Journal of Acquired Immune Deficiency Syndromes (12.15.03);
The current study documents the first-year results of the
Dominican Republic's program to prevent mother-to-child
transmission (PMTCT) of HIV. Outside sub-Saharan Africa, the
Caribbean is the hardest-hit region for HIV/AIDS. Nine of the
12 countries with the highest HIV prevalence in the Americas
are in the Caribbean basin. In the Dominican Republic, one
adult in 40 has HIV. Data from sentinel site testing of
pregnant women, in place since 1991, suggest that the
prevalence of HIV among pregnant women ranges from <2 percent
to >5 percent and that the epidemic is growing among women of
HIV transmission in the Dominican Republic is primarily
heterosexual. Since the first pediatric AIDS case was reported
in 1985, the number of infected children has risen sharply. In
2001, almost 500 cumulative HIV/AIDS pediatric cases were
documented, the study stated.
On May 15, 2000, the Dominican Republic's Ministry of Health
(MOH) initiated an integrated package of interventions to
reduce MTCT. The program was to be implemented in 3 phases,
the first phase including four mother and child hospitals, the
second phase including 8 mother and child health institutions
in Santo Domingo, and the third including all remaining (12)
mother and child health care institutions in the country.
During the first year, the first phase was conducted and 4
hospitals from the second phase were added to the program. All
8 hospitals offered HIV rapid tests and counseling, with
counselors paid by the MOH.
During the first year, 42,666 women attended prenatal care. Of
those, 6,528 (28 percent) went to pretest-counseling sessions,
and 3,467 (15 percent) attended posttest-counseling sessions.
Fifty-four percent (23,067) of the women took an HIV test; of
those, 581 (2.5 percent) had HIV.
PMTCT offered HIV-positive mothers a 200mg nevirapine tablet
during labor or 8 hours before elective caesarian section. In
the first year, 185 of the mothers delivered. Sixty-seven
percent received caesarian sections (124 of 185); the
remaining 33 percent were admitted for delivery from the
emergency room. Infants born to HIV-positive mothers were
given 0.6mL of nevirapine. The program recommended formula
feeding rather than breast-feeding and offered formula-feeding
counseling and infant formula, which PMTCT dispensed to 47
percent of the mothers.
PTMCT offered testing at age 6 weeks for the first 45 infants
only "due to the limited polymerase chain reaction testing by
the National AIDS Program for the MTCT program," the study
said. Seventy-eight percent of those 45 children had
undetectable HIV-1 RNA viral loads.
"This report demonstrates the feasibility of implementing a
large-scale program to prevent mother-infant HIV transmission
in a developing country," the authors noted. "Based on this 1-
year project evaluation, we estimate that implementation of
the PMTCT program in the Dominican Republic, using the
nevirapine regimen, could reduce the average risk for MTCT by
50 percent, preventing approximately 1,000 infant HIV
infections each year."
"Prenatal counseling and testing must be simplified as much as
possible and offered routinely while remaining voluntary,
confidential, and supportive of HIV and AIDS prevention in
women and their partners," the investigators concluded. "These
efforts are essential to maintain and further decrease the
reduction in HIV vertical transmission observed during the 1st
year of this program."