Abstract
BackgroundEliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally..MethodsA cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model.ResultsAmong 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death.ConclusionsIn Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.
Highlights
Elimination of mother-to-child HIV transmission (EMTCT) is a critical milestone in ending the HIV epidemic globally by 2030
Maternal HIV-prevalence and Eliminating mother-to-child HIV-transmission (EMTCT) impact indicators The estimated unadjusted community HIV-prevalence among women with a live birth in the previous 4 years was 30.8%
The mother-to-child transmission was below 5%, the case rate of new pediatric HIV infections was 1654 per 100, 000 live births, which exceeds the World Health Organization (WHO) target rate of 50 new HIV infections per 100,000 required to eliminate mother-tochild HIV transmission (MTCT)
Summary
Elimination of mother-to-child HIV transmission (EMTCT) is a critical milestone in ending the HIV epidemic globally by 2030. Prevention and surveillance of MTCT (PMTCT) for HIV-exposed children (HEC) includes early infant diagnosis conducted between 4 and 6 weeks of life and clinical follow-up until 18 months of life or until the end of breastfeeding. The global number of annual new infections in children (aged 0–14 years) has decreased from 230,000 to 160,000 and the associated HIV-associated child mortality from 170,000 to 100,000 deaths (2012–2018), the absolute numbers of annual cases remain elevated, especially in sub-Saharan Africa [3]. Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIVinfections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally
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