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Mother and Child Prevention and Care: Results from the DREAM Program in Mozambique
G Liotta*1, L Palombi1, S Mancinelli1, P Germano2, M Giuliano3, P Narciso4, G Guidotti3, G Tintisona2, E Buonomo1, S Vella3, M Magnano San Lio2, M Bartolo2, C F Perno1, A Barreto5, and M C Marazzi6
1Univ. of Tor Vergata, Rome, Italy; 2Community of Sant'Egidio, Rome Italy; 3Natl. Inst. of Hlth., Rome, Italy; 4Natl. Inst. of Infectious Diseases "L.Spallanzani", Rome, Italy; 5Ministry of Hlth., Maputo, Mozambique; and 6LUMSA, Rome., Italy
Background:
Mother and child prevention and care is the DREAM (Drug Resource
Enhancement against AIDS and Malnutrition) approach to reach both the results
of caring for the mothers and preventing the vertical transmission. This link
is crucial to ensure the survival of women and a good adherence to the
treatment programme. DREAM is run by the Community of Sant’Egidio and has in
charge >3000 HIV+ individuals.
Methods:
Since May 2002, VCT, Nutritional Assessment and Supplementation, Health
Education and HAART were offered, free-of-charge, to pregnant women at the
maternity wards of Matola II, Mozambique,
at their first antenatal visit. All the women started HAART (generic AZT or
d4T+3TC+NVP in combination tablets) during pregnancy not before the 15th week.
Prophylaxis and treatment of opportunistic infection and STD were provided during pregnancy. After delivery
women had access both to free-of-charge formula milk and water filters to
provide clean water. All the women were instructed on safe formula feeding.
Within 72 hours from delivery the newborn received NVP solution (2 mL/Kg).
HAART is administered to the mother for 30 days after delivery. Women meeting
international criteria to start HAART at the first antenatal visit did not stop
treatment.
Results:
As of August
15, 2003, VCT was offered to 2074 women, of whom 1931 accepted
testing for HIV. The percentage of HIV+ women was 18.6% (360 women);
average viral load and CD4 were 23.600 (IQ 25 to 75: 6.400 to76.000) and 414 (IQ 25 to 75: 254 to 539), respectively The mean time of
HAART treatment before delivery was 67 days (±32). About 75% of the women were
compliant with the whole protocol; 12.5% refused to start treatment, 7.8%
interrupted treatment before delivery, and 5% did not come back after delivery.
The rate of HIV-RNA positivity in children 1 to 2 months after birth was 3.2%
(4/125). All 42 children tested at 6 month of life remained seronegative. Mixed
breast and artificial feeding was done in <10% of mothers. Early start of
HAART induced a sharp decrease of Viral Load (68.4% of women <50 at
delivery, median value = 90 copies/mL). No deaths were reported.
Conclusions:
Preliminary results show that DREAM approach ensures a good adherence of
the women and is able of reaching both aims of strong reduction of vertical
transmission (>85%) and survival of women.
Keywords: Vertical transmission; HAART; Public Health Program
