Mother to child transmission of HIV and its option B+ cascade predictors: An ecological study

Abstract

Context: In 2013, the world Health Organization endorsed Option B plus as a strategy towards elimination of vertical transmission of HIV (human immunodeficiency virus). The purpose of the study was to examine the Option B+ trends and outcome predictors in Zimbabwe. Aims: to examine the PMTCT trends in Mashonaland East Province in Zimbabwe to determine the programmatic correlates of reduced MTCT in the first three years of introduction of PMTCT option B+. Settings and Design: Ecological study in Mashonaland East Province, Zimbabwe. Methods and Materials: The study was based on Option B plus data from the Provincial Health information system. Spatial mapping of MTCT rates was done using ArcMap 10.1. Statistical Analysis Used: Descriptive statistics and multiple linear regression of the correlates of MTCT rates using R software based on step-wise Akaike information criterion. Results: The MTCT rate for Mashonaland East was 5.3% in 2014, 5.2% in 2015 and 4.0% in 2016. The predictors for reduced PMTCT included: booking the pregnancy with a known HIV positive status (β= -0.011, SEB=0.0035), arriving in labour and delivery with unknown HIV status (β= -0.029, SEB=0.0078), testing HIV positive at retesting in labour and delivery (β= - 0.04; SEB=0.03), women with unknown HIV status within 24 months post-delivery (β= - 0.0044; SEB=0.0032) and identification of HIV exposed infants within 72 hours of birth (β= - 0.01; SEB=0.0026). Conclusions: PMTCT Option B+ was associated with a decline in MTCT rate. Intensive psychosocial support of pregnant or nursing women may facilitate reduction of MTCT rates.