Child Transmission Program Research Articles

Strengthening community health volunteers as a community empowerment in the reduction of HIV/AIDS stigma

Negative stigma of society is one of the inhibitory factors of HIV/AIDS promotion and prevention programs. The Community Health Volunteer HIV (CHV HIV) program represents a community attempt to reduce the negative stigma of society concerning HIV/AIDS. The purpose of this activity is the formation of CHV HIV activities which are expected to educate the Primary Health Care (PHC) patients who are childbearing age women and expectant mothers in HIV/AIDS prevention; to support the success of the Prevention of Mother to Child Transmission (PMTCT) program; to increase the participation of childbearing age women and expectant mothers in Voluntary Counselling and Testing (VCT), and to reduce the incidence rate of HIV. Community empowerment activities were conducted in 2018, from July until November in Sleman, District Istimewa Yogyakarta (DIY). These activities involved the socialization of HIV/AIDS programs and education about VCT for CHVs in cooperation with PHC and non-government organizations (NGOs). The CHVs provided counselling for childbearing age women and expectant mothers related to prevention of HIV/AIDS transmission. The results of these activities were the increasing of CHV knowledge about HIV/AIDS and the formation of twelve CHV HIV in Sleman, DIY. In conclusion, this activity effectively increases the participation of childbearing age women and expectant mothers in voluntary HIV tests, so that the formation of CHV HIV could not only involve adult age volunteers but also adolescents.

976. A Descriptive Retrospective Data Analysis of Maternal Sociodemographic Factors and Access of Healthcare Resources within the African Cohort Study, an Integrated Multicountry Preventative Mother to Child Transmission Program

BackgroundGlobal reduction in new infant HIV infections is largely due to the expansion of prevention of mother-to-child transmission (PMTCT) programs. Identification of gaps in healthcare services is paramount in targeting interventions that identify high-risk populations and healthcare barriers that could lead to increased risk of mother to child transmission (MTCT) of HIV.MethodsHIV infected women from 5 regions of Africa enrolled in the African Cohort Study (AFRICOS) were followed prospectively with assessments performed every 6 months. Sociodemographic factors, pregnancy outcomes, and access of PMTCT resources were reviewed for retrospectively reported pregnancies and those followed prospectively from study enrollment. Statistical analysis compared the impact of clinical factors on infant mortality and preterm delivery.ResultsThe study reported 5591 pregnancies from January 2013 to June 2019 of which 5363 were retrospectively reported prior to study enrollment and 228 occurred after enrollment. Pregnancies followed prospectively had higher rates of linkage to PMTCT services prenatally (92.5% vs 6.8%, P< 0.001), intrapartum (64.5% vs 3.5%, P< 0.001), and post-partum (64.5% vs 2.9%, P< 0.001). This group had higher rates of delivery by a skilled birth attendant (93.4% vs 66.7%, P< 0.001) and antiretroviral therapy (ART) prescribed antepartum (96.1% vs 5.5%, P< 0.001) and post-partum (74.6% vs 3.6%, P< 0.001). Both groups had similar rates of prescriptions for intrapartum ART (98.7% vs 97.9%). The majority of women reported ART adherence (96.5%, P< 0.001) which was associated with a decrease in both preterm delivery and infant mortality (adjusted OR 0.24, 95% CI 0.15-0.39). A significant proportion of women followed prospectively reported their infants received ART with good adherence (51.8% vs 0.3% and 93.4% vs 6.3%, respectively P< 0.001).ConclusionParticipation in AFRICOS increased linkage to PMTCT programs which resulted in increased likelihood of skilled delivery and appropriate ART use for women and their infants. It highlights that linkage to care continues to be a crucial factor in limiting MTCT of HIV especially in resource-limited settings. Limitations in this study exist due to the low number of prospectively followed pregnancies.Disclosures All Authors: No reported disclosures

Barriers of PMTCT (Prevention Mother to Child Transmission) Program: Systematic Review

