Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 23297-23301 401

Results: Between 1990 and 1996 the estimated total number of births to HIV
positive mothers was 3,633. Depending on the chosen incubation period distribution, with regard to the entire study period the estimated total number of HIV
infected children ranges from 510 to 947, and the 6-year period transmission
rate from 0.10 to 0.29. Five of the seven incubation period distributions used
provided a rate ranging in the very narrow interval 0.17-0.19. Between each pair
of consecutive years no strong variations in the rate estimates were found. Over
the entire study period, the estimated vertical transmission rates did not show
any increasing or decreasing trend.
Conclusions: The method provided estimates of vertical transmission rates
consistent with those reported by longitudinal studies performed in several European countries. The lack of decrease of the vertical transmission rate in Italy
may reflect a limited adoption of intervention measures which became available
in the more recent years of the study period. The method here presented could be
useful for monitoring the future impact of prophylactic intervention policies aimed
to reduce the vertical transmission rates.
S23297 Antiretroviral drugs for pregnant women in rural South
Africa: cost-effectiveness and capacity
David Wilkinson1 2, K. Floyd2, C.F. Gilks2. 1South African Medical Research
Council, South Africa; 2Liverpool School of Tropical Medicine, Liverpool, UK
Objective: To estimate cost-effectiveness of, and capacity requirements for providing antiretroviral drugs (ARVs) to pregnant HIV-indfected women in rural South
Africa
Setting: Hlabisa health district where HIV prevalence among pregnant women
was 26.0% in 1997
Methods: Calculation of number of paediatric HIV infections averted under
three scenarios, and their cost. No intervention compared with A: zidovudine
(ZDV; ACTG 076 protocol) delivered within current infrastructure, B: ZDV delivered through enhanced and C: short-course ZDV plus lamivudine (3TC) delivered through enhanced. Cost-effectiveness defined as cost/infection averted and
cost/potential year of life gained. Capacity in terms of staff and infrastructure
required to effectively implement.
Results: With no intervention, 657 paediatric HIV infections are projected for
1997. In scenario A this could be reduced by 15% at a cost of about R2.7 million
(1US$ = R4.5), in scenario B by 42% at about R7.1 million, and in scenario C
by 47% at about R3.6 million. In scenario C, drugs account for 75.9% of costs,
while additional staff account for 18.4%. Cost per infection averted was RI 1,710
and cost per potential year of life gained (discounted at 3%) was R404. Cost of
scenario C is equivalent to 14% of the 1997 district health budget. At least 12
extra counsellors and nurses and one laboratory technician, together with substantial logistical and managerial support would be needed to deliver an effective
intervention.
Conclusion: Although ARVs may be relatively cost-effective in this setting
the budget required is currently unaffordable. Developing the capacity required
to deliver the intervention poses both a major challenge and an opportunity to
improve maternity services.
S23298 Fear, low risk perception and lack of knowledge remains
a barrier to HIV testing among high risk pregnant women
in New Orleans, LA
Patricia Kissinger1, N. Fuchs2, J. Herwehe2, C. Groft2, D. Gruber2. 1136 S
Roman Street 3rd Floor New Orleans LA 70112; 2Pediatric AIDS Program New
Orleans LA, USA
Objectives: To assess the prevalence and barriers to HIV testing among high
risk pregnant women.
Design: A period cross-section survey.
Methods: Self-administered, street intercept interviews of women, between
the ages of 14-35, living in the six areas with the highest gonorrhea rates were
conducted every six weeks from June 1996 to October 1997 in New Orleans. A
quota sample of adolescent and adult women was employed.
Results: Of 1080 women surveyed, 16.8% reported that they had been pregnant in the last 12 months. Of these 181 women, 97% were African American,
18% were under 18 years of age and 86.5% had been tested for HIV during
that pregnancy. Age, self-reported HIV risk behavior and self-report of a previous
HIV test were not associated with testing. Women who perceived themselves to
be at high risk for HIV were less likely to be tested than those who perceived
themselves to be at lesser risk (58% vs. 89%, p <.01). While only 6.6% identified
themselves to be at high risk for HIV infection, 49.7% reported exhibiting a high
risk behavior. Reasons for not getting tested among the 24 women who had not
been tested during the pregnancy were: fear (47%), perceived no risk (26%), a
previous negative result (11%), and did not want to know status (11%). Many
women did not know about AZT prophylaxis for HIV perinatal prevention (55%)
and thought that HIV was always transmitted to the baby from an HIV-infected
pregnant mother (21%).
Conclusion: While testing rates among high risk pregnant women were high,

they were not 100%. HIV risk perception and knowledge about perinatal HIV
transmission was generally low. Fear of testing remains a barrier for adolescent
and adult women.

