Mother-to-child Transmission Of HIV Research Articles

Knowledge of mother-to-child transmission of HIV among women living with HIV in Malawi.

To reduce the incidence of mother-to-child transmission (MTCT) of HIV in Malawi, interventions have been created for women to be informed about the MTCT of HIV and for women living with HIV to be entered into the HIV care cascade to ensure safer deliveries. Our study aimed to examine the effectiveness of these strategies by exploring the determinants of adequate knowledge of MTCT of HIV among women living with HIV in Malawi. We used the 2015-16 Malawi Demographic and Health Survey data and applied logistics regression analysis to explore the determinants of adequate knowledge of MTCT of HIV among women living with HIV. Our findings estimated that 75% of women living with HIV possessed adequate knowledge of MTCT of HIV. We also found that compared to those with no formal education, women with primary education (OR = 1.88, 95% CI = 1.04, 3.41) and secondary education or higher (OR = 2.61, 95% CI = 1.21, 5.62) were more likely to have adequate knowledge of MTCT of HIV. Furthermore, women who were resident in rural areas (OR = 2.97, 95% CI = 1.58, 5.57), were more likely to have adequate knowledge of MTCT of HIV relative to those in urban areas. Finally, women who had adequate HIV knowledge (OR = 1.85, 95% CI = 1.19, 2.89) and those who rejected the endorsement of HIV stigma and discrimination (OR = 2.30, 95% CI = 1.39, 3.81) were more likely to have adequate knowledge about the MTCT of HIV. Based on our findings, there is an urgent need to offer women living with HIV in Malawi the opportunity to increase their knowledge of MTCT of HIV if the country is to make progress towards the elimination of MTCT of HIV as part of the overall strategy to contain new HIV infections in the country.

Knowledge of Mother-To-Child Transmission of HIV Among Pregnant Women Attending a Health Centre in Addis Ababa

Background: Mother-to-child transmission (MTCT) of HIV is the primary source of HIV infection in children younger than 15 years. The knowledge of pregnant women about MTCT and its prevention is essential in the control of MTCT of HIV. Objective: To assess the knowledge of Mother-to-Child Transmission of HIV (MTCT) and the prevention of MTCT (PMTCT) of HIV among pregnant women attending the antenatal clinic at the Wereda 04 Health Center, Kolfe Keranio sub-city, Addis Ababa, Ethiopia. Methods: This study used a cross-sectional design. It used systematic random sampling to select 231 participants from the clinic attendees. Data were collected using a semi-structured questionnaire. Binary logistic regression was used to determine the association between variables. Results: About 78.1% and 74.6% of the participants knew MTCT and PMTCT of HIV, respectively. Close to half (43.5%) agreed that MTCT of HIV could occur through breastfeeding, 33.5 % agreed it could be transmitted during pregnancy, and 23% agreed it could be transmitted during labour and delivery. Nearly 75% knew that MTCT of HIV is preventable, but only about half (47.9%) knew that MTCT is preventable through antiretroviral therapy (ART). The knowledge of pregnant women about MTCT and PMTCT was associated with place of residence as it was lower in rural women.  Conclusions: Some of the participants were not knowledgeable about MTCT and PMTCT of HIV. Effective health education is recommended for women of reproductive age to reduce the MTCT of HIV.

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BackgroundWhile mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.MethodsData was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.ResultsFrom 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of − 3.50 (95% CI -6.28 ~ − 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.ConclusionsThe implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Modeling Health Systems and Male-Partner Involvement Determinants of Prevention of Mother to Child Transmission of Human Immune-deficiency Virus among Women in Homa Bay County Referral Hospital, Kenya