HIV infection during pregnancy is a serious problem that requires special attention because the number of case increasing every year. According to UNAIDS data, more than 36.9 million people were living with HIV on 2017. An increase of 1.8 million new cases and 940,000 deaths occurs in the same year. In Indonesia especially, there were about 630,000 HIV cases on 2017 and nearly 49,000 new cases reported. This number consists of cases of vertical transmission from mother to child during pregnancy. The government has implemented PMTCT (Prevention Mother to Child Transmission) program as a solution to reduce the number of HIV cases. Nevertheless this program has not been running well due to several barriers regarding to its implementation. This study aimed to provide an understanding of various barriers to PMTCT program implementation. A systematic review approach by PRISMA design was used to study literatures from databases. Stigma or discrimination from community and health care, experienced by HIV patients, was major barrier that impede PMTCT program. In addition, lack of support from partner or family, depression, economic factors, stigma from health workers, and health workers’ income-workload discrepancy were also significantly affected the implementation. Contrary, the active role of health workers to provide counseling and education about HIV/AIDS among community as well as to client’s families was a success key of PMTCT program.

Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua...

Muslim Wives’ Intention to Undertake an HIV test: A Conceptual Development

Background: The intention in the Theory of Planned Behavior is preceded by attitude, perceived control, and subjective norm. This theory had been applied to hundreds of studies from many disciplines. However, when a nurse applies this theory, it requires a detail description related to Muslim wives’ intention to undertake an HIV test. This detailed concept development will help nurses in employing the nursing process accurately to achieve the target of Prevention from Mother to Child Transmission (PMTCT) program.&#x0D; Purpose: The study aims to develop a model of Muslim wives’ intention to undertake an HIV test.&#x0D; Methods: Concept validation of Muslim wives’ intention to undertake an HIV test was traced by using keywords “intention”, “willingness”, “desire”, “HIV tests”, “readiness”, “commitment”, “woman and HIV/AIDS”, “awareness”, in EBSCO, CINAHL, and Proquest.&#x0D; Results: The concept of Muslim wives’ intention was developed from existing theories as deductive origin and literature reviews as an inductive origin. The concept consists of many antecedents that being categorized into two categories includes internal and external factors and six sub-categories as follows internal commitment, knowledge, ethical values, risk perception, demographic factor and subjective norms. Both attribute and consequence key words each have one category.&#x0D; Conclusion: The tentative model can be generalized for other settings or situations. There is no specification that this model just for a specific gender or specific situation.

Barriers to and Opportunities for Male Partner Involvement in Antenatal Care in Efforts to Eliminate Mother-to-child Transmission of Human Immunodeficiency Virus in Kenya: Systematic Review

Introduction: Men’s involvement in antenatal care (ANC) is intended to encourage husbands to support women’s care and associated interventions, including prevention of mother-to-child transmission from pregnancy to delivery, and throughout the postnatal period. The present study aimed to systematically review the barriers and opportunities for male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus (HIV) in Kenya. Methods: A systematic search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID, and Google scholar. The reference list of included studies was manually searched for possible additional eligible articles. The searches were conducted from May 2019 to April 2020. Qualitative analysis was done and data were presented in thematic domains. Results: The search generated 2208 articles, of which only 19 met the inclusion criteria. The major findings were discussed under two thematic domains: 1) Barriers: Knowledge, Social-cultural/economic factors, Institutional factors, and Age. 2) Opportunities: Skilled Birth Attendant, Human Immunodeficiency virus-free infant and Human Immunodeficiency virus testing. Conclusion: The review notes that the main barriers to male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus in Kenya include; socio-cultural factors, the low maternal-child health education by the male partner, and institutional factors. It further provides insight on the opportunities associated with male partner involvement in antenatal care/prevention of mother-to-child transmission, which includes; having Human Immunodeficiency virus-free infants and increased, skilled birth deliveries. The review strongly calls out for sustainable initiatives to incorporate males into the antenatal care/prevention of mother to child transmission programs.

