Abstract:
To determine the feasibility of using short-course zidovudine (ZDV) to pr
event mother-to-child trans-
mission of human immunodeficiency virus (HIV) in a breastfeeding populat
ion in a rural area in Kenya, pregnant
mothers attending clinics in seven health centers in western Kenya betwee
n 1996 and 1998 were requested to volunteer
for participation in this study. The HIV-infected mothers were given a dai
ly dose of 400 mg of ZDV starting at 36 weeks
of gestation and another 300 mg every three hours intrapartum. After deliv
ery, mothers and their children were
followed-up and clinically monitored every 3–4 months for two years, and c
hild and mother mortality rates were
analyzed. Of the 825 mothers who consented, 216 (26.2%) were infected with
HIV. Of those infected, 51 (23.6%) took
the full prescribed dose, 69 (31.9%) took only the prenatal dose, and the re
maining 96 (44.4%) did not take any dose.
Failure to take ZDV was attributed mainly to delivery occurring earlier th
an expected, while non-compliance to the
intrapartum dose was due to mothers giving birth at home and fear of traditi
onal birth attendants. By the end of the
second year, 75 HIV-exposed children (34.7%) and 33 HIV-infected mothers
(15.3%) had died. The HIV-free survival
of children at 24 months was significantly associated with mother surviva
l(
P
< 0.001) and prenatal ZDV compliance (
P
< 0.003). Our findings suggest that implementation of programs for preven
tion of mother-to-child transmission of HIV
in rural areas of Africa need to consider the various socioeconomic and cul
tural barriers that may prevent successful
uptake of antiretroviral prophylaxes. Similarly, the rapid disease prog
ression in mothers may eliminate the increase in
child survival due to ZDV prophylaxis.
