Abstract
BackgroundTo evaluate the performance and to identify predictive factors of performance in prevention of mother-to-child HIV transmission programs (PMTCT) in sub-Saharan African countries.MethodsFrom 2000 to 2011, PMTCT programs included in the Viramune Donation Programme (VDP) were prospectively followed. Each institution included in the VDP provided data on program implementation, type of management institution, number of PMTCT sites, key programs outputs (HIV counseling and testing, NVP regimens received by mothers and newborns). Nevirapine Coverage Ratio (NCR), defined as the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care), was used to measure performance. Included programs were followed every six months through progress reports.ResultsA total of 64 programs in 25 sub-Saharan African countries were included. The mean program follow-up was 48.0 months (SD = 24.5); 20,084,490 women attended in antenatal clinics were included. The overall mean NCR was 0.52 (SD = 0.25), with an increase from 0.37 to 0.57 between the first and last progress reports (p<.0001); NCR increased by 3.26% per year-program. Between the first and the last report, the number of women counseled and tested increased from 64.3% to 86.0% (p<.0001), the number of women post-counseled from 87.5% to 91.3% (p = 0.08). After mixed linear regression analysis, type of responsible institution, number of women attended in ANC, and program initiation in 2005-2006 were significant predictive factors associated with the NCR. The effect of the time period increased from earlier to later periods.ConclusionA longitudinal assessment of large PMTCT programs shows that scaling-up of programs was increased in sub-Saharan African countries. The PMTCT coverage increased throughout the study period, especially after 2006. Performance may be better for programs with a small or medium number of women attended in ANC. Identification of factors that predict PMTCT program performance may help in the development and expansion of additional large PMTCT services in sub-Saharan Africa.
Highlights
As home to more than two-thirds of the global population of individuals living with HIV/ AIDS, sub-Saharan Africa has the highest HIV/AIDS burden of any region in the world
A longitudinal assessment of large prevention of mother-to-child transmission (PMTCT) programs shows that scaling-up of programs was increased in sub-Saharan African countries
The PMTCT coverage increased throughout the study period, especially after 2006
Summary
As home to more than two-thirds of the global population of individuals living with HIV/ AIDS, sub-Saharan Africa has the highest HIV/AIDS burden of any region in the world. Of children newly infected with HIV in 2011, 90% lived in sub-Saharan Africa [1]. Effective interventions for the prevention of mother-to-child transmission (PMTCT) are critical to reducing the HIV/AIDS burden in sub-Saharan Africa. PMTCT is critical to reducing the global HIV/AIDS burden in the developing world, and a variety of programs have provided more than 900,000 pregnant women with ARV prophylaxis or treatment by the end of 2012 [1]. In combination with other measures to reduce or eliminate vertical transmission of HIV, expansion of PMTCT services could help to reduce the number of newly infected children by 90%. To evaluate the performance and to identify predictive factors of performance in prevention of mother-to-child HIV transmission programs (PMTCT) in sub-Saharan African countries
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