Gambaran Minat Ibu Hamil dalam Mengikuti Program Preventation of Mother to Child Transmission (PMTCT) di Kelurahan Tanjung Uma Wilayah Kerja Puskesmas Lubuk Baja

Penyebaran HIV dan AIDS di Indonesia dari tahun ke tahun menunjukan peningkatan yang cepat. Jumlah kasus HIV sampai dengan mei 2017 sebanyak 103.759 dan AIDS sebanyak 43.347, dengan kematian sebanyak 8.340. dengan peningkatan kasus yang sangat besar tersebut maka WHO mengingatkan Indonesia sebagai salah satu negara Asia tercepat dalam hal peningkatan populasi HIV dan AIDS. (Kemenkes RI, 2015). Ibu hamil merupakan kelompok beresiko tertular HIV yang berdampak pada bayi yang dikandungnya seiring dengan meningkatnya jumlah laki-laki yang melakukan hubungan seksual tidak aman atau beresiko, yang selanjutnya akan menularkan pada pasangannya (istrinya)Dari data yang didapat dari 5.138 ibu hamil yang konseling dan test HIV, ada 32 yang positif HIV dan 15 AIDS, serta ada 19 bayi yang lahir dari ibu dengan HIV positif. Secara keseluruhan, penderita HIV di Kota Batam tahun 2017 mencapai 1038. Tujuan dari penelitian ini adalah untuk mengetahui minat ibu hamil dalam memanfaatkan program PMTCT. Jenis penelitian adalah penelitian survey yang bersifat analitik dengan pendekatan cross sectional. Besar sampel yaitu 100 ibu hamil di Wilayah Kerja Puskesmas Lubuk Baja. Alat pengumpulan data dengan kuesioner. Dari penelitian didapatkan minat ibu hamil dalam mengikuti program Prevention of Mother to Child Transmission (PMTCT) sebagian besar berada pada kategori berminat sebanyak 70 ibu hamil (70%) sedangkan tidak berminat 30 ibu hamil (30%). Untuk mengatasi masalah ini diharapkan kepada tenaga kesehatan untuk memberikan informasi ataupun penyuluhan tentang pemanfaatan PMTCT kepada Ibu hamil.

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa.

BackgroundDespite the success of prevention of mother to child transmission (PMTCT) program in South Africa, the 30% HIV prevalence among women of childbearing age requires the PMTCT program to be maximally efficient to sustain gains in the prevention of vertical HIV transmission. We aimed to determine the immunologic and virologic status at entry into antenatal care (ANC) and at childbirth among HIV positive women who conceived under the CD4<500 cells/μl antiretroviral therapy (ART) eligibility threshold and universal test and treat (UTT) policies in the Gauteng province of South Africa.MethodWe conducted a retrospective cohort study of 692 HIV positive adult (>18 years) postpartum women who gave birth between September 2016 and December 2017. Demographic, viral load (VL) and CD4 data at ANC start (3–9 months before delivery) and delivery (3 months before/after) were obtained from medical records of consenting women. We compared CD4≥500 cell/μl and viral load (VL) suppression (<400 copes/ml) rates at ANC start and delivery among women with a pre-pregnancy ART, women known HIV positive but with in-pregnancy ART and newly diagnosed women with in-pregnancy ART. Predictors of having a high CD4 and suppressed VL were assessed by log-binomial regression.ResultsOf the 692 participants, 394 (57.0%) had CD4 data and 326 (47.1%) had VL data. Overall women with a pre-pregnancy ART were more likely to start ANC with CD4 count≥500 cell/μl (46.3% vs 24.8%, adjusted risk ratio (aRR) = 1.9; 95% confidence interval (95% CI): 1.4–2.5), compared to newly diagnosed women. This difference was no longer apparent at the time of delivery (aRR 1.2 95% CI: 0.4–3.7). Similarly, viral suppression at delivery was higher among women with pre-pregnancy ART (87.2% vs 69.3%, aRR 1.3, 95% CI: 1.1–1.6) as compared to the newly diagnosed women. Viral suppression rate among newly diagnosed women increased substantially by the time of delivery from 43.5% to 69.3% (p = 0.001).ConclusionThese results show that pre-pregnancy ART improves immunologic and virologic control during pregnancy and call for renewed efforts in HIV testing, linkage to ART and viral monitoring.