In 2017, Homa Bay County accounted for 10% of HIV cases among children aged 0-14 years in Kenya. Additionally, it reported 8.8% of new HIV infections among children of the same age group and 9.7% of annual AIDS-related mortalities. In 2018, the County reported a mother-to-child transmission (MTCT) rate of 8.1%, higher than the 5% target set by WHO. Limited studies in Kenya have documented health systems and male-partner involvement determinants of prevention of MTCT (PMTCT) of HIV, which vary by context. Thus, this paper documents health systems and male-partner involvement determinants of PMTCT outcomes among women attending Homa Bay County Referral Hospital. We used an analytical cross-sectional study design that had a sample of 274 (Fishers et al. 1998) randomly selected from 4129 women of reproductive age ever on PMTCT follow-up. Questionnaires were used to collect data from the women on child HIV status, health systems factors, and male partner-involvement factors. The mean age of the women was 32.16 years. Results show that provision and discussion of infant diagnosis results by health care providers increased the chances of occurrence of HIV seronegative PMTCT outcome by 1.5 times (OR=1.530, 95% CI: 0.361-6.486; p<0.0001). Provision of routine pre-conception counselling decreased the odds of determining PMTCT outcome by 60% (OR=0.404, 95% CI: 0.046-3.521; p=0.018). Males knowing the HIV status of their partner had higher odds of determining the occurrence of HIV seronegative PMTCT outcome (OR=6.0, 95% CI: 0.655-54.997; p<0.0001). Health systems factors aligned with the provision and discussion of infant diagnosis results by healthcare provider and male-partner involvement factor related to the male partner knowing the HIV status of participant(s) demonstrated higher chances of predicting the occurrence of HIV seronegative for the child. These findings will inform the formulation of interventions geared towards reducing the high MTCT rates in Homa Bay County

Low Prevalence and Risk Factors Related to HIV-1 Mother to Child Transmission under Option B+ Program at 3 Referral Military and Public Hospitals in Cameroon

Immunodeficiency Virus type 1 (HIV-1) Mother-To-Child Transmission (MTCT) prevalence and its predictors. Following the limited success achieved with the previous MTCT prevention programs, the Cameroon’s public health ministry adopted in 2014 the Option B+ program that recommends a systematic lifelong treatment to all HIV positive pregnant woman.
 Study Design: A case-control study was conducted within two groups: a reference group constituted of exposed infants from HIV positive mothers undergoing Option B+ program, and a control group of infants from Anti-Retroviral Treatment (ART) naive HIV positive mothers during pregnancy.
 Place and Duration of Study: Douala and Yaounde Military Hospitals (HMR2 and HMR1 respectively) as well as the Bertoua Regional Hospital (HRB), From October 2017 to March 2018.
 Methodology: This research included infected mother - exposed child pairs. Infected mothers’ sociodemographic and clinical characteristics were reported. Infants sampled at six weeks at the HIV MTCT prevention units were tested at the Military Health Research Center for HIV-1 RNA early detection through rtPCR with Abbott m2000sp automated system. Multivariate logistic regression model was built to assess the predictors of MTCT and to compare groups.
 Results: Within the study period, the overall HIV-1 prevalence in the 107 six weeks old reference group infants and 23 control group infants was nil and 4.35% (1/23) respectively. Logistic regression showed that predictors of HIV-1 MTCT were: home delivery p=0.03 and absence of ART during pregnancy p = 0.04.
 Conclusion: Vertical transmission of HIV-1 infection is more likely in ART naïve pregnant women as compared to their counterparts established on ART. Hence, implementation of the Option B+ appear to be very essential in eliminating HIV-1 MTCT. Consequently, a systematic enrolment of these pregnant women living with HIV if scaled up, would be very instrumental in eliminating HIV-1 MTCT in Cameroon.

Hepatitis B Virus Prevalence and Mother-to-Child Transmission Risk in an HIV Early Intervention Cohort in KwaZulu-Natal, South Africa.

