ICRH Kenya

INTERNATIONAL CENTRE FOR REPRODUCTIVE HEALTH -KENYA

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Intervention study to reduce Mother-to-child transmission of HIV

Team members:
Philippe Gaillard; Fabian Mwanyumba; Patricia Claeys, Marleen Temmerman;

OBJECTIVES

  • To examine whether the intervention strategy of vaginal cleansing with a diluted chlorhexidine solution during labour can reduce the risk of transmission of HIV infection from mother-to-child
  • To acquire a better understanding of the timing of perinatal transmission of HIV-1.

METHODS 

  • Prospective clinical trial
  • On alternating weeks, women were allocated to non-intervention or to intervention consisting of vaginal lavage with 120 ml 0.2% chlorhexidine, later increased to 0.4%, repeated every 3 h from admission to delivery. Infants were tested for HIV by DNA polymerase chain reaction within 48 h and at 6 and 14 weeks of life.

RESULTS

  • Enrolment and follow-up data were available for 297 and 309 HIV-positive women, respectively, in the non-lavage and the lavage groups.
  • Vaginal lavage with diluted chlorhexidine during delivery did not show a global effect on MTCT in our study. However, the data suggest that lavage before the membranes are ruptured might be associated with a reduction of MTCT, especially with higher concentrations of chlorhexidine:
  • There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% CI 0.6-1.4) between the groups.
  • Lavage solely before rupture of the membranes tended towards lower MTCT with chlorhexidine 0.2% (OR 0.6, 95% CI 0.3-1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% CI 0.0-0.9).
  • The results were published in AIDS. 2001 Feb 16;15(3):389-96