HIV-positive women and their newborns along with formula feeding. Some infants were enrolled retrospectively and followed irrespective of whether they had or had not received antiretroviral prophylaxis. A multidisciplinary team at the paediatric centres supervised protocol-driven management of the infants. Infants were followed for clinical progress and definitive HIV-infection status was to be confirmed at 18 months of age by ELISA or the Determine Rapid Test.

RESULTS

During September 1, 2002 through August 31, 2003, 132 HIV-exposed infants were identified. For those infants prospectively enrolled (78), 97% received antiretroviral prophylaxis and 90% were not breastfed For all HIV-exposed children, 90% received cotrimoxazole prophylaxis and 88% continued follow-up care. Ninety-two per cent of all the infants remained asymptomatic and five died; of these deaths one is possibly HIV-related (severe sepsis at 11 weeks). This infant was retrospectively identified, had received no antiretroviral prophylaxis and was breastfed The main programme challenges, which were overcome, included the impact of stigma, compliance with antiretroviral chemoprophylaxis, breast-milk substitution and follow-up care. Financial constraints and laboratory quality assurance issues limited early diagnosis of HIV infection.

CONCLUSION

Despite the challenges, the expected outcome is to prevent 50 new cases of HIV/AIDS in children living in Greater Kingston per year (300 over six years).

Authors+Show Affiliations

Departments of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston, Jamaica, West Indies.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15675496

Citation

Steel-Duncan, J C., et al. "Uptake of Interventions, Outcomes and Challenges in Caring for HIV-exposed Infants in Kingston, Jamaica." The West Indian Medical Journal, vol. 53, no. 5, 2004, pp. 308-14.
Steel-Duncan JC, Pierre R, Evans-Gilbert T, et al. Uptake of interventions, outcomes and challenges in caring for HIV-exposed infants in Kingston, Jamaica. West Indian Med J. 2004;53(5):308-14.
Steel-Duncan, J. C., Pierre, R., Evans-Gilbert, T., Rodriquez, B., Smikle, M. F., Palmer, P., ... Christie, C. D. (2004). Uptake of interventions, outcomes and challenges in caring for HIV-exposed infants in Kingston, Jamaica. The West Indian Medical Journal, 53(5), pp. 308-14.
Steel-Duncan JC, et al. Uptake of Interventions, Outcomes and Challenges in Caring for HIV-exposed Infants in Kingston, Jamaica. West Indian Med J. 2004;53(5):308-14. PubMed PMID: 15675496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uptake of interventions, outcomes and challenges in caring for HIV-exposed infants in Kingston, Jamaica. AU - Steel-Duncan,J C, AU - Pierre,R, AU - Evans-Gilbert,T, AU - Rodriquez,B, AU - Smikle,M F, AU - Palmer,P, AU - Whorms,S, AU - Hambleton,I, AU - Figueroa,J P, AU - Christie,C D C, PY - 2005/1/29/pubmed PY - 2005/3/1/medline PY - 2005/1/29/entrez SP - 308 EP - 14 JF - The West Indian medical journal JO - West Indian Med J VL - 53 IS - 5 N2 - BACKGROUND: In a few Caribbean islands, prevention of mother-to-child transmission (pMTCT) of HIV with zidovudine prophylaxis has reduced transmission rates from 27 - 44% to 5.5 - 9 %. OBJECTIVES: To highlight the uptake of interventions, preliminary outcomes and challenges in caring for HIV-exposed infants in a pMTCT HIVprogramme in a resource-limited setting. METHOD: A cohort of HIV-infected pregnant women were identified at the leading maternity centres in Greater Kingston through HIV counselling and testing and enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme. Antiretroviralprophylaxis with zidovudine or nevirapine was given to the HIV-positive women and their newborns along with formula feeding. Some infants were enrolled retrospectively and followed irrespective of whether they had or had not received antiretroviral prophylaxis. A multidisciplinary team at the paediatric centres supervised protocol-driven management of the infants. Infants were followed for clinical progress and definitive HIV-infection status was to be confirmed at 18 months of age by ELISA or the Determine Rapid Test. RESULTS: During September 1, 2002 through August 31, 2003, 132 HIV-exposed infants were identified. For those infants prospectively enrolled (78), 97% received antiretroviral prophylaxis and 90% were not breastfed For all HIV-exposed children, 90% received cotrimoxazole prophylaxis and 88% continued follow-up care. Ninety-two per cent of all the infants remained asymptomatic and five died; of these deaths one is possibly HIV-related (severe sepsis at 11 weeks). This infant was retrospectively identified, had received no antiretroviral prophylaxis and was breastfed The main programme challenges, which were overcome, included the impact of stigma, compliance with antiretroviral chemoprophylaxis, breast-milk substitution and follow-up care. Financial constraints and laboratory quality assurance issues limited early diagnosis of HIV infection. CONCLUSION: Despite the challenges, the expected outcome is to prevent 50 new cases of HIV/AIDS in children living in Greater Kingston per year (300 over six years). SN - 0043-3144 UR - https://www.unboundmedicine.com/medline/citation/15675496/Uptake_of_interventions_outcomes_and_challenges_in_caring_for_HIV_exposed_infants_in_Kingston_Jamaica_ DB - PRIME DP - Unbound Medicine ER -