HIV and hepatitis B virus (HBV) prevalence are both high in KwaZulu-Natal, South Africa. HIV coinfection negatively affects HBV prognosis and can increase the likelihood of HBV mother-to-child transmission (MTCT). In an early HIV infant treatment intervention cohort of HIV-transmitting mother-child pairs in KwaZulu-Natal, we characterized maternal HBV prevalence and screened infants at risk. Infants were treated for HIV MTCT at birth, and combination regimens incidentally active against HBV were initiated within 21 days. Maternal samples (N = 175) were screened at birth for HBV infection (HBV surface antigen [HBsAg]), exposure to HBV (HBV anti-core IgG), and vaccination responses (HBV anti-S positive without other HBV markers). Infants of mothers who were HBV positive were screened for HBsAg at 1 and 12 months. Evidence of HBV infection was present in 8.6% (n = 15) of maternal samples. Biomarkers for HBV exposure were present in 31.4% (n = 55). Evidence of HBV vaccination was uncommon in mothers (8.0%; n = 14). Despite prescription of antiretroviral therapy (ART) active against HBV, HBV DNA was detectable in 46.7% (7/15) of mothers who were HBsAg positive. Three mothers had HBV viral loads >5.3 log10 IU/mL, making them high risk for HBV MTCT. Screening of available infant samples at 1 month (n = 14) revealed no cases of HBV MTCT. At 12 months, we identified 1 HBV infection (1/13), and serologic evidence of vaccination was present in 53.8% (7/13) of infants. This vulnerable cohort of HIV-transmitting mothers had a high prevalence of undiagnosed HBV. Early infant ART may have reduced the risk of MTCT in high-risk cases. Current HBV guidelines recommend ART prophylaxis, but these data underline the pressing need to increase availability of birth dose vaccines.

Educational needs assessment of medical and midwifery students about prevention of mother-to-child transmission of HIV: a cross-sectional study.

Mother-to-child transmission (MTCT), is an important way of acquired immune deficiency virus (AIDS) transmission. Medical and midwifery students need to have sufficient knowledge in terms of MTCT. The aim of this study was to evaluate the educational needs of these students regarding MTCT of HIV. This cross-sectional study was conducted on 120 medical (extern and intern) and midwifery Bachelor (semester 4 and above) and Master students in Gonabad University of Medical Sciences in 2019. The real needs questionnaire on MTCT AIDS and the perceived needs questionnaire on MTCT were used for need assessment evaluation. Majority of the participants were female (77.5%) and single (65%). Study participants included 48.3% medical and 51.7% midwifery students. High real educational need was reported by 63.5% of medical and 36.5% of midwifery students. More than half of the participants (59.2%) felt a great need for education on MTCT of HIV. OF the areas of real educational needs, the highest and lowest scores were related to the areas of prevention and symptoms, respectively. Students in higher semesters had the highest percentage of real need compared to other students (p = 0.015). The real need for MTCT of HIV prevention was higher among medical students compared to midwifery students (p = 0.004). The observed high real and perceived needs of students, especially in the higher semesters and the field of medicine, necessitates the re-examination of their educational curricula.

Sociodemographic characteristics of children born to HIV-infected mothers in Western French Guiana

BackgroundFrench Guiana is the French department most affected by HIV. The situation in Western French Guiana is complicated by the transborder context and isolation of many patients. This study aims to describe the epidemiological characteristics of children born to mothers living with HIV followed in Western French Guiana. MethodsThis was a retrospective and descriptive study. All children born to HIV-infected mothers between 2014 and 2018 were included. Data were collected using a survey sheet to generate an Excel database. ResultsWe recorded 177 newborns exposed to maternal HIV, four of whom (2.26 %) were infected. The majority of women (87 %) were of foreign origin, and only 7 % had conventional health insurance coverage. The infection was discovered during pregnancy in 20 % of women. Overall 21.71 % of newborns were preterm and 22.5 % hypotrophic. All neonates had received antiretroviral prophylaxis for four weeks, either as monotherapy (AZT) (67.43 %) or triple therapy (AZT/3TC/NVP) (25.71 %). Twenty-two neonates had at least one neonatal illness: transient respiratory distress (9 cases), asphyxia (3 cases), hyaline membrane disease (8 cases), and there were two cases with birth defects: clubfoot (1 case) and heart disease (1 case). The follow-up rate at 24 months was 65 % and 35 % of cases were lost to follow-up. The most common biological anomalies were anemia (69.14 %), hyperlacticaemia (23 %), and neutropenia (9.14 %). ConclusionThe prevalence of mother-to child transmission of HIV was high; a quarter of maternal infections were discovered during pregnancy. The mother’s socio-economic situation was often precarious and follow-up interruptions common.

