Abstract
BackgroundAntiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019.MethodsCountry-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model.ResultsART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = − 0.18, 95% CI − 0.19–− 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18–8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate.ConclusionsART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.
Highlights
Antiretroviral therapy for pregnant women infected with human immunodeficiency virus (HIV) has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa
Astawesegn et al BMC Infectious Diseases (2022) 22:134 on HIV/Acquired immune deficiency syndrome (AIDS) (UNAIDS) categorized these interventions into four prongs: [1] preventing HIV infection among women of childbearing age; [2] preventing unintended pregnancies among women living with HIV; [3] providing antiretroviral therapy (ART) to HIV positive pregnant women to prevent HIV transmission from women living with HIV to their infants; and [4] providing appropriate treatment, care, and support to mothers living with HIV, their children, and families [2, 3]
From the nine countries which have achieved the global target of over 95% ART coverage during pregnancy in 2019, only three countries (Botswana, Namibia, and South Africa) were able to reduce the Mother-to-child HIV transmission (MTCT) rate below 5%. These variations might be due to differences in the prevention of mother-to-child transmission of HIV (PMTCT) policy guidelines that have been implemented across countries, the timing of ART initiation during pregnancy [48,49,50,51,52] and the non-completion of the PMTCT cascades amongst mothers [53,54,55,56,57,58,59,60]
Summary
Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. This study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019. ART coverage during pregnancy at a national level has been identified as one of the process indicators by the World Health Organization [5]. This strategy to prevent mother-to-child HIV transmission has evolved through three iterations, with the application of a particular indicator dependent on the resources within a country [6]. Option B + specifies triple ARV drug regimens for pregnant mothers regardless of maternal CD4 cell counts and which continue throughout life, including throughout breastfeeding and subsequent pregnancies [8]
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