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BACKGROUND: The World Health Organization (WHO) risk assessment algorithm for vertical transmission of HIV (VT) assumes the availability of maternal viral load (VL) result at delivery and early viral control 4 weeks after initiating antiretroviral treatment (ART). However, in many low-and-middle-income countries, VL is often unavailable and mothers' ART adherence may be suboptimal. We evaluate the inclusion of the mothers' self-reported adherence into the established WHO-algorithm to identify infants eligible for enhanced post-natal prophylaxis when mothers' VL result is not available at delivery. METHODS: We used data from infants with perinatal HIV infection and their mothers enrolled from May-2018 to May-2020 in Mozambique, South Africa, and Mali. We retrospectively compared the performance of the WHO-algorithm with a modified algorithm which included mothers' adherence as an additional factor. Infants were considered at high risk if born from mothers without a VL result in the 4 weeks before delivery and with adherence <90%. RESULTS: At delivery, 143/184(78%) women with HIV knew their status and were on ART. Only 17(12%) obtained a VL result within 4 weeks before delivery, and 13/17(76%) of them had VL ≥1000 copies/ml. From 126 women on ART without a recent VL result, 99(79%) had been on ART for over 4 weeks. 45/99(45%) women reported suboptimal (

Original publication

DOI

10.1186/s12889-022-13543-9

Type

Journal article

Journal

BMC Public Health

Publication Date

08/07/2022

Volume

22

Keywords

Enhanced post-natal prophylaxis, HIV-exposed infants, Mother-to-child transmission, Paediatric HIV, Prevention of mother-to-child transmission, Vertical transmission, Algorithms, Anti-HIV Agents, Anti-Retroviral Agents, Female, HIV Infections, Humans, Infant, Infectious Disease Transmission, Vertical, Male, Pregnancy, Pregnancy Complications, Infectious, Retrospective Studies, Risk Assessment, Self Report, World Health Organization