Determinants of comprehensive knowledge on mother-to-child transmission of HIV and its prevention among childbearing women in Rwanda: insights from the 2020 Rwandan Demographic and Health Survey

BackgroundMaternal knowledge on mother-to-child transmission (MTCT) and its prevention has been identified to enhance maternal testing and adherence to antiretroviral therapy (ART) regimen. Examining prevalence and associated factors on MTCT and its prevention among women provides empirical evidence for design and implementation of health strategies aimed at increasing MTCT knowledge and its elimination. This study therefore examined women’s comprehensive knowledge and associated factors on MTCT and its prevention among childbearing women in Rwanda.MethodsAnalysis was conducted on a weighted sample of 14,634 women from the 2020 Rwanda Demographic and Health Survey (RDHS). Dataset cleaning and missing value analysis was conducted. Chi square, bivariate and multivariable regression was then conducted in complex samples in SPSS. Alpha level set at p < 0.05 and at 95% Confidence Interval (95% CI). All analysis were adjusted for unequal probability sampling using survey weights. Bivariate and multivariable results were reported with crude and adjusted odds ratios.ResultsThe mean age was 29.2 years, SD-9.1. Prevalence of HIV testing and comprehensive knowledge on MTCT and its prevention among women in Rwanda was 79.6% and 65.1% respectively. Findings from this study showed that married women have higher odds (aOR = 1.18, 95% CI = 1.04–1.35) of comprehensive knowledge on MTCT and its prevention compared to those unmarried. Women who were living in southern (aOR = 1.23, 95%CI = 1.02–1.48) and eastern (aOR = 1.37, 95% CI = 1.13–1.66) parts of Rwanda were more likely to have adequate knowledge on MTCT of HIV and its prevention than those in Kigali. Also, women who received post-test counselling (aOR = 1.26, 95% CI = 1.01–2.11) have increased knowledge on MTCT than those who did not. Women with access to radio (aOR = 1.18, 95% CI = 1.06–1.32) and television (aOR = 1.25, 95% CI = 1.07–1.45) at least once a week were more likely to have adequate knowledge on MTCT and its prevention compared to those who do not in Rwanda.ConclusionThere is inadequate knowledge on MTCT and its elimination among women of reproductive age in Rwanda. Strategies to enhance knowledge on MTCT and its prevention among childbearing women should be adopted through rigorous educational sensitization campaigns using local media such as radio and television. Health services that focus on prevention of MTCT must emphasize post-test counselling.

ELIMINATION OF MTCT OF HIV IN INDIA BY 2030: CURRENT STATUS AND THE WAY AHEAD

Background:Considering the global public health priority of eliminating Mother-to-child transmission (MTCT) of HIV, World Health Organization (WHO) started the initiative of Global Plan Towards Eliminating New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive. Owing to those efforts, the number of children aged between 0-14 years acquiring HIV has decreased since 2011, but not rapidly enough. India is one among the 23 focus countries and while Cuba, Maldives, Thailand and recently Sri Lanka have successfully eliminated MTCT of HIV, India is lagging behind in this ambitious goal despite sustained efforts. Methods: A systematic review of recent literature on MTCT of HIV, current global and Indian status regarding MTCT and the successful approach and methods of countries which were certified by WHO as to have eliminated MTCT of HIV was performed and analysed. Results: As MTCT of HIV has three distinct points – during pregnancy, during delivery and during breastfeeding, the approaches to prevent MTCT also focus on these points chiefly. However, educating the adolescent girl and women of child bearing age would serve as the primordial prevention which also enormously reduces the burden among the three points mentioned above. Awareness also pave a way for volunteering in testing for HIV before planning for pregnancy and regularly checking if the mother found to be HIV positive, keeping the viral load under the desired level in addition to adherence to ART wherever necessary. Discussion: Focusing in all areas where there is possibility of MTCT, Promoting antiretroviral therapy adherence to mothers and children, Involving community level workers, Improved case detection and Strengthening of health system are the measures to be followed in order to achieve elimination of MTCT of HIV in India Conclusion: In the developing countries like India early diagnosis, awareness and the community participation and in collaboration with NGOs can help to achieve the target of elimination of MTCT of HIV.

