Abstract
BackgroundDespite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into “High” or”Low” MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status.ObjectiveThe study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment.MethodsCross-sectional study using review of records of routinely collected program data.ResultsOf the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as “high risk” for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants’ ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine).ConclusionThere was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily.
Highlights
Most of the 1.8 million human immunodeficiency virus (HIV) infected children are in subSaharan Africa [1], where the majority (~90%) acquired infection through mother-to-child transmission (MTCT) either during pregnancy, at the time of delivery or during breastfeeding. [2][3] As one of the strategies to end the global AIDS epidemic by 2030, it is necessary to eliminate new Human Immunodeficiency Virus (HIV) infections in children.[4]With comprehensive prevention of MTCT (PMTCT) interventions, MTCT rates which range from 15–45% can fall to 5%.[2]
There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available
"high risk" HIV exposed infant (HEI) are deprived of dual ARV prophylaxis and priority HIV nucleic-acid test (NAT) at birth and onwards which they require for prevention of mother-to-child transmission (PMTCT)
Summary
Most of the 1.8 million human immunodeficiency virus (HIV) infected children are in subSaharan Africa [1], where the majority (~90%) acquired infection through mother-to-child transmission (MTCT) either during pregnancy, at the time of delivery or during breastfeeding. [2][3] As one of the strategies to end the global AIDS epidemic by 2030, it is necessary to eliminate new HIV infections in children.[4]With comprehensive prevention of MTCT (PMTCT) interventions, MTCT rates which range from 15–45% can fall to 5%.[2]. HIVinfected pregnant women who fulfill one of the four criteria are considered as ‘high-risk’: i) maternal viral load (VL) >1,000 copies/mL at 32 weeks of gestation; ii) are ARV-naive; iii) are on ARV treatment for
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