Outcomes of HIV-Exposed infants enrolled in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in Philippine General Hospital: An 8-year retrospective study

Background@#Our country has the fastest growing number of HIV cases in the Asia-Pacific region with a 203% increase from 2010 to 2018. MTCT represents 6% of infections in children and interventions such as the PMTCT program are essential to help reduce new infant infections. @*Objective@#To determine the outcomes of HIV-exposed infants born in PGH from 2010 to 2018 enrolled in the PMTCT program. To analyze the association of maternal and neonatal clinicodemographic factors to MTCT of HIV.@*Methods@#A retrospective cohort study using data collected from medical records of HIV exposed infants enrolled in the program. @*Results@#Out of 117 mother-infant pairs, only 70 met the eligibility criteria. Maternal factors showed that majority have: timely antenatal visit (56/70), maternal HIV diagnosis (70/70) and ART initiation (67/70) prior to delivery, triple lifelong maternal ART (69/70), CD4 >200 prior to delivery (52/70) and cesarean delivery (67/70). Amongst the infant factors-early infant prophylaxis (60/62), >4weeks prophylaxis duration (62/70) and replacement feeding (62/70) were noted in the majority. 2/70 infants were HIV positive. Mortality rate was 1.4% and 50% for HIV infected infants. Overall LTFU rate was 33.3%. Logistic regression showed that maternal co-infection with Hepatitis B(p=0.0275) was a possible determinant of MTCT. Infant HIV prophylaxis duration of >4 weeks had higher survival proportion(p=.0001). @*Conclusion@#The HIV MTCT rate was 2.86% upon implementation of our PMTCT program, meeting the <5% goal of WHO, suggesting that the program was an effective health intervention strategy. The high LTFU rate though should be considered in the evaluation of the program effectiveness.

Outcomes of infants born to mothers with SARS-CoV-2 infection in a tertiary hospital

Introduction@#Pregnant women are a susceptible population to emerging infections. Recent published data have shown evidence of possible transplacental transmission of SARS-CoV-2. However, at present there are not enough data to determine its effect on the fetus. This study aims to determine the outcomes of infants born to mothers with SARS-CoV-2 infection. @*Methods@#A retrospective descriptive institution-based study using data collected from medical records of infants born to confirmed COVID-19 mothers delivered from April to June 2020. @*Results@#Of the 47 neonates, none of them were positive for SARS-CoV-2 RT-PCR. Majority were born full-term, mean gestational age of 37 weeks, weight of 2867 grams, appropriate for gestational age, good APGAR score, and delivered through cesarean section. Symptomatic neonates (27.7%) had tachypnea and vomiting as the most common manifestation, 13.3% had lymphopenia while pneumonia was the predominant radiologic finding. There was a significant association between the presence or absence of symptoms among mothers and neonates (p=0.037). @*Conclusion@#The neonatal outcome in this study was good with 98% survival at 2 weeks of life. There was note of 2.1% morbidity and mortality. Given that the clinical data in newborns are very limited and the possibility of a vertical transmission is still uncertain, it is crucial to closely monitor neonates with increased risk of COVID-19 infection.

Antimicrobial Stewardship (AMS) program in private hospitals in the Philippines: Its acceptability, barriers, and enablers

Background@#Antimicrobials are drugs that are often misused and inappropriate antimicrobial prescribing often results in poor clinical outcome and drug resistance. Monitoring and regulation of antimicrobial use is currently being done by the Department of Health through the Antimicrobial Stewardship (AMS) Program. There is a need to determine the factors that affect successful implementation of an AMS program in private hospitals in the Philippines. This study was conducted to identify the enablers and potential barriers in implementing an AMS program in nine (9) private hospitals. @*Methodology@#A concurrent mixed methods design was used to assess various stakeholders’ (physicians, administrators, other AMS members) perceptions of existing or proposed AMS programs, and to identify barriers and enablers in their implementation. Quantitative data were collected using self-administered survey questionnaire to assess clinician’s acceptance of AMS programs. Qualitative data were collected through semi-structured one-on-one interviews of clinicians and other AMS personnel and focus group discussions (FGD) of selected clinician groups. Data were gathered from October 2018 to October 2019. @*Results@#409 clinicians were surveyed, 52 were interviewed and 46 sat for 13 sessions of FGDs. Overall, the survey established that physicians were well aware of antimicrobial resistance problem. Majority of the clinicians indicated general agreement with the currently practiced antimicrobial protocols in their hospitals and with the AMS program. However, there were disagreements in perceptions with how antimicrobial restrictions impair prescribing practices and overuse of the same. These responses were strong points of discussion during the Key Informant Interviews (KII) and FGDs. All respondents were amenable with the institutionalization of an AMS program in their hospitals. The hospital leadership’s commitment was determined to be the key enabler of a successful AMS program’s implementation. Barriers identified for hospitals with existing AMS programs were: lack of dedicated staff, resistance and/or non-cooperation of physicians, lack of support from non-medical departments, and inadequate cooperation between hospital personnel. Barriers identified, regardless of the status of the AMS programs were: deficiency in knowledge with developing and implementing an AMS program, inadequate information dissemination, unavailability of an IT-based monitoring for antibiotic use, and the influence of pharmaceutical companies on stakeholders with regards to antimicrobial use. @*Conclusion@#Similar enablers and barriers to a successful implementation of an AMS program were seen in the different hospitals. A hospital leadership’s commitment was determined to be the key enabler. The success or failure of any AMS program appears to depend on physician understanding, commitment and support for such a program. By involving the main players in an AMS program- the hospital administrators, clinicians and other key members, perceived barriers will be better identified and overcome, and enablers will help allow a successful implementation of an AMS program. This multi-center study was funded by Philippine Council on Health Research and Development ( PCHRD) and Pediatric Infectious Disease Society of the Philippines ( PIDSP) and was conducted by the PIDSP Research Committee.

Epidemiology and outcome of children living with HIV in a tertiary hospital: A 6-year retrospective study

Introduction@#Infection with HIV is multi-faceted and involves the interplay of medical, social, and economic factors thus, management of the disease continues to be a challenge to most physicians. The Philippines is experiencing a surge in cases since 2013. Understanding the local epidemiology of pediatric HIV may reveal opportunities to reduce or eliminate transmission through timely diagnosis. @*Objective@#This study was conducted to identify the features and outcome of children living with HIV in a hospital where a program for HIV treatment and monitoring was implemented. @*Methodology@#Medical records of all children Guidance Intervention Prevention (SAGIP) Unit were reviewed. Data was analysed using descriptive statistics. @*Results@#Thirty pediatric HIV patients were included in the study. The most common mode of acquisition is by sexual transmission (57%) and most patients were male (76%),bisexual (47%), and heterosexual (47%). Weight loss (50%),rash (50%), fever (37%) and cough (37%) were the most common clinical findings. The most common opportunistic infections were tuberculosis (47%) and oral candidiasis (34%). Only 27 of 30 patients were started on antiretroviral therapy within 6 months from diagnosis. One patient showed resistance to a non-nucleoside reverse transcriptase inhibitor (NNRTI). There were 11 children who died of various opportunistic infections and its complications, while 2 were transferred to a different treatment hub after 6 months, and 1 lost to follow-up. @*Conclusion@#Sexual means of HIV transmission among adolescents is evident in this study. Weight loss, cough, rash, fever, and lymphadenopathy are common presenting features. Tuberculosis and oral candidiasis are the most common opportunistic infections and should alert physicians on possible HIV infection. A mortality rate of 37% was noted mostly in the first 6 months of initiating ART treatment.