|Type||Journal Article - JAIDS Journal of Acquired Immune Deficiency Syndromes|
|Title||Preventing mother-to-child HIV transmission in a developing country: the Dominican Republic experience|
Transmission of HIV in the Dominican Republic occurs primarily through heterosexual contact. As part of a continuing strategy to prevent and contain the spread of HIV infection, the Ministry of Health of the Dominican Republic established an integrated package of interventions to reduce HIV mother-to-child transmission that was initiated on May 15, 2000. The program was designed to be implemented in 3 phases. The 1st phase included 4 mother and child hospitals; the 2nd phase included 8 mother and child health institutions in Santo Domingo, the capital of the Dominican Republic, and 7 additional mother and child hospitals. The 3rd phase will include the remaining 12 mother and child health care institutions of the Dominican Republic. Evaluation of the 1st year of this program, involving 8 hospitals and >40,000 pregnant women, identified specific benefits and limitations. Low numbers of voluntary counseling sessions (6528/42,666 = 28%) and inadequate number of HIV rapid tests (23,067/42,666 = 54%) were the 2 main obstacles encountered. From the 23,067 pregnant women tested, 581 (2.5%) were HIV positive. Advantageous aspects included the successful administration of antiretroviral treatment to 89% (164/185) of the mothers and 98% (183/186) of the children. Cesarean section was performed in 67% (124/185) of the HIV-positive pregnant women, and infant formula was dispensed to 47% (87/186) of all cases. These findings demonstrate the feasibility of implementing a large-scale program to prevent mother-to-child transmission in a developing country.
Worldwide, approximately 2.2 million women and 600,000 infants are infected with HIV each year. 1 Antiretroviral prophylaxis, obstetric interventions (cesarean section), and the avoidance of breast-feeding have dramatically reduced mother-infant HIV transmission in countries with adequate health care resources. 2,3 In developing countries, where the impact of HIV is greatest, however, implementation has been limited by the complexity and expense of these interventions. 4
The Caribbean is the region hardest hit by HIV/AIDS in the world outside sub-Saharan Africa. 5 Nine of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean basin. In the Dominican Republic, 1 adult in 40 is HIV infected. Sentinel site testing for HIV prevalence among pregnant women has been ongoing since 1991. 5 Data from these sources suggest that the prevalence of HIV among pregnant women ranges from <2% to >5% and that the epidemic is rapidly increasing among women of reproductive age. 5
Transmission of HIV in the Dominican Republic occurs primarily through heterosexual contact. Since the 1st pediatric AIDS case was documented in 1985, the number of infected children has increased markedly, and the health care for these children is becoming an increasing burden on the public health system. 5 In 2001, almost 500 cumulative HIV/AIDS pediatric cases were documented. 5
As part of a continuing strategy to prevent and contain the spread of HIV infection, the Ministry of Health (MOH) of the Dominican Republic recently established an integrated package of interventions, including voluntary counseling and testing, the administration of a single-dose of nevirapine to the mother at the onset of labor or 8 hours previous to the cesarean section, and to the neonate 8-72 hours postpartum, an elective cesarean section, and alternative method of breast-feeding to prevent HIV mother-to-child transmission (PMTCT).
Although the MOH has been conducting sentinel site voluntary counseling and testing (VCT) among pregnant women since 1991, very little experience in providing universal voluntary and counseling testing among this population has been reported. Most of the MOH hospitals do not routinely perform HIV pre- and posttest counseling or testing. The majority (98.5%) of women in the Dominican Republic receive prenatal care, however, suggesting that a program to screen women for HIV infection would cover most of the pregnant population and would be a sustainable activity. This report documents the 1st-year results of the Dominican PMTCT program, pointing out the strengths and limitations observed during this period.
|»||Dominican Republic - Encuesta Demográfica y de Salud 1996|