Evaluation of strategies for the prevention of mother-to-child transmission of HIV in Cameroon: a mixed qualitative and quantitative cross-sectional analysis from the Adamawa region of Cameroon

BackgroundTo accelerate the fight against HIV/AIDS and eliminate the mother-to-child transmission (MTCT) of the virus, Cameroon has implemented and intensified several strategies despite which numerous children continue to be born infected with HIV. This study aimed to evaluate these strategies put in place for the prevention of MTCT (PMTCT) in Cameroon.MethodsA qualitative and quantitative cross-sectional analysis was conducted in seven PMTCT care units situated in the Adamawa region of the country. The qualitative analysis included 16 individual interviews of key informants and observations of attitudes and practices being implemented in each unit. On the other hand, the quantitative analysis targeted 106 known HIV-positive breastfeeding women being followed-up at the unit.ResultsTask-shifting and sharing was effective, but majority of staffs had not received any specific training on PMTCT. Moreover, the integration of PMTCT within the maternal, neonatal and child health services remained ineffective, especially in health facilities of heavy workload. The coordination of PMTCT services was led by a well-designated focal person; however, his/her roles and responsibilities had not clearly been defined. Of the 106 women enrolled, 59.4% had a level of knowledge on PMTCT less than 80%. Similarly, their attitudes and practices towards PMTCT were inadequate or inaccurate in more than 60% of cases.ConclusionPMTCT strategies are globally well known and accepted by healthcare professionals. However, weaknesses have been figured out regarding service integration, task shifting and sharing, and coordination. In addition, beneficiaries’ attitudes and practices are insufficient, and their level of knowledge does not guarantee to lessen the risk of MTCT of HIV.

Maternal and neonatal risk factors associated with increased mother-to-child transmission of HIV-1 in Mexico: Results of a case-control study.

Maternal, obstetric and neonatal factors that increase the possibility of mother-to-child HIV transmission (MTCT) are known as mechanisms of transmission. Our aim was to determine the risk factors associated with MTCT in Mexico. We conducted a case-control study from March to December 2015. Cases were 60 mothers with HIV infection who transmitted HIV to their children, and controls were 120 mothers with HIV infection whose children tested negative for HIV. Data were extracted from medical records and a self-reported questionnaire for each participant. To determine associations with MTCT, odds ratios (ORs) and 95% confidence intervals (CI) were obtained with the chi-squared test and a logistic-regression modeling. A total of 180 patients were included. HIV diagnosis for cases occurred after pregnancy in 88% of the patients, during pregnancy in 9%, and before pregnancy in 3% of patients. Among the controls, 38% of patients were diagnosed before pregnancy, 32% during pregnancy, and 30% after pregnancy. In multivariate analysis, the risk factors associated with MTCT were: absence of antiretroviral treatment during pregnancy (OR 5.21; 95% CI 1.24-16.11; p = 0.019); vaginal delivery (OR 3.2; 95% CI 1.27-8.26; p = 0.014); forceps-assisted delivery (OR 13.4; 95% CI 1.91-93.66; p = 0.009); breastfeeding (OR 6.23; 95% CI 2.27-17.05; p = <0.001) and the practice of mixed breastfeeding (OR 4.6; 95% CI 1.56-13.73; p = 0.006). MTCT is preventable with early diagnosis; treatment initiation before pregnancy and avoidance breastfeeding could decrease the risk of transmitting HIV to their children.

