What Will it Take to Eliminate Pediatric HIV? Reaching WHO Target Rates of Mother-to-Child HIV Transmission in Zimbabwe: A Model-Based Analysis

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What Will it Take to Eliminate Pediatric HIV? Reaching WHO Target Rates of Mother-to-Child HIV Transmission in Zimbabwe: A Model-Based Analysis

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dc.contributor.author Perez, Freddy
dc.contributor.author Keatinge, Jo
dc.contributor.author Park, Ji-Eun
dc.contributor.author Engelsmann, Barbara
dc.contributor.author Maruva, Matthews
dc.contributor.author Dabis, Francois
dc.contributor.author Chu, Jennifer
dc.contributor.author Rusibamayila, Asinath
dc.contributor.author Mushavi, Angela
dc.contributor.author Walensky, Rochelle P.
dc.contributor.author Ciaranello, Andrea Lynne
dc.contributor.author Freedberg, Kenneth Alan
dc.date.accessioned 2012-08-07T15:06:27Z
dc.date.issued 2012
dc.identifier.citation Ciaranello, Andrea L., Freddy Perez, Jo Keatinge, Ji-Eun Park, Barbara Engelsmann, Matthews Maruva, Rochelle P. Walensky, et al. 2012. What will it take to eliminate pediatric HIV? Reaching WHO target rates of mother-to-child HIV transmission in zimbabwe: A model-based analysis. PLoS Medicine 9(1): e1001156. en_US
dc.identifier.issn 1549-1277 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:9368044
dc.description.abstract Background: The World Health Organization (WHO) has called for the “virtual elimination” of pediatric HIV: a mother-to-child HIV transmission (MTCT) risk of less than 5%. We investigated uptake of prevention of MTCT (PMTCT) services, infant feeding recommendations, and specific drug regimens necessary to achieve this goal in Zimbabwe. Methods and Findings: We used a computer model to simulate a cohort of HIV-infected, pregnant/breastfeeding women (mean age, 24 y; mean CD4, 451/\(\mu\)l; breastfeeding duration, 12 mo). Three PMTCT regimens were evaluated: (1) single-dose nevirapine (sdNVP), (2) WHO 2010 guidelines' “Option A” (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral therapy for women with advanced disease), and (3) WHO “Option B” (pregnancy/breastfeeding-limited combination antiretroviral drug regimens without advanced disease; lifelong antiretroviral therapy with advanced disease). We examined four levels of PMTCT uptake (proportion of pregnant women accessing and adhering to PMTCT services): reported rates in 2008 and 2009 (36% and 56%, respectively) and target goals in 2008 and 2009 (80% and 95%, respectively). The primary model outcome was MTCT risk at weaning. The 2008 sdNVP-based National PMTCT Program led to a projected 12-mo MTCT risk of 20.3%. Improved uptake in 2009 reduced projected risk to 18.0%. If sdNVP were replaced by more effective regimens, with 2009 (56%) uptake, estimated MTCT risk would be 14.4% (Option A) or 13.4% (Option B). Even with 95% uptake of Option A or B, projected transmission risks (6.1%–7.7%) would exceed the WHO goal of less than 5%. Only if the lowest published transmission risks were used for each drug regimen, or breastfeeding duration were shortened, would MTCT risks at 95% uptake fall below 5%. Conclusions: Implementation of the WHO PMTCT guidelines must be accompanied by efforts to improve access to PMTCT services, retain women in care, and support medication adherence throughout pregnancy and breastfeeding, to approach the “virtual elimination” of pediatric HIV in Zimbabwe. en_US
dc.language.iso en_US en_US
dc.publisher Public Library of Science en_US
dc.relation.isversionof doi:10.1371/journal.pmed.1001156 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254654/pdf/ en_US
dash.license LAA
dc.title What Will it Take to Eliminate Pediatric HIV? Reaching WHO Target Rates of Mother-to-Child HIV Transmission in Zimbabwe: A Model-Based Analysis en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal PLoS Medicine en_US
dash.depositing.author Walensky, Rochelle P.
dc.date.available 2012-08-07T15:06:27Z

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