Use of services for prevention of mother-to-child transmission of HIV in Angola: a retrospective analysis

Abstract

BackgroundAfter a long civil war (1975–2002) that destroyed much of the country's health infrastructure, Angola faced the challenge of reconstruction while fighting HIV/AIDS. Despite expansion of services for prevention of mother-to-child transmission (PMTCT) since 2004, Angola was included as one of the 22 priority countries for UNAIDS Global Plan Towards The Elimination Of New HIV Infections Among Children By 2015 And Keeping Their Mothers Alive. We assessed recent progress in access and use of PMTCT services in Angola.MethodsWe analysed data for PMTCT between 2005 and 2012. We collected data from national and international reports, including the report of UN General Assembly Special Session and the WHO Progress Report on HIV Treatment. We assessed progress made, developed best-fit regression models, and predicted future points for five indicators of PMTCT: estimated number of HIV-positive pregnant women in need of PMTCT, number of PMTCT sites, proportion of pregnant women tested for HIV, proportion of HIV-positive pregnant women, and proportion of HIV-positive pregnant women who received any antiretroviral therapy.FindingsThe number of PMTCT sites increased from nine in 2005, to 347 in 2012, and the number of pregnant women tested for HIV increased from 12 061 to 314 805 over the same period. However, in 2012, fewer than half (n=2656) of the pregnant women who tested positive for HIV (n=5805) were receiving PMTCT—ie, only 17% of the HIV-positive pregnant women in Angola are being reached by PMTCT services. Our models predict that by 2015, 520 PMTCT sites will exist in Angola, 52% of pregnant women will be tested for HIV, 0·6% of women will test positive for HIV at PMTCT sites, and 43% of HIV-positive pregnant women identified at PMTCT sites will receive antiretroviral therapy. Additionally, in a post-hoc analysis, new HIV infections among children increased by 12% between 2009 and 2012, with Angola the only country among the 22 priority countries where no progress took place.InterpretationAngola is unlikely to meet the goals of the Global Plan in 2015. Despite expansion of PMTCT services and an increase in HIV testing for pregnant women, urgent action is needed to rapidly scale-up HIV prevention and treatment services for HIV-positive pregnant women and for children.FundingNone.