Prevalence of HIV sero-positivity among pregnant women and prevention of parent to child transmission

Background: Globally majority of new HIV infections occur in young women. Each year 1.5 million women living with HIV become pregnant. PTCT (Parent-to-Child transmission) is the most significant route of infection in infants and children under the age of 15 and proportion of paediatric HIV is increasing. The transmission of HIV from a HIV sero-positive mother to child can occur during pregnancy, process of labour and childbirth or breastfeeding. In the absence of any intervention, transmission rates range from 15% to 45%. This rate can be reduced to below 5% with effective interventions primarily involving antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby.Aim: To determine the prevalence of HIV sero-postivity among pregnant women and predictors for prevention of parent to child transmission (PPTCT) and infant outcome.Methods: A Cross-sectional study was conducted in RIMS, Imphal for 15 years (2004-18). A retrospective review of secondary data from the facility based registers maintained in PPTCT, ICTC (Dept. of Microbiology) and ART centre, RIMS, Imphal. All data were analysed and descriptive statistics (proportions) were used to describe the prevalence of HIV positive deliveries and rate of PTCT. The HIV infected infants were assessed for age of diagnosis, antiretroviral prophylaxis, mode of delivery, feeding practices, Co-trimoxazole Preventive Therapy (CPT) prophylaxis and outcome.Results: Seroprevalence of HIV in 2004 was 0.13%, increased in 2007 to 0.6% and then showed a steady decline with least prevalence in 2017 (0.11%) followed by 0.27% in 2018. The proportion of HIV positive pregnant women deliveries from 2004-18 was found to be 0.31%. Majority (33.7%) of HIV positive pregnant women were in the age group of 20-24 years followed by 25-29 years (31.8%). The rate of PTCT was found to be 5.5% (2010-2018). 78.6% were breastfed, 14.3% were mixed fed and 7.1% were given formula feedings 71.4% were delivered by normal vaginal delivery and only 28.6% were delivered by C-section. (57.1%) of the infants had received 6 week-Nevirapine prophylaxis and 14.2% received single dose NVP at birth. All (100%) HIV infected infants were given CPT prophylaxis and 42.9% of the infected infants were started on CPT prophylaxis by 4-6 weeks of age. 42.9% of the infants are alive on ART and 28.6% were lost to follow up, whereas 28.6% babies died.Conclusion: Prevalence of ser-positivity among pregnant women in our study is almost comparable with the national prevalence among pregnant women and hence PPTCT is found to be effective in preventing HIV transmission from sero-positive mother to child. However, screening has to be more emphasised to cover all pregnant women for HIV status by setting PPTCT centres in PHC, CHC level and private sectors.