Leveraging antigenic seniority for maternal vaccination to prevent mother-to-child transmission of HIV-1

The development of a maternal HIV vaccine to synergize with current antiretroviral drug prophylaxis can overcome implementation challenges and further reduce mother-to-child transmission (MTCT) of HIV. Both the epitope-specificity and autologous neutralization capacity of maternal HIV envelope (Env)-specific antibodies have been implicated in decreased risk of MTCT of HIV. Our goal was to determine if heterologous HIV Env immunization of SHIV.C.CH505-infected, ART-suppressed female rhesus macaques (RMs) could boost autologous Env-specific antibodies. SHIV.C.CH505-infected female RMs (n = 12), began a daily ART regimen at 12 weeks post-infection (wpi), which was continued for 12 weeks. Starting 2 weeks after ART initiation, RMs received 3 monthly immunizations with HIV b.63521/1086.C gp120 or placebo (n = 6/group) vaccine with adjuvant STR8S-C. Compared to the placebo-immunized animals, Env-vaccinated, SHIV-infected RMs exhibited enhanced IgG binding, avidity, and ADCC responses against the vaccine immunogens and the autologous SHIV.C.CH505 Env. Notably, the Env-specific memory B cells elicited by heterologous vaccination were dominated by cells that recognized the SHIV.C.CH505 Env, the antigen of primary exposure. Thus, vaccination of SHIV-infected, ART-suppressed RMs with heterologous HIV Envs can augment multiple components of the antibody response against the Env antigen of primary exposure, suggesting antigenic seniority. Our results suggest that a universal maternal HIV vaccination regimen can be developed to leverage antigenic seniority in targeting the maternal autologous virus pool.

Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania.

Peer support services are increasingly being integrated in programmes for the prevention of mother-to-child HIV transmission (PMTCT). We aimed to evaluate the effect of a peer-mother interactive programme on PMTCT outcomes among pregnant women on anti-retroviral treatment (ART) in routine healthcare in Dar es Salaam, Tanzania. Twenty-three health facilities were cluster-randomized to a peer-mother intervention and 24 to a control arm. We trained 92 ART experienced women with HIV to offer peer education, adherence and psychosocial support to women enrolling in PMTCT care at the intervention facilities. All pregnant women who enrolled in PMTCT care at the 47 facilities from 1st January 2018 to 31st December 2019 were identified and followed up to 31st July 2021. The primary outcome was time to ART attrition (no show >90 days since the scheduled appointment, excluding transfers) and any difference in one-year retention in PMTCT and ART care between intervention and control facilities. Secondary outcomes were maternal viral suppression (<400 viral copies/mL) and mother-to-child HIV transmission (MTCT) by ≥12 months post-partum. Analyses were done using Kaplan Meier and Cox regression (ART retention/attrition), generalized estimating equations (viral suppression) and random effects logistic regression (MTCT); reporting rates, proportions and 95% confidence intervals (CI). There were 1957 women in the peer-mother and 1384 in the control facilities who enrolled in routine PMTCT care during 2018-2019 and were followed for a median [interquartile range (IQR)] of 23 [10, 31] months. Women in both groups had similar median age of 30 [IQR 25, 35] years, but differed slightly with regard to proportions in the third pregnancy trimester (14% versus 19%); advanced HIV (22% versus 27%); and ART naïve (55% versus 47%). Peer-mother facilities had a significantly lower attrition rate per 1000 person months (95%CI) of 14 (13, 16) versus 18 (16, 19) and significantly higher one-year ART retention (95%CI) of 78% (76, 80) versus 74% (71, 76) in un-adjusted analyses, however in adjusted analyses the effect size was not statistically significant [adjusted hazard ratio of attrition (95%CI) = 0.85 (0.67, 1.08)]. Viral suppression (95%CI) was similar in both groups [92% (91, 93) versus 91% (90, 92)], but significantly higher among ART naïve women in peer-mother [91% (89, 92)] versus control [88% (86, 90)] facilities. MTCT (95%CI) was similar in both groups [2.2% (1.4, 3.4) versus 1.5% (0.7, 2.8)]. In conclusion, we learned that integration of peer-mother services in routine PMTCT care improved ART retention among all women and viral suppression among ART naïve women but had no significant influence on MTCT.

Implementation of HIV Retesting During Pregnancy and Postpartum in Kenya: A Cross-Sectional Study.