S23299 1 Zidovudine (ZDV) for perinatal prophylaxis starting on
week 24 in Argentina
Patricia Coll1, Maria Jose Rolon1, S. Perez Macri1, 0. Cando1, M. Avila2,
P. Martinez2, D. Liberatore2, P. Cahn2. 1Infectologia, Hospital Fernandez, Angel
Peluffo 3932 (1181), Buenos Aires; 2Buenos Aires University, Buenos Aires,
Argentina
Objective: To evaluate efficacy and safety of ZDV prophylaxis in perinatal HIV
transmission, starting on week 24.
Methods: Between 12/94-11/97, 144 pregnant women and their newborns
were assisted. ZDV was given following CDC guidelines, but beginning prophylaxis on week 24. Informed consent was obtained. HIV-1 tests were performed at
birth and on a 6 month basis. Newborns CD4 and blood counts were studied post
ZDV. In 50 patients p24 antigen, PCR and HIV cultures were done depending on
the facilities. Monthly differential blood and CD4 counts at entry and postpartum
were performed to mothers.
Results: Atotal of 144 pregnant women were assisted, 10 were excluded because of symptomatic disease. Among 134 eligible, 21 refused treatment and 23
were not evaluable due to lost follow up of the newborns. Pretreatment median
maternal CD4: 446, post treatment: 570. Median maternal hemoglobin: 11.37
gr/dl, post-treatment: 12. Infant median Hb post ZDV: 10.2. No discontinuation
of treatment was necessary in any case. A total of 92 newborns were assisted
at January 12, 1997. 3 symptomatic; 76 seroreverted (82.6%), the other 13 babies remain stage "E" (14.1%). Median follow up: 14 months (1-34). Updated
transmission rates will be presented.
Conclusions: Use of ZDV in pregnant and newborns was well tolerated in
our population. Starting on week 24 seems to be effective and safe in reducing
perinatal transmission. We conclude that this shorter treatment is advantageous
in terms of cost, toxicity and compliance.
23300 1 Prevention of mother-to-child transmission of HIV and its
implications in developing countries: From research to
programs
Frangois Dabis1, D.L. Newell2, L. Fransen3, J. Saba4, I. De Vincenzi4. Ghent
International Working Group; 1NSERM U. 330, Universite Bordeaux 2, 146 rue
Leo Saignat 33076 Bordeaux, France; 2lnstitute of Child Health, London, UK;
3D6 VIII/8 European Commission, Brussels, Belgium; 4 Policy Strategy and
Research Unit, UNAIDS Geneva, Switzerland
Issues: Randomised trials are ongoing in many developing countries to evaluate
different approaches to prevention of mother-to-child transmission (MTCT) of HIV.
The first of these trials will be completed in 1998. International and local public
health strategies will need to be developed before implementation.
Project: To develop public health policy options for the local implementation of
interventions to prevent MTCT of HIV into basic health and maternal and child
care (MCH) services in developing countries. In 1997 the International Working
Group on MTCT of HIV, supported by the European Commission and UNAIDS,
undertook the following tasks: a critical review of completed, ongoing and planned
randomised trials; a feasibility assessment of different preventive strategies, including a survey on HIV voluntary counselling and testing of pregnant women;
a review of the cost-effectiveness and cost-benefit of antiretroviral therapy; the
identification of requirements and research priorities for prenatal, obstetrical and
paediatric care services; and anupdate of transmission of HIV through breastfeeding with an international pooled analysis of late postnatal transmission. These
preparatory projects provided the background for a three-day workshop in Ghent,
Belgium, in November 1997.
Results: A summary of relevant evidence and 10 public health recommendations to assist policy makers in implementing intervention strategies.
Lessons learned: Any specific intervention package to reduce MTCT should
be fully integrated in the overall antenatal, obstetrical, and paediatric care, the
prime goal of which is to reduce overall maternal and infant morbidity and mortality. Integration of HIV MTCT prevention into basic health services is a priority and
should involve governments and donor agencies.
|23301 Mother-to-child transmission of HIV-1: Effect of
preventive measures in full-term pregnancies
Claudia Fortuny1, E. Sanchez-Ruiz2, O. Coll3, M. Lonca3, MC. Muhoz1,
R. Jimenez1. Hospital Sant Joan De deu, P Sant Joan De Deu, z 08950
Esplugues De Llobregat; 2Catalan Health Service Barcelona; 3Hospital Clinic,
Provincial, Barcelona, Spain
Background: Several studies have stated that transmission of HIV-1 from a
pregnant woman to her fetus often occurs late in gestation or at delivery. We
hypothesize that preventive measures, like prophylactic zidovudine (ZDV) and
perhaps cesarean section, may be more effective in full-term pregnancies.
Design: Prospective study of children born to HIV-1 -infected women in a
university hospital in Barcelona, Spain.
Methods: Infants born to women with confirmed HIV-1 infection from January

1, 1987 to December 31, 1997 were selected and divided in two groups according
to gestational age (<37 wk and >37 wk). Logistic regression was used to test the
study variables against the risk of vertical transmission of HIV-1.
Results: A total of 248 children, 56 premature and 192 full-term, with confirmed
HIV-1 infection or seroreverters were studied. Vertical transmission rates were
25% (95% Cl: 13.7%-36.3%) and 11.5% (95% Cl: 7.0%-16.0%), respectively, p
= 0.006. Among premature infants, HIV-1 infection was not associated with the