JAMA logoHuman immunodeficiency virus (HIV) is considered as one of the killer infections worldwide. In 2001, the United Nations General Assembly had set up a goal of reducing the global spread of this infection by 50 percent till 2010. Scientists however claim that around half of infants born to HIV-infected mothers in some African countries receive a minimum preventive dose of the drug nevirapine to aid in lowering the risk of mother-to-child HIV transmission.

In spite of the various international investments made across the globe, application for mother-to-child HIV prevention services appear to be lacking. While conducting the research, the investigators highlighted the present day services made available to avoid mother-to-child HIV transmission in the African countries of Cameroon, Cote d’Ivoire, South Africa and Zambia.

The research encompassed data accumulated between June 2007 and October 2008. Information regarding the umbilical cord blood samples from 43 randomly-selected facilities providing delivery services was thoroughly analyzed by the experts. It was initiated by Jeffrey S. A. Stringer, M.D., of the University of Alabama at Birmingham and the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.

The investigators said, “Such an effort would require not only new scientific discoveries, but also substantial policy work, mobilization of huge new resources, and large-scale implementation of services in some of the least-resourced health systems in the world. A number of antiretroviral interventions are now available to reduce the risk of mother-to-child HIV transmission and clear guidelines have been developed for their implementation and use.”

It was then noted that while all sites employed at least single-dose nevirapine to avoid mother-to-child HIV transmission, a few sited utilized additional prophylaxis drugs. The experts measured the maternal nevirapine ingestion as confirmed by testing for the drug in the cord blood at delivery and infant nevirapine ingestion, which was confirmed by direct observation. As a result, the researchers were able to gauge the nevirapine coverage for HIV-exposed infants in the sample.

The scientists quoted, “This cascade begins with the offering of an HIV test and proceeds through posttest counseling to drug adherence and beyond. Our findings indicate that programmatic failures are common along this path, and that each clinic faces its own mix of challenges in maximizing service coverage.”

From a total of 27,893 that were gathered and tested cord blood specimens, almost 12 percent which formed 3,324 seemingly revealed to be HIV seropositive. 3,196 HIV-seropositive mother-infant pairs provided entire data for cord blood nevirapine results. It was mentioned that the primary outcome of total coverage of both maternal and infant dosing was acquired in 1,725 HIV-exposed infants. The investigation supposedly covered an estimation of 4 countries of 51 percent.

The experts explained, “This is a critical move toward global pediatric AIDS control, yet it holds only half the key. The other half lies in service coverage. Even the most potent interventions to prevent mother-to-child HIV transmission will not protect those infants who do not receive them.”

A common variation in the total coverage rates appeared by country and by site, and maternal non-adherence which is a lack of nevirapine in the cord blood among women with documented dispensation of antenatal [before birth] nevirapine. A considerable link between failed coverage of nevirapine-based services with younger maternal age, fewer antenatal care visits, vaginal delivery, and lower infant birth weight was apparently registered.

The results supposedly call for immediate counseling of younger mothers and confirm the usual importance of repeat antenatal visits as part of good obstetrical care. The exact path or ‘cascade’ that each mother-infant pair must negotiate in order to achieve successful prevention of mother-to-child HIV transmission is seemingly revealed in the research findings. The international guidelines were revised by the World Health Organization in November 2009. It suggested adopting more advanced complex drug regimens to avoid mother-to-child HIV transmission.

The research is published in the July 21 issue of JAMA, a theme issue on HIV/AIDS.