PMTCT (Prevention of Mother-to-Child Transmission of HIV)

In Africa, especially in the most affected areas of Eastern and Southern Africa, the transmission of HIV from the mother to the child during pregnancy, labour and via breast feeding is the most common route. The risk of transmission in developing countries lays at about 30% and is highest perinatally.

PMTCT Programmes

PMTCT Programmes were established in 38 health facilities in Kenya, Tanzania and Uganda. Pregnant women with a positive serostatus are offered the possibility of taking antiretroviral medicine during delivery and of administering the drug to the newborn baby within 72 hours after birth. This measure reduces the risk of HIV transmission by about 50%. In addition to this, longterm treatment with antiretroviral drugs (ART) was implemented.

Research questions are addressed in comprehensive monitoring protocols as well as in specific research proposals with regard to the following topics:

Operational

KAPB studies on mother-to-child transmission in different population goups
Practice of infant nutrition in areas with high prevalence of HIV
Minimal requirements for the implementation of PMTCT programmes
Analysis of different strategies of nevirapine administration (e.g. self-administration)
Comparison of different methods to simplify treatment monitoring
Cost-benefit analyses
Male partner involvement into PMTCT services
Feasibility of combination prophylaxis

Mother-Child cohorts

Analysis of factors influencing the vertical transmission (point of time of nevirapine intake, relationship of viral load and nevirapine concentration in different body compartments such as plasma, breast milk, vaginal- and oropharyngeal secretions)
Resistance formation in breast milk and plasma of mothers and children

ART-cohorts

Analysis of clinical, immunological, virological treatment outcome in the patient groups of 3 countries in Eastern Africa
Side effects of treatment in the patient groups in Eastern Africa
Adherence to treatment in peripheral areas of Eastern Africa

Project coordination

Prof. Dr. Gundel Harms-Zwingenberger

Publications

Poggensee G, Schulze K, Moneta I, Baryomunsi C, Mbezi P, Harms G. Infant feeding practices in western Tanzania and Uganda: implications for infant feeding recommendations for HIV-infected mothers. J Trop Med Int Hlth 2004; 4:1-9.

Herzmann C, Karcher H. Nevirapine plus zidovudine to prevent mother-to-child transmission of HIV. N Engl J Med 2004; 351:2013-2015.

Karcher H, Moses A, Weide AL, Stelzenmueller J, Mayer A, Harms G. Evaluation of antiretroviral treatment in Fort Portal, western Uganda. MedGenMed 2004 6:B12706.

Kunz A, Mayer A, Petruschke I, Kabasinguzi R, Mbezi P, Odera J, Weidenhammer A, Karcher H, Harms G. Nevirapine intake in PMTCT programmes in Kenya, Tanzania and Uganda. MedGenMed 2004;6(3):ThPeE8032.

Karcher H, Mugenyi K, Odera J, Mbezi P, Masanja B, Kabasonguzi R, Ali M, Simo S, Kunz A, Mayer A, Weidenhammer A, Harms G. MedGenMed 2004;6(3):WePeE6828.

Harms G, Theuring S, Karcher H, Kunz A, Kagwire F, Mbezi P, Odera J. Cost evaluation of PMTCT Programmes. MedGenMed 2004;6(3):TuPeC4953.

Karcher H, Kunz A, Mbezi P, Mugenyi K, Odera J, Harms G. Prevention of HIV-1 mother to child transmission (PMTCT) and antiretroviral treatment in East Africa. Eur J Med Res 2005;10(Suppl II):1-125.

Karcher H, Boehning D, Downing R, Mashate S, Kunz A, Harms G. Comparison of two alternative methods for CD4+ T-cell determination (Coulter Manual CD4 count and CyFlow) against standard dual platform flow cytometry in Uganda. Eur J Med Res 2005;10(Suppl II):1-125.

Harms G, Mayer A, Schulze K, Moneta I, Baryomunsi C, Mbezi P, Poggensee G. Mother-to-Child transmission of HIV and its prevention: awareness and knowledge in Uganda and Tanzania. JSAHA 2005;2:258-266.

Harms, G, Kunz A, Karcher H, Simo S, Kurowski M. Nevirapine concentration in cervicovaginal and oropharyngeal secretions after single dose administration to the mother. Antivir Ther 2005; 10:777.

Karcher H, Kunz A, Poggensee G, Mbezi P, Mugenyi K, Harms G. Outcome of different nevirapine administration strategies in preventing mother-to-child transmission (PMTCT) programs in Tanzania and Uganda. MedGenMed 2006;8:12.

Karcher H, Boehning D, Downing R, Mashate S, Harms G. Comparison of two alternative methods for CD4+ T-cell determination (Coulter manual CD4 count and CyFlow) against standard dual platform flow cytometry in Uganda. Cytometry B Clin Cytom 2006;70:163-169.

Kunz A, Mugenyi K, Karcher H, Mayer A, Simo S, Ali M, Kurowski M, Harms G. Intrapartum transmission after mucosal exposure to HIV was not observed with single-dose nevirapine for mother and child. J Acquir Immune Defic Syndr 2007; 44(5): 562-565.

Karcher H, Omondi A, Odera J, Kunz A, Harms G. Risk factors for treatment denial and loss to follow up in an antiretroviral treatment cohort in Kenya. Trop Med Int Health 2007; 12(5): 687-694.

Kunz A, Frank M, Mugenyi K, Kabasinguzi R, Weidenhammer A, Kurowski M, Kloft C, Harms G. Persistence of nevirapine in breast milk and plasma of mothers and their children after single-dose administration. J Antimicrob Chemother 2009; 63:170-177.