AEGiS-13IAC: Implementation of a population-based pilot program to reduce mother-to-child HIV transmission, Botswana.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Implementation of a population-based pilot program to reduce mother-to-child HIV transmission, Botswana.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC550)

Mazhani L, Phiri L, Keapoletswe K, Bowelo M, Mugabe M, Mouzin E
L. Mazhani, Ministry of Health, Nyangabgwe Hospital, Private Bag 127, Francistown, Botswana, Tel.: +267 211 000, Fax: +267 216 706, E-mail: Lmazhani@info.bw

BACKGROUND: In Botswana, HIV prevalence is estimated to be 35% among pregnant women. Without interventions, mother-to-child transmission of HIV is about 40% resulting in about 8,000 HIV-infected babies each year. In April 1999, the government of Botswana, with UNICEF support, launched a program to pilot an intervention aimed at reducing vertical transmission of HIV among pregnant women in the two main urban areas, Francistown and Gaborone.

METHODS: Pregnant women attending antenatal clinics were offered HIV counseling. HIV-positive women were offered treatment by oral zidovudine (AZT) twice daily starting at 34 weeks of pregnancy and every 3 hours during labor. AZT syrup was given twice daily to the infants for a month. Infant formula was provided without cost, for at least 6 months, to mothers who elected not to breastfeed after counseling.

RESULTS: During the first 8 months of the pilot phase, from April to December 1999, 4197 women were counseled at 25 clinics and 2 hospitals, and 1935 (46%) agreed to be HIV tested. Results were available for 1692 women. 693 (41%) were HIV-positive. 397 (57%) had delivered live infants at the time of data analysis. 221 (56%) women and 367 (92%) newborns received AZT. 67% of women counseled about feeding options chose not to breastfeed (85% in Gaborone and 57% in Francistown).

CONCLUSION: A large, population-based pilot program is now in place in Botswana to reduce vertical transmission of HIV based on short-course antenatal and neonatal AZT. Acceptance of HIV testing and AZT is low; possible reasons include fear of positive result and stigmatization as well as inadequacy of counseling and public information. Efforts are now focused on trying to raise the uptake of both testing and intervention. Requirements for expanding the program nationwide are also being assessed.

Keywords: AEGIS, HIV Infections, Disease Transmission, Vertical, Zidovudine, Mothers, Breast Feeding, Counseling, HIV Seropositivity, Prevalence, Infant Food, Botswana, Child, Infant, Human, Female, Infant, Newborn, Pregnancy, transmission
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WeOrC550