Factors Associated with Mother-to-child Transmission of HIV in Eswatini

ABSTRACT Background: Mother-to-child-transmission of the human immunodeficiency virus (HIV) continues to cause increased child morbidity and mortality despite the constantly improved prevention of mother to child transmission (PMTCT) programme interventions. The programme interventions continue to be surrounded by barriers hindering eradication of HIV in newborns. Objective: To identify factors associated with HIV seropositivity in infants aged 6–8 weeks in Eswatini. Method: A secondary analysis of 1415 HIV infected mothers and their HIV exposed infants who attended child immunisation clinics between 2011 and 2012 was performed. Factors associated with HIV seropositivity were analysed through univariate and multivariable logistic regression methods. Results: Of the 1415 HIV exposed infants, 31 were HIV positive reflecting a mother-to-child-transmission rate of 2.2%. Maternal age, number of antenatal clinic (ANC) visits, maternal antiretroviral regimen, place of delivery and birth-weight were associated with HIV seropositivity on univariate analysis. On multivariate analysis, the only factor which remained significantly protective (OR = 0.83; P value = 0.004) for HIV transmission to infants were the number of ANC visits. Those infants whose mothers had more than 4 visits were less likely to be HIV positive when compared with fewer visits. Conclusion: Increased number of antenatal care visits attended by pregnant women is beneficial as it increases access to PMTCT services thereby decreasing the prospect of mother-to-child HIV transmission.

Pregnancy outcomes following exposure to efavirenz based antiretroviral therapy in indian women.

OBJECTIVES:Mother-to-child transmission of HIV has witnessed a significant reduction due to effective antiretroviral therapy (ART). Efavirenz has been introduced as a part of ART since last few years in the national Prevention of Parent to Child Transmission (PPTCT) program for pregnant women living with HIV. However, data related to adverse pregnancy outcomes associated with efavirenz-based ART are limited in the Indian scenario. The present study evaluated pregnancy outcomes in HIV-infected pregnant women who were given efavirenz-based ART during pregnancy.MATERIALS AND METHODS:It is a retrospective, observational, analytic study carried out at a referral hospital in Western India. Collection of data was done for a period of 5 years, and various adverse outcomes were studied which included preterm delivery, low birth weight (LBW), stillbirths, congenital anomaly, and neonatal death.RESULTS:This study showed a preterm birth rate of 19% and LBW in 36% of cases. There was no significant association with congenital anomaly, stillbirth, or neonatal death.CONCLUSION:There was an association of exposure to efavirenz with an increased incidence of adverse pregnancy outcomes, especially LBW infants. This study emphasizes the requirement of large prospective studies to investigate fetomaternal outcomes in pregnant women exposed to efavirenz.

Mother to Child Transmission of HIV and Associated Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, Ethiopia.

