Identifying risk factors for vertical HIV transmission from a prevention of mother-to-child transmission (PMTCT) program evaluation in bamako, Mali

BACKGROUND: In Mali, Prevention of Mother-to-Child Transmission (PMTCT) is not yet available in community health centers (CSCOMs), the lowest tier of the public health system. We therefore (1) established a PMTCT program in a CSCOM located in Bamako, Mali, (2) identified risk factors associated with vertical HIV transmission among HIV-positive women and their children attending the clinic, and (3) evaluated whether the PMTCT intervention was successful at the five-year point. METHODS AND RESULTS: A PMTCT program was established within a CSCOM in collaboration with the local department of health. Structured interviews were conducted with women enrolled in the PMTCT program to assess risk factors for HIV transmission and program participation five years after the program was initiated. Significant reductions in odds of transmission were seen when antiretroviral (ARV) treatment was provided during pregnancy (OR=14.4, 95%CI: 2.20-90.6, p=0.0048) or to infants immediately after birth (OR=11.3, 95%CI: 1.86-90.6, p=0.0070). Breastfeeding with concomitant ARV treatment was also shown to significantly reduce the risk of HIV transmission (p=0.0340), though breastfeeding without ARV treatment significantly increased the odds of transmission (OR=5.7, 95%CI: 1.15-28.3, p=0.0447). CONCLUSIONS: Prevention of mother-to-child transmission can be achieved in low-resource settings. This evaluation of a PMTCT program based in an infirmary-style (CSCOM) clinic in Mékin-Sikoro, a peri-urban slum located in Bamako, suggests PMTCT interventions are feasible and can be successful in such contexts. Expansion of PMTCT programs to more CSCOMs in West Africa may limit vertical HIV transmission in the region and could reduce the prevalence of HIV among children.