Pediatrics HIV/AIDS and PMTCT research in Barbados: lessons learned for monitoring the epidemic and evaluating the interventions.   ALOK KUMAR, MD. Lecturer in Child Health School of Clinical Medicine & Research, UWI(Cave Hill) Departments of Pediatrics, The Queen Elizabeth Hospital, BARBADOS

Background Barbados is among the few developing countries, where PMTCT of HIV has received high priority. Program for the surveillance of the MTCT has been in operation since early nineties has facilitated vast amount of research in this field.

Background Surveillance of MTCT is useful for assessing the trends in HIV epidemics and effectiveness of the prevention programs. It is also useful in studying the trend in the over all HIV epidemics in the population.

Objectives Surveillance of MTCT is useful for assessing the trends in HIV epidemics and effectiveness of the prevention programs. It is also useful in studying the trend in the over all HIV epidemics in the population.  

Design and Methods focuses on the period from 2003 - 2006. limited to the research in the field of PMTCT of HIV & Pediatrics HIV/AIDS Need for future research and its directions were based on the ongoing program requirements and findings from the past research.  

Design and Methods Studies covered in this presentation are those that   Studies covered in this presentation are those that have been presented at various regional and international conferences or have been published in international journal.

Design and Methods surveyed all the women who gave birth at the QEH between April and September 2002 for the antenatal VCT service. Data was collected from the antenatal records and a 5 min structured interview with these women during routine postnatal counseling session on day 2 of delivery.  

Figure1. Pattern of HIV counseling and testing offered to the 1342 women who delivered in Barbados during the study period, based on the documentation in their antenatal notes.  

Conclusions Majority of the pregnant women get tested for HIV. However, only in two thirds of these women HIV results are known at the time of delivery. Most women counseled for HIV, accept the screening test. Some women receive HIV testing without pretest.  

Design and Methods A population based descriptive study. Data for this report was collected prospectively. This report is based on observation during 1993- 2004. Kumar et al 2005

Conclusions implementing programs for universal access to VCT and provision for antiretroviral prophylaxis is associated with high uptake of HIV screening. decrease in the over all prevalence of HIV infection among pregnant women in Barbados is encouraging.

Methods Includes all HIV infected women in Barbados, who delivered during 1996 through 2003. Disclosure data was collected by one to one interview. Data on health care uptake and sexual behavior were collected prospectively from ANC record and records at LRU.

Results A total of 139 (98%) HIV infected women were studied. 29% had self disclosed their HIV status to others. 71% had not disclosed their HIV status.

Reason for nondisclosure Fear of stigmatization 30 (30%) Fear of abnormal reactions 23 (23%) Lack of reasons for disclosure 16 (16%) Others 9 (9%) No answer 21 (21%)

Conclusions A substantial proportion of HIV-infected pregnant women never disclosed HIV status to others. Fear of stigmatization and abnormal reaction from their partner were reasons given by majority for nondisclosure.

From: Departments of Paediatrics’ and Pathology2, Queen Elizabeth Correspondence: Dr A Kumar, Queen Elizabeth Hospital and School of Clinical Medicine and Research, The University of the West Indies, Cave Hill, Barbados. Fax: (246) 429-5374, e-mail: bhavna@sunbeach.net. West Indian Med J 2005; 54 (3): 167

Methods based on all the long term survivors from a prospective cohort of HIV infected children born to HIV positive women in Barbados, during the 1986-1995. Infants born to HIV infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV in the postnatal period and followed up at regular interval.

Table1. Demographic data on the cohort of HIV infected children born during the 1986-95 period. 1986-90 1991-95 Nos. (%) HIV infected children born during 1986-1995 19 25 44 Males 12 (63.1) 13 (52.0) 25 (56.8) Females 7 (36.9) 12 (48.0) 19 (43.2) Time of diagnosis of HIV in the mother Antepartum/Intrapartum 8 (36.8) 21 (84.0) 29 (65.9) Postpartum during first 6 months of life 11 (63.2) 4 (16.0) 15 (34.1) Survival pattern Survival to age less than 8 years 11 (57.9) 16 (64.0) 27 (61.4) Survival to age of 8 years or more 8 (42.1) 9 (36.0) 17 (38.6) Survival status at the time of this report Alive 7 (36.8) 16 (36.4) Deceased 12 (63.2) 28 (63.6) Age range of the live LTS children (in years) 13.4-16.7 8.0-12.1 8.0-16.7 Median age of the live LTS children (in years) 15.4 9.3 12.0

Figure1. Disease progression among the long term surviving HIV infected children who were alive at the time of this report.

Conclusions In a small cohort of HIV infected children, in the absence of antiretroviral therapy only a little over one third survived beyond eight years of age. On further follow up of these long terms surviving children over one third had a slow rate of disease progression.

Alok Kumar*, Krishna R Kilaru, Anne O Carter*, Sheila Forde, Uptake of health care provisions and health status of the HIV infected women diagnosed from the antenatal VCT in Barbados during 1996-2004. Alok Kumar*, Krishna R Kilaru, Anne O Carter*, Sheila Forde, Ira Waterman. School of Clinical Medicine & Research*, University of the West Indies (Cave Hill) and Ladymeade Reference Unit, Ministry of Health, Barbados.

Objectives study the utilization of the HIV related health care services and describe the health status of the HIV infected women diagnosed form the antenatal VCT.

Methods A retrospective descriptive study. Study population - all women diagnosed to be HIV infected from VCT during the 1996-2004. Subdivided into three subperiods 1996 – 98; free VCT 1999 – 01: special follow up clinic 2002 – 04: HAART

Follow up status of the 163 HIV infected women.   Nos. (%) Attendance at the HIV clinic for care and treatment (n = 163) Ever attended 102 (62.6) Never attended 61 (37.4) Current status Living 134 (87.7) Deceased 24 (9.8) Not known 5 (1.5) Follow up status (n = 102) Satisfactory follow up (atleast once in six months) 79 (77.4) Median lag between diagnosis and follow up 16 mon

Trends in uptake of health services and health status   1996-98 N (%) 1999-01 2002-04 Number of women diagnosed as HIV infected 68 (41.7) 58 (35.6) 37 (22.7) Status at the time of this report Deceased 13 (19.1) 9 (15.5) 2 (5.4) Alive 53 (77.9) 46 (79.3) 35 (94.6) Not known 2 (3.0) 3 (5.2) 0 (0.0) Follow up at LRU/RU Never had any follow up 30 (44.1) 23 (39.6) 8 (24.3) Ever had a follow up 38 (55.9) 35 (60.4) 29 (75.7) Quality of follow up those ever had follow up Good follow up (at least once every 6 months) 19 (50.0) 23 (65.7) 21 (75.0) Poor follow up 12 (34.3) 8 (25.0)

Summary Poor return for follow up. Long lag period for follow up Advance stage of disease at presentation Median lag time and the proportion of women with low CD4 counts have both declined significantly in 2002-04.

Conclusions Despite the provision for free HAART, poor return for follow up could be a pointer to the high degree stigma and discrimination. HIV diagnosis is not enough to ensure that all women with HIV will get adequate and timely health care. Repeated counseling stressing the importance of follow.

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