Abstract
BackgroundWe established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID). To these ends, we implemented the following interventions in 5 districts: 1) health worker training and mentorship; 2) couples’ HTC and male partner involvement; 3) women’s psychosocial support groups; and 4) health and laboratory system strengthening for EID.MethodsWe conducted a serial cross-sectional study using facility-level quarterly (Q) program data and individual-level infant HIV-1 DNA PCR data to evaluate STF performance on PMTCT indicators for project years (Y) 1 (April—December 2011) through 3 (January—December 2013), and compared these results to national averages.ResultsFacility-level uptake of HTC, ART, infant nevirapine prophylaxis, and infant DNA PCR testing increased significantly from quarterly baselines of 66 % (n/N = 32,433/48,804), 23 % (n/N = 442/1,958), 1 % (n/N = 10/1,958), and 52 % (n/N = 1,385/2,644) to 87 % (n/N = 39,458/45,324), 96 % (n/N = 2,046/2,121), 100 % (n/N = 2,121/2,121), and 62 % (n/N = 1,462/2,340), respectively, by project end (all p < 0.001). Quarterly HTC, ART, and infant nevirapine prophylaxis uptake outperformed national averages over years 2–3. While transitioning EID laboratory services to MoH, STF provided first-time HIV-1 DNA PCR testing for 2,226 of 11,261 HIV-exposed infants (20 %) tested in the MoH EID program in STF districts from program inception (Y2) through Y3. Of these, 78 (3.5 %) tested HIV-positive. Among infants with complete documentation (n = 608), median age at first testing decreased from 112 days (interquartile range, IQR: 57–198) in Y2 to 76 days (IQR: 46–152) in Y3 (p < 0.001). During Y3 (only year with national data for comparison), non-significantly fewer exposed infants tested HIV-positive (3.6 %) at first testing in STF districts than nationally (4.1 %) (p = 0.4).ConclusionsSTF interventions, integrated within the MoH Option B+ program, achieved favorable HTC, maternal ART, infant prophylaxis, and EID services uptake, and a low proportion of infants found HIV-infected at first DNA PCR testing. Continued investments are needed to strengthen the PMTCT cascade, particularly around EID.
Highlights
We established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID)
As Prevention of mother-to-child transmission (PMTCT) interventions, including improved HIV testing strategies, maternal combination antiretroviral therapy (ART), and infant nevirapine prophylaxis have become more widely available, marked reductions in mother-to-child HIV transmission (MTCT) throughout the perinatal period have been observed—from a baseline of 20-45 % over a decade ago to less than 5 % under research conditions in the ART era [4,5,6]. Such reductions may be realized when HIV prevention and treatment interventions are optimized for HIV-infected mothers and their HIV-exposed infants at each step of the PMTCT cascade—from HIV testing and counseling (HTC) and maternal ART initiation through infant nevirapine prophylaxis provision, early infant HIV diagnosis (EID), and maternal-infant follow-up until breastfeeding cessation [7, 8]
We report high facility-level utilization of HTC, ART, and infant nevirapine prophylaxis, and moderate EID services uptake in five Malawi districts supported by STF interventions
Summary
We established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID). As PMTCT interventions, including improved HIV testing strategies, maternal combination antiretroviral therapy (ART), and infant nevirapine prophylaxis have become more widely available, marked reductions in mother-to-child HIV transmission (MTCT) throughout the perinatal period have been observed—from a baseline of 20-45 % over a decade ago to less than 5 % under research conditions in the ART era [4,5,6] Such reductions may be realized when HIV prevention and treatment interventions are optimized for HIV-infected mothers and their HIV-exposed infants at each step of the PMTCT cascade—from HIV testing and counseling (HTC) and maternal ART initiation through infant nevirapine prophylaxis provision, early infant HIV diagnosis (EID), and maternal-infant follow-up until breastfeeding cessation [7, 8]
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