HIV retesting during pregnancy/postpartum can identify incident maternal HIV infection and prevent mother-to-child HIV transmission (MTCT). Guidelines recommend retesting HIV-negative peripartum women, but data on implementation are limited. We conducted a cross-sectional study in Kenya to measure the prevalence of maternal HIV retesting in programs and HIV incidence. Programmatic HIV retesting data was abstracted from maternal and child health booklets among women enrolled in a cross-sectional and/or seeking services during pregnancy, delivery, or 9 months postpartum in Kenya between January 2017 and July 2019. Retesting was defined as any HIV test conducted by MTCT programs after the initial antenatal care test or conducted as part of retesting policies at/after delivery for women not tested during pregnancy. Poisson generalized linear regression was used to identify correlates of programmatic retesting among women enrolled at 9 months postpartum. Among 5,894 women included in the analysis, 3,124 only had data abstracted and 2,770 were enrolled in a cross-sectional study. Overall prevalence of programmatic HIV retesting was higher at 6 weeks (65%) and 9 months postpartum (72%) than in pregnancy (32%), at delivery (23%) and 6 months postpartum (28%) (P<.001 for all comparisons). HIV incidence was 0.72/100 person-years (PY) (95% confidence interval (CI)=0.43,1.22) in pregnancy and 0.23/100 PY (95% CI=0.09, 0.62) postpartum (incidence rate ratio: 3.09; 95% CI=0.97, 12.90; P=.02). Maternal retest coverage was high at 6 weeks and 9 months postpartum but low during pregnancy. Strategies to ensure high retesting coverage and detect women with incident maternal HIV infection are needed.

Self-efficacy in the Context of PMTCT of HIV: A Concept Clarification

Despite the effort and emphasis of Prevention of Mother to Child Transmission (PMTCT) strategies, the rate of Mother-to-child transmission (MTCT) of HIV continue to be high. Selfefficacy beliefs may be very helpful for not only perception and avoidance of risk for MTCT of HIV but also for coping with the disease and empowering health and socio-economic conditions. However, previous analyses of self-efficacy were found to be only partially useful in the context of PMTCT of HIV. The purpose of this paper is to explore the current knowledge about the selfefficacy concept and clarify its theoretical application in the context of PMTCT of HIV research. The Norris method of concept clarification was used as the guiding framework. Literature Review. Literature review was conducted in MEDLINE, PUBMED, CINHAL, and Google Scholar. Six antecedents of self-efficacy identified were perceived risk, challenges, tasks, goals, adversity, and difficulty. High self-efficacy was found to influence the development of cognitive, personal, behavioral, and environmental factors which influence the adherence of PMTCT strategies and prevention of MTCT of HIV. The clarification of the self-efficacy concept will assist nurse researchers, practitioners, and educators in developing interventions and education strategies aimed at promoting PMTCT of HIV.

Process Evaluation of Prevention of Mother-to-Child Transmission of HIV Service at Gondar City Administration Governmental Health Facilities, Northwest Ethiopia: A Mixed Approach Case Study Evaluation Design.

IntroductionMother-to-child HIV transmission (MTCT), or vertical transmission of HIV, is one mode of HIV transmission from mother to baby during pregnancy, delivery and after childbirth. The continuation of new pediatric HIV infection due to the improper prevention of MTCT is a challenge in developing countries; however, the program is not evaluated yet in Ethiopia. Therefore, this study was aimed to assess the process of PMTCT service implementation status.ObjectiveThis evaluation study evaluated the implementation of process levels and identified problems of PMTCT service at Gondar city administration governmental health facilities.MethodsA case study evaluation design with a mixed method was conducted from March to May 2020. A systematic random sampling technique was used to select participants. Data were collected using an interviewer-administered questionnaire and document review, observation, and key informant interviews. Collected data were entered using EPI data version 7 and analyzed using SPSS version 25.ResultsThe study found that, generally, the PMTCT program implementation was complying with the Ethiopian national guidelines by 78.32%. All facilities had most of the minimum required resources recommended by the guidelines by 75%. The services required to be provided by the facilities were highly accommodated by 90.18%, acceptable by 77.2%, with 78% compliance. Trained human resources and continuous supply of material are the main gaps.ConclusionThe overall level of program implementation was judged to be good. However, there is a need for improvements such as ensuring the privacy of counselling rooms, availability of human, test kits, guidelines, beds, waiting areas, drugs, and refresher training for provider. Also, counsellors should record properly the services provided to clients in their cards, such as counselling sessions.