BackgroundVertical transmission of Human Immunodeficiency Virus (HIV) is the primary route of infection among children. Ethiopia is among the top ten countries in the world with the highest burden of HIV infections among children. Therefore we aimed to assess mother to child transmission (MTCT) of HIV and associated factors among HIV exposed infants (HEIs).MethodsA cross-sectional study was conducted using retrospective data collected from HEIs paired with their mothers who had received the services in prevention of mother to child transmission (PMTCT) programs from January 2014 to December 2017 in public health facilities in Dessie town. Data of a total of 313 HEIs paired with their mothers were obtained by using semi-structured data extraction proforma from their medical records. The data were processed in Epi-info version 7.1.2.0 and analyzed using SPSS version 22. Crude and adjusted odds ratios with their 95% confidence intervals and p-value were used to identify significant factors.ResultsThe prevalence of HIV among exposed infants was 3.8%. Absence of maternal antenatal care visit (AOR = 4.6, 95% CI: 1.17–17.99), home delivery (AOR = 4.2, 95% CI: 1.04 −16.76), absence of antiretroviral intervention to the mother (AOR= 5.7, 95% CI: 1.10–29.36), and failure to initiate nevirapine prophylaxis for the infant (AOR = 5.3, 95% CI: 1.11 −25.44) were significant factors of MTCT of HIV.ConclusionPrevalence of MTCT of HIV was low (3.8%) in Dessie town public health facilities. Having ANC visit, delivery at health facility, maternal ARV drug intake, and infant ARV prophylaxis were the significant protective factors against MTCT of HIV. Promoting ANC service utilization among pregnant women and providing counseling as well as setting up linkage with PMTCT and giving ARV intervention to all HIV positive pregnant women and timely initiation of NVP prophylaxis to all HEIs should be recommended by the minister of health and health facilities.

Knowledge, attitude and practice among private medical professionals enrolled in public private partnership program for prevention of mother to child transmission of human immunodeficiency virus in three districts of Karnataka

Background: Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), is one of the world’s most serious public health challenges. Nearly all young children newly infected with HIV are infected through mother-to-child transmission. Only about half of the HIV infected mothers received ART and quarter of the babies born through HIV infected mothers receive ARV prophylaxis. This low coverage due to a high proportion of women delivering in private health facilities. Lack of policy for the private sector, inadequate knowledge and fear of occupational exposure are some barriers.Methods: A cross sectional study conducted among private practitioners enrolled in parent to child transmission (PPTCT) program in three districts of Karnataka. 175 obstetricians and pediatricians engaged in giving care to HIV infected mother and children were selected randomly and were interviewed using a pre tested semi structured questionnaire and the scores were graded.Results: Mean age of the participants was 38.95 years with SD of 9.12 years. The mean years of experience was found to be 14.36 years with SD of 6.45 years. The knowledge was average scoring 66.56%. The attitude and practice were 69.21% and 64.21% respectively. The mean score for KAP was 28.89 (9.56) out of 43 questions. There was significant association between age of the participants, specialization and years of experience with scoring.Conclusions: The knowledge, attitude and practice among private practitioners were average. To enhance the coverage of PMTCT, there is a need for strengthening private sector with strong political will thus reducing morbidity and mortality of the disease.

Correlates and determinants of Early Infant Diagnosis outcomes in North-Central Nigeria

BackgroundA negative status following confirmatory Early Infant Diagnosis (EID) is the desired pediatric outcome of prevention of Mother to Child Transmission (PMTCT) programs. EID impacts epidemic control by confirming non-infected HIV-exposed infants (HEIs) and prompting timely initiation of ART in HIV-infected babies which improves treatment outcomes.ObjectivesWe explored factors associated with EID outcomes among HEI in North-Central Nigeria.MethodThis is a cross-sectional study using EID data of PMTCT-enrollees matched with results of HEI’s dried blood samples (DBS), processed for DNA-PCR from January 2015 through July 2017. Statistical analyses were done using SPSS version 20.0 to generate frequencies and examine associations, including binomial logistic regression with p < 0.05 being statistically significant.ResultsOf 14,448 HEI in this analysis, 51.8% were female and 95% (n = 12,801) were breastfed. The median age of the infants at sample collection was 8 weeks (IQR 6–20), compared to HEI tested after 20 weeks of age, those tested earlier had significantly greater odds of a negative HIV result (≤ 6 weeks: OR = 3.8; 6–8 weeks: OR = 2.1; 8–20 weeks: OR = 1.5) with evidence of a significant linear trend (p < 0.001). Similarly, HEI whose mothers received combination antiretroviral therapy (cART) before (OR = 11.8) or during the index pregnancy (OR = 8.4) had significantly higher odds as compared to those whose mothers did not receive cART. In addition, HEI not breastfed had greater odds of negative HIV result as compared to those breastfed (OR = 1.9).ConclusionscART prior to and during pregnancy, earlier age of HEI at EID testing and alternative feeding other than breastfeeding were associated with an increased likelihood of being HIV-negative on EID. Therefore, strategies to scale-up PMTCT services are needed to mitigate the burden of HIV among children.

