Abstract
BackgroundA series of interventions are required to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) starting from HIV testing of pregnant women, initiating antiretroviral therapy (ART) or antiretroviral prophylaxis to HIV-positive pregnant women to providing HIV prophylaxis to newborn babies. Gaps in each step can significantly affect the effectiveness of PMTCT interventions. We aimed to determine the gap in initiation of ART/antiretroviral prophylaxis for pregnant women living with HIV, delay in initiation of ART/antiretroviral prophylaxis and factors associated with the delay.MethodsThis is a cross sectional study using routinely collected programme data from five health facilities providing PMTCT services located at Township Health Departments (THD) of Mandalay, Myanmar.ResultsThere were 363 pregnant women living with HIV enrolled between January 2012 and December 2017. Sixty (16%) women were excluded from the study due to missing data on dates of HIV diagnosis. Of 303 (84%) women included in the study, 89/303 (29%) and 214/303 (71%) were diagnosed with HIV before and during current pregnancy respectively. Among 214 women, 180 (84%) women were started on ART by the censor date (31st March 2018). Among those who started ART, 109 (61%) women had a delay of starting ART > 2 weeks from diagnosis. Women residing in township 4 had a significantly higher risk of delay in initiation of ART/antiretroviral prophylaxis compared to women residing in township 1 [adjusted prevalence ratio 4.2 (95% confidence interval 1.2–14.8].ConclusionsWe found that one in four women living with HIV knew their HIV status before current pregnancy. Although the rate of ART/antiretroviral prophylaxis initiation was high among pregnant women living with HIV, there was a delay. Early initiation of ART/antiretroviral prophylaxis among newly HIV diagnosed pregnant women needs to be strengthened.
Highlights
A series of interventions are required to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) starting from HIV testing of pregnant women, initiating antiretroviral therapy (ART) or antiretroviral prophylaxis to HIV-positive pregnant women to providing HIV prophylaxis to newborn babies
A study conducted in Cape Town between 2003 and 2010 showed that there was a delay in initiation of ART (21 days after HIV diagnosis) among pregnant women attending antenatal care services [9]
There were 363 pregnant women living with HIV registered in the study sites, of whom, 303 (84%) women were included in the analysis
Summary
A series of interventions are required to prevent mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) starting from HIV testing of pregnant women, initiating antiretroviral therapy (ART) or antiretroviral prophylaxis to HIV-positive pregnant women to providing HIV prophylaxis to newborn babies. Prevention of mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services include providing maternal antiretroviral therapy (ART)/ antiretroviral prophylaxis and infant’s antiretroviral prophylaxis. World Health Organization (WHO) recommends early ART initiation in HIV-positive women (as soon as possible) as an effective intervention in reducing mother to child transmission of HIV and studies show that at least 4–13 weeks of ART is required to achieve viral suppression at the time of delivery [2, 8]. WHO published updated guideline in 2016 which recommended provision of lifelong ART to HIV-positive pregnant women regardless of WHO staging and CD4 count which can minimize or remove the delay in initiation of ART without waiting for the CD4 results and deterioration of patients’ clinical condition [10]
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