RESUMO
Non-nucleoside reverse transcription inhibitor (NNRTI)-containing antiretroviral therapy (ART) for the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) has led to dramatic reductions in perinatal HIV infection in resource-constrained settings. Nonetheless, PMTCT programs are complicated by repeat pregnancies, in which long-term or repeat exposures to PMTCT regimens over time may lead to the acquisition of HIV drug resistance mutations, and consequent treatment failure. In this study, we retrospectively assessed the effectiveness of the NNRTI-based PMTCT protocol from 2008 to 2010 in The Bahamas National HIV/AIDS Program. We show that women who had been in repeat pregnancies and those who were already prescribed ART at conception were at increased risk of virologic failure, relative to treatment-inexperienced women and primigravida, respectively (AOR 3.1, 95% CI: 1.3-7.1, p = .008 and AOR 5.0, 95% CI: 1.8-14.1, p = .002). In addition, women undergoing treatment at conception were more likely to possess HIVDR mutations relative to treatment-naive women (AOR 447.1, 95% CI: 17.9-11,173.5, p = .001). Therefore, individual treatment history is a key metric determining the effectiveness of current and future PMTCT interventions. The implications of this to PMTCT programmatic success in light of the most recent WHO guidelines are discussed.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Inibidores da Transcriptase Reversa/efeitos adversos , Adulto , Estudos Transversais , Feminino , Infecções por HIV/transmissão , Humanos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/classificação , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco , Carga ViralRESUMO
Initiatives to increase access to quality rapid HIV diagnostics have had relative success in the Caribbean in recent years, including use of oral rapid HIV testing. However, to date, there has not been any investigation into the performance or acceptability of oral fluids HIV testing in the region. In this cross-sectional study in The Bahamas, 252 persons of unknown serostatus were tested side-by-side with two oral rapid test brands, and the results were compared with the national fingerprick algorithm. In addition, an exit survey was administered to 234 study participants to assess user test preference. The most frequent survey response was to have no test preference (47.8%), but of those who expressed a test preference, most preferred oral (34.4%) versus fingerprick (17.8%) method. Both OraQuick and AWARE were 100% concordant with the gold standard. Therefore, our results show that oral fluids rapid testing is preferred over fingerprick testing by a subset of the potential target population and performs well in a population of undiagnosed persons attending screening clinic in The Bahamas.