Mother-to-Child Transmission of HIV and Associated Factors Among Exposed Infants in Pastoralist Health Facilities, South Omo Zone, Ethiopia, 2020 – A Retrospective Cross-Sectional Study

BackgroundAlthough HIV/AIDS is affecting all age groups, it is a primary cause of illness and deaths among children globally. A significant bulk of HIV infections in children under the age of 15 were as a result of vertical transmission, where it accounts for 95% of childhood HIV infections in Ethiopia.ObjectiveTo assess the proportion of mother-to-child transmission (MTCT) of HIV and associated factors among exposed infants on follow-up in pastoralist health facilities, South Omo, Ethiopia.MethodologyA retrospective, cross-sectional study was employed among 228 HIV-exposed infants. Medical records of HIV-exposed infant-mother pairs in the study institutions were extracted. The confirmatory HIV serostatus of every infant was taken at the end of 24 months. Data were entered in Epi Data 4.2 version and exported to SPSS version 25 for final analysis. Multivariable logistic regression analysis was used to identify significant predictor variables at P-value < 0.05.ResultsA total of 228 records were included in the analysis. The rate of HIV transmission was 5.3% (95% CI: 2.6–8.3%). Not receiving antiretroviral prophylaxis at birth (AOR = 5.8, 95% CI: 1.02–33.53), absence of maternal antiretroviral prior to current pregnancy (AOR = 5.6, 95% CI: 1.14–28.1), and mother’s advanced World Health Organization clinical stage of HIV (AOR: 10.5, 95% CI: 1.4–81) were associated with MTCT of HIV.ConclusionThis study identified a high proportion of MTCT among exposed infants in the study area. Not receiving antiretrovirals prior to pregnancy and advanced WHO clinical stage of HIV, and not getting antiretroviral prophylaxis at birth resulted in higher risk of MTCT of HIV. Hence, health workers and policy-makers should offer antiretroviral prophylaxis, put mothers on antiretroviral therapy and limit the stage of HIV at lower WHO clinical stages.

Understanding Viral and Immune Interplay During Vertical Transmission of HIV: Implications for Cure.

Despite the significant progress that has been made to eliminate vertical HIV infection, more than 150,000 children were infected with HIV in 2019, emphasizing the continued need for sustainable HIV treatment strategies and ideally a cure for children. Mother-to-child-transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in absence of prevention measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding. The exact mechanisms and biological basis of these different routes of transmission are not yet fully understood. Some infants escape infection despite significant virus exposure, while others do not, suggesting possible maternal or fetal immune protective factors including the presence of HIV-specific antibodies. Here we summarize the unique aspects of HIV MTCT including the immunopathogenesis of the different routes of transmission, and how transmission in the antenatal or postnatal periods may affect early life immune responses and HIV persistence. A more refined understanding of the complex interaction between viral, maternal, and fetal/infant factors may enhance the pursuit of strategies to achieve an HIV cure for pediatric populations.

Maternal Intervention to Prevent Mother-to-Child Transmission of HIV: Moving Beyond Antiretroviral Therapy.

Widespread availability of antiretroviral therapy among pregnant women living with HIV has greatly reduced the rate of mother-to-child transmission (MTCT) of HIV across the globe. However, while Joint United Nations Programme on HIV/AIDS has set targets to reduce the annual number of new pediatric HIV infections to fewer than 40,000 in 2018 and fewer than 20,000 in 2020, progress towards these targets has plateaued at an unacceptably high global estimate of greater than 160,000 children newly infected with HIV in 2018. Moreover, it has become clear that expansion of maternal antiretroviral therapy alone will not be sufficient to close the remaining gap and eliminate MTCT of HIV. Additional strategies such as maternal or infant passive and/or active immunization that synergize with maternal antiretroviral therapy will be required to end the pediatric HIV epidemic. In this review, we outline the landscape of existing maternal interventions and emerging maternal immune-based approaches to prevent MTCT of HIV.