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dc.contributor.authorPerez, Freddy
dc.contributor.authorKeatinge, Jo
dc.contributor.authorPark, Ji-Eun
dc.contributor.authorEngelsmann, Barbara
dc.contributor.authorMaruva, Matthews
dc.contributor.authorDabis, Francois
dc.contributor.authorChu, Jennifer
dc.contributor.authorRusibamayila, Asinath
dc.contributor.authorMushavi, Angela
dc.contributor.authorWalensky, Rochelle P.
dc.contributor.authorCiaranello, Andrea Lynne
dc.contributor.authorFreedberg, Kenneth Alan
dc.date.accessioned2012-08-07T15:06:27Z
dc.date.issued2012
dc.identifier.citationCiaranello, 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.issn1549-1277en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:9368044
dc.description.abstractBackground: 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.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pmed.1001156en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254654/pdf/en_US
dash.licenseLAA
dc.titleWhat Will it Take to Eliminate Pediatric HIV? Reaching WHO Target Rates of Mother-to-Child HIV Transmission in Zimbabwe: A Model-Based Analysisen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorWalensky, Rochelle P.
dc.date.available2012-08-07T15:06:27Z
dc.identifier.doi10.1371/journal.pmed.1001156*
dash.authorsorderedfalse
dash.contributor.affiliatedCiaranello, Andrea
dash.contributor.affiliatedFreedberg, Kenneth
dash.contributor.affiliatedWalensky, Rochelle


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