Prevalence of male partners involvement in antenatal care visits \u2013 in Kyela district, Mbeya

BackgroundIn most countries in the world, promotion of maternal and child health is perceived as women’s role and men do not feel that they are responsible and see no reason to accompany their partners to Antenatal Care (ANC) clinics [Vermeulen, E., et al., BMC Pregnancy Childbirth 16:66, 2016]. Male involvement in Reproductive, Maternal, Neonates and Child and Adolescent Health (RMNCAH) programs in Tanzania is low. In Prevention of Mother to Child Transmission (PMTCT) program, the data shows only 30% attend couple counseling and only 8% for HIV counseling with their partners. There is limited data on prevalence of male involvement in ANC visits in Kyela. The purpose of this study was to determine prevalence of male involvement in ANC services and assess factors influencing male partners’ involvement in ANC visits in Kyela district in Mbeya. The findings from this study will serve as a baseline in efforts to increase male involvement in ANC care in Kyela.MethodsHospital based cross-sectional study was undertaken in Kyela district, Mbeya from October 2017 to November 2017. Data was collected using structured questionnaire and analyzed using SPSS version 20. Factors with P values of < 0.05 in univariate logistic regression were included in a multivariable logistic regression model to determine predictor variables that are independently associated with the outcome. Significant difference was defined as a P- value less than 0.05 and Odds Ratio (OR) that did not include 1.0.ResultsAbout 174 pregnant women who were visiting the ANC in their second to fourth visits or higher. About, 56.9% (99) attended with their male partners and 51% (52) of these reported to be accompanied by male partners to ANC because the women had requested their partners to accompany them. Attendance of male partners to ANC was significantly associated with male partner awareness of ANC visiting dates OR 24.1, 95% CI 6.8, 86.5, and P < 0.0001.ConclusionPrevalence of male attendance to the ANC in Kyela district is not adequate as fearing of HIV testing seemed to decrease male attendance to ANC services. So, there is high need to improve ANC health services with a focus on male friendly services.

Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa

BackgroundInternational sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies.MethodsWe developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective.ResultsBased on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs.ConclusionGiven the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings.

Tantangan Pelaksanaan Program Prevention Of Mother To Child Transmission (PMTCT): Systematic Review

Background: HIV / AIDS is still a global health problem which needs to be addressed including prevention of HIV / AIDS transmission from mother to child. Prevention of transmission is carried out by implementing the Prevention of Mother to Child Transmission or PMTCT program. The PMTCT program is considered successful in reducing the risk of mother-to-child transmission, but this has not been done well and thoroughly, various kinds of challenges have occurred in the implementation of the PMTCT program.Objective: To know the challenges that occur in implementing the PMTCT programMethod: This study uses a systematic review based on Preferred Reporting Items For Systematic Reviews &amp; Meta-Analyzes (PRISMA) to identify all the literature published using relevant keywords.Results: challenges in implementing the PMTCT program are the lack of information on HIV treatment, lack of family support, the heavy workload experienced by health workers and the limited availability of HIV testing equipment and drug stocks.Conclusion: The success of efforts to prevent HIV / AIDS transmission from mother to child does not depend on one party only, but involves several parties, the active role of health workers in providing education and information about HIV / AIDS to mothers and their families is not enough but must be added with active roles and support from family members to HIV mothers as the primary motivator for good behavior in accordance with the guidelines for PMTCT.

