Nine years’ follow-up of successful implementation of PPTCT program in Government Medical College, Dhule, Maharashtra

Abstract

Sir, The mother to child transmission of HIV is the most common mode of infection in children, contributing to 95.4% transmission rate; this was noted very early in the history of HIV/AIDS.[1 2] Attempts have been sincerely made to reduce this transmission. Maharashtra State AIDS Control Society has started Prevention of Parent to Child Transmission program in SBH Government Medical College, Dhule, since 2002. Counseling and testing services are provided to all ANC attendees as per NACO guidelines so that expectant mothers become aware of HIV/AIDS and various facilities are also provided to combat this condition. HIV-positive mothers get mental support and know exact mode of action to be undertaken to reduce transmission of HIV to baby. Availability of early diagnosis and free treatment with antiretroviral drugs is a boon for HIV-infected antenatal women. Al-nozha et al., found that 9 babies born to HIV-positive mothers were all HIV positive. Mothers were ignorant about their HIV status and did not receive nevirapine or avoid breast feeding.[3] This study emphasizes the need of implementation of PPTCT program. Since 2002 to 2010, 47820 ANC mothers were screened for HIV, 313 mothers were found reactive to HIV 1, and viral load was not performed. Prevalence of HIV infection in pregnant women attending Antenatal Clinics was 1.05% in 2002, 0.96% in 2003, and 0.88% in 2004, which further reduced to 0.84% and 0.80% in 2005 and 2006, respectively. From 2007 to 2010, it was 0.69%, 0.57%, 0.44%, and 0.32%, respectively. This data shows gradual decline of HIV prevalence in pregnant women attending attending antenatal Clinics. This indicates the success of PPTCT program implemented in Government Hospital, Dhule. Out of 313 HIV-positive mothers, 249 (79.55%) delivered in our hospital. Remaining 64 deliveries included abortions, premature births, and home delivery. Out of 249 hospital deliveries, in 33 (13.25%) cases, there was intrauterine death of baby, and 2 babies were brought late after delivery. Hence, nevirapine was not given in these 35 cases. In 214 deliveries, 29 (11.64%) babies expired before discharge of the mother. Out of 185 live births, 99 babies were brought for follow-up and tested after 18 months to check their HIV status. Out of 99 babies, 88 (88.88%) were negative for HIV at 18 months of life. Only 11 (11.12%) babies born to HIV-positive mothers were positive. Dried blood spot (DBS) test for diagnosis of HIV infection in babies from 6 weeks of life become available since 2009 to 2010; 40 babies were screened by DBS test at 6 weeks of their life. Two babies tested positive for HIV-1 and the remaining 38 were negative. In our setup, the risk of parent to child transmission is reduced to 0.32% from 1.05%, noted in 2002. Mother to child transmission rate was 11.12% in our setting. This was because of opting for cesarean section, nevirapine therapy and top feeding preferred after counseling services, as noted previously.[4] Higher rate of 32.89% was noticed in Amritsar.[5] The intrauterine deaths were recorded in 13.25% HIV-infected mothers.