Perinatal intervention trial in Africa: Effect of a birth canal cleansing intervention to prevent HIV transmission

Robert J. Biggar, Paolo G. Miotti, Taha E. Taha, Laban Mtimavalye, Robin Broadhead, Aafke Justesen, Frances Yellin, George Liomba, Wendel Miley, David Waters, John D. Chiphangwi, James J. Goedert

Research output: Contribution to journalArticle

Abstract

Background. Perinatal transmission of human immunodeficiency virus (HIV) type 1 contributes significantly to infant mortality. Exposure in the birth canal may account for some transmission. We examined the efficacy of a birth canal washing procedure in reducing perinatal transmission in Malawi. Methods. The infection status of infants of 3327 control women (conventional delivery procedures) was compared with that of 3637 infants of intervention-delivered women. The infants' HIV status was determined by polymerase chain reaction on dried blood spots collected at 6 and 12 weeks of age. The intervention consisted of manual cleansing of the birth canal with a cotton pad soaked in 0.25% chlorhexidine, which was done on admission in labour and every 4 h until delivery. Findings. No adverse reactions to the intervention procedure were seen. 2094 (30%) of the enrolled women follow-up. Among 982 vaginal vertex singleton deliveries to HIV-infected women, 269 (27%) infants were infected. The intervention had no significant impact on HIV transmission rates (27% in 505 intervention women compared with 28% in 477 control women), except when membranes were ruptured more than 4 h before delivery (transmission 25% in the intervention group vs 39% in the control group). Interpretation. If birth canal exposure is an important risk factor, different or additional methods to reduce the risk of perinatal HIV transmission should be tested. Alternatively, perhaps birth canal exposure is not a major contributor to perinatal infection risk.

Original languageEnglish (US)
Pages (from-to)1647-1650
Number of pages4
JournalLancet
Volume347
Issue number9016
DOIs
StatePublished - Jun 15 1996

ASJC Scopus subject areas

  • Medicine(all)

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    Biggar, R. J., Miotti, P. G., Taha, T. E., Mtimavalye, L., Broadhead, R., Justesen, A., Yellin, F., Liomba, G., Miley, W., Waters, D., Chiphangwi, J. D., & Goedert, J. J. (1996). Perinatal intervention trial in Africa: Effect of a birth canal cleansing intervention to prevent HIV transmission. Lancet, 347(9016), 1647-1650. https://doi.org/10.1016/S0140-6736(96)91486-5