Is co-location of services with HIV care associated with improved HIV care outcomes? A systematic review

ABSTRACTThis systematic review identifies models of service co-location, a structural intervention strategy to remove barriers to HIV care and services, and examines their associations with HIV care outcomes. A cumulative database (e.g., MEDLINE, EMBASE) of HIV, AIDS, and STI literature was systematically searched and manual searches were conducted to identify relevant studies. Thirty-six studies were classified into six models of co-location: HIV care co-located with multiple ancillary services, tuberculosis (TB) care, non-HIV specific primary care, drug abuse treatment, prevention of mother to child transmission programs (PMTCT), and mental health care. More evidence of a positive association was seen for linkage to care and antiretroviral therapy (ART) uptake than for retention and viral suppression. Models of co-location that addressed HIV and non-HIV medical care issues (i.e., co-location with non-HIV specific primary care, PMTCT, and TB) had more positive associations, particularly for linkage to care and ART uptake, than other co-location models. While some findings are encouraging, more research with rigorous study designs is needed to strengthen the evaluation of, and evidence for, service co-location.

Protocol for the evaluation of the population-level impact of Zimbabwe\u2019s prevention of mother-to-child HIV transmission program option B+: a community based serial cross-sectional study

BackgroundWHO recommends that HIV infected women receive antiretroviral therapy (ART) minimally during pregnancy and breastfeeding (“Option B”), or ideally throughout their lives regardless of clinical stage (“Option B+”) (Coovadia et al., Lancet 379:221–228, 2012). Although these recommendations were based on clinical trials demonstrating the efficacy of ART during pregnancy and breastfeeding, the population-level effectiveness of Option B+ is unknown, as are retention on ART beyond the immediate post-partum period, and the relative impact and cost-effectiveness of Option B+ compared to Option A (Centers for Disease Control and Prevention, Morb Mortal Wkly Rep 62:148–151, 2013; Ahmed et al., Curr Opin HIV AIDS 8:473–488, 2013). To address these issues, we conducted an impact evaluation of Zimbabwe’s prevention of mother to child transmission programme conducted between 2011 and 2018 using serial, community-based cross-sectional serosurveys, which spanned changes in WHO recommendations. Here we describe the rationale for the design and analysis.Methods/designOur method is to survey mother-infant pairs residing in the catchment areas of 157 health facilities randomly selected from 5 of 10 provinces in Zimbabwe. We collect questionnaires, blood samples from mothers and babies for HIV antibody and viral load testing, and verbal autopsies for deceased mothers/babies. Using this approach, we collected data from two previous time points: 2012 (pre-Option A standard of care), 2014 (post-Option A / pre-Option B+) and will collect a third round of data in 2017–18 (post Option B+ implementation) to monitor population-level trends in mother-to-child transmission of HIV (MTCT) and HIV-free infant survival. In addition, we will collect detailed information on facility level factors that may influence service delivery and costs.DiscussionAlthough the efficacy of antiretroviral therapy (ART) during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV (PMTCT) has been well-documented in randomized trials, little evidence exists on the population-level impact and cost-effectiveness of Option B+ or the influence of the facility on implementation (Siegfried et al., Cochrane Libr 7:CD003510, 2017). This study will provide essential data on these gaps and will provide estimates on retention in care among Option B+ clients after the breastfeeding period.Trial registrationNCT03388398 Retrospectively registered January 3, 2018.

Utilization of \u201cprevention of mother-to-child transmission\u201d of HIV services by adolescent and young mothers in Mulago Hospital, Uganda

BackgroundPrevention of mother to child transmission (PMTCT) has lowered the incidence of paediatric HIV globally. The risk of mother-to-child transmission of HIV (MTCT) remains high in Africa, where there is a high prevalence of pregnancy and poor health-seeking behaviour among young girls and women.MethodsIn this cross-sectional, mixed-methods study, we evaluated the utilization of PMTCT services and associated factors among adolescent and young postpartum mothers aged 15 to 24 years at a public urban referral hospital in Uganda. Both HIV-positive and HIV-negative participants were recruited. Utilization of PMTCT services was defined as use of the PMTCT cascade of services including ever testing for HIV, receiving HIV test results; If tested negative, subsequent retesting up to 14 weeks; If tested positive, Antiretroviral drugs (ARVs) for the mother, ARVs and septrin prophylaxis for infant, safe delivery, safer infant feeding, early infant diagnosis within 6 weeks, and linkage to treatment and care. Optimal utilization of PMTCT was defined as being up to date with utilization of PMTCT services for reported HIV status at the time of being interviewed. The overall proportion of participants who optimally utilized PMTCT services was determined using descriptive statistics. Qualitative data was analyzed manually using the content thematic approach.ResultsOf the 418 participants, 65 (15.5%) were HIV positive. Overall, only 126 of 418 participants (30.1%) had optimally utilized PMTCT services. However, utilization of PMTCT services was better among HIV positive mothers, with 83% (54/65) having utilized the services optimally, compared to only 20% (72/353) of the HIV negative mothers (OR 18.2 (95% CI; 9.0–36.7)). The benefits of knowing ones HIV status, health of the unborn child, and counseling and support from health workers and peers, were the major factors motivating adolescent and young mothers to utilize PMTCT services, while stigma, financial constraints, non-disclosure, and lack of partner and family support were key demotivating factors.ConclusionUtilization of PMTCT services by these adolescent and young mothers was suboptimal. Special consideration should be given to adolescents and young women in the design of elimination of mother to child transmission (EMTCT) programs, to improve the utilization of PMTCT services.

Determinants of HIV infection among children born to mothers on prevention of mother to child transmission program of HIV in Addis Ababa, Ethiopia: a case control study

BackgroundDespite wide spread use of Antiretroviral Therapy (ART) by pregnant women living with Human Immunodeficiency Virus (HIV), the transmission rate is still higher by 18% after breastfeeding ends. The aim of this study was to identify factors affecting mother-to-child HIV transmission.MethodsUnmatched case–control study was conducted in Addis Ababa, from April to May, 2017. A case was HIV positive mother who had been on PMTCT program with her child confirmed HIV positive at or before 24 months and control was HIV positive mother who had been on PMTCT program with her child tested definitive HIV negative at 24 months. Accordingly, 44 cases were identified and for each case four controls with the nearest date of birth to the cases were selected from same health facilities. Primary data collected from the mothers were supplemented by record reviews and entered to Epidata version 3.1 and analyzed using SPSS version 22. Multivariate logistic regression was fitted to identify factors independently associated with mother-to-child HIV transmission.ResultsLack of participation in mother-to-mother support program (AOR: 5.1; 95% CI: 1.4, 18.1), low partner involvement (AOR: 6.9; 95% CI: 1.4, 13.4), poor ART adherence (AOR:3.1; 95% CI: 1.3, 7.5), positive syphilis test results (AOR: 3.2; 95% CI: 1.2, 8.6), maternal malnutrition (AOR: 3.1; 95% CI: 1.4, 6.8), unplanned pregnancy (AOR: 10.3; 95% CI: 3.9, 27.2), home delivery (AOR: 5.3; 95% CI: 1.4, 19.4) and mixed feeding of the child during first six months of life (AOR: 12.5; 95% CI: 2.9, 52.7) were significantly associated with MTCT of HIV.ConclusionsMother-to-mother support, male partner involvement in PMTCT of HIV, strengthening antenatal care, counseling mothers on appropriate infant feeding options are important to reduce mother –to- child transmission of HIV.