PMTCT Program Research Articles

Residual transmission of HIV infection from mother to child in the Atlantic and littoral departments in Benin

BackgroundThe implementation of the WHO’s 2015 recommendations in Benin, requires an assessment of the progress made over time in preventing the transmission of the infection to exposed-infants, and the identification of its determinants.MethodsThis was a retrospective study of HIV-1 exposed-infants who underwent PCR between the 6th and 8th weeks of life. Early diagnostic tests were performed using the Abbott m2000 RealTime platform. Comparison of proportions tests (analysis of the significance of the difference in prevalence) with an error threshold of 5% were used to assess the determinants of the transmission. Statistical analysis was performed using R statistical software, version 4.1.3.0.ResultsA total of 5,312 infants benefited from early diagnosis by PCR between 2016 and 2021. Among them, 52% are males, tritherapy before pregnancy was the majority treatment used by mothers (30.6%) and monotherapy that of newborns (70%). Mixed breastfeeding is the feeding method with the highest prevalence. The overall transmission rate was 3.4% over the six years. The highest prevalence was achieved in 2018 (4.2%) and the lowest in 2021 (2.7%). The prevalence was lower when mothers were on tritherapy before pregnancy. The determinants of transmission were: mixed breastfeeding, lack of treatment in mothers (22.4%), lack of treatment in infants (19.7%), undefined treatments or absence of treatment in the mother-child pair.ConclusionThis study shows the contribution over time of the PMTCT program to reducing HIV transmission among exposed-infants and also underlines the need for proper conduct of treatment in any women of childbearing age.

Incidence and predictors of opportunistic infections among HIV-infected children on antiretroviral therapy at public health facilities of Southwest Ethiopia People Regional State, 2023: a multicenter retrospective follow-up study

BackgroundOpportunistic infections (OIs) pose a significant threat to children infected with HIV. Despite advancements in antiretroviral therapy (ART), these infections continue to be a public health concern. However, there is limited evidence regarding the incidence and predictors of OIs among HIV-infected children in Ethiopia, particularly in the study area. Therefore, the objective of this study was to assess the incidence and predictors of OIs among HIV-infected children on ART at public health facilities of Southwest Ethiopia People Regional State.MethodsThe study employed an institution-based retrospective cohort design, conducted from July 1, 2018 to July 31, 2023, among HIV-infected children aged less than 15 years. Data were extracted using the national ART intake and follow-up forms. KoboCollect version 2023.2.4 and STATA version 14.0 were used for data collection and analysis, respectively. The Kaplan-Meier survival curve was used to estimate the probability of OI-free survival time. Variables with P-value < 0.25 in the bivariable Cox proportional hazard model were selected as candidates. In multivariable analysis, P-value < 0.05 and adjusted hazard ratio (AHR) with 95% confidence interval (CI) were used to declare statistically significant predictors.ResultsOf the total 409 HIV infected children, 122(29.8%) developed at least one OI, contributing to 954.95 person-years of risk. The overall incidence rate was 12.8 (95% CI: 10.7, 15.2) per 100 person-years. The OI-free survival probability at the end of the follow-up period was 0.277(95% CI: 0.139, 0.434). The commonest OI was pulmonary tuberculosis, 30.33% (95% CI: 22.7, 39.2). Non-disclosing HIV status (AHR: 2.56, 95% CI: 1.42, 4.63), children aged 10–14 years (AHR: 2.34, 95% CI: 1.10, 4.95), no history of prevention of mother-to-child transmission of HIV (AHR: 2.33, 95% CI: 1.48, 3.66), hemoglobin level < 10 mg/dL (AHR: 2.26, 95% CI: 1.37, 3.75), fair or poor adherence to ART (AHR: 1.74, 95% CI: 1.09, 2.79), and having past history of OIs (AHR: 1.61, 95% CI: 1.03, 2.55) were statistically significant predictors of OIs.Conclusion and recommendationsThe incidence of OIs was high in the study area. Hence, health facilities need to regularly monitor hemoglobin, enhance ART adherence, provide OI prophylaxis for at-risk children, reinforce PMTCT programs for early OI detection and management, and encourage timely and age-appropriate HIV status disclosure. Caregivers of HIV-infected children are also required to oversee and assist their children in adhering to the ART.

Prediction Models for HIV Infection in Infants: Analysis of Scoring Systems on Maternal, Infants, and Mode of Delivery Risk Factors.

Diagnosis for HIV in infants is hard to determine, particularly in limited- resource areas. A delay in the diagnosis of HIV-infected infants will lead to high morbidity and mortality. The purpose of this project is to construct a model of an HIV-positive infant and develop a useful and practical scoring system to estimate the likelihood of mother-to-child transmission that can be applied in the field. A cross-sectional study on 100 subjects through medical records of infants born to HIV-infected mothers was conducted at four hospitals and one community health center. Several models of risk prediction scores of HIV-infected infants were then made. Furthermore, the performed validation was performed on 20 subjects of infants born to mothers with HIV in three hospitals by comparing the scoring system and the result of the PCR RNA examination performed at the age of 6 weeks old. The risk of HIV-infected infants was higher in mothers who did not receive ARV through PMTCT programs (OR 33.6; 95% CI 4.0 to 282.2), pulmonary TB infection (OR 5.1; IK95% 1.6 to 16.0) and vaginal delivery (OR 9.2; IK95 2.2 to 38.0%). Two models can predict the occurrence of infected HIV infants effectively. Model 1 consists of maternal age, maternal ARVs, lung TB infection, gestational age, mode of delivery, and sex of the infants with sensitivity and specificity of 78.9% and 70.8% (AUC=0.817 [95% CI 0.709 to 0.926]) and likelihood ratio score of 4. Model 2 consists of ARVs to the mother, pulmonary TB infection, and mode of delivery with sensitivity and specificity of 73.7% and 86.1%; AUC value of 0.812 (95% CI 0.687 to 0.938) and likelihood ratio of 5. External Validation gave similar results to the Model 2 scoring system with PCR RNA. The prediction score of HIV-infected infants in Model 2 can be used in newborns of HIV-positive mothers as an effective and practical risk screening tool for HIV-infected infants before the gold standard examination by PCR.

Guidance for triangulating data and estimates of HIV prevalence among pregnant women and coverage of PMTCT using the Spectrum AIDS Impact Module.

Most countries use the Spectrum AIDS Impact Module (Spectrum-AIM), antenatal care routine HIV testing, and antiretroviral treatment data to estimate HIV prevalence among pregnant women. Non-representative programme data may lead to inaccurate estimates HIV prevalence and treatment coverage for pregnant women. 154 countries and subnational locations across 126 countries. Using 2023 UNAIDS HIV estimates, we calculated three ratios: (1) HIV prevalence among pregnant women to all women 15-49y (prevalence), (2) ART coverage before pregnancy to women 15-49y ART coverage (ART pre-pregnancy), and (3) ART coverage at delivery to women 15-49y ART coverage (PMTCT coverage). We developed an algorithm to identify and adjust inconsistent results within regional ranges in Spectrum-AIM, illustrated using Burkina Faso's estimates. In 2022, the mean regional ratio of prevalence among pregnant women to all women ranged from 0.68 to 0.95. ART coverage pre-pregnancy ranged by region from 0.40 to 1.22 times ART coverage among all women. Mean regional PMTCT coverage ratios ranged from 0.85 to 1.51. The prevalence ratio in Burkina Faso was 1.59, above the typical range 0.62-1.04 in western and central Africa. Antenatal clinics reported more PMTCT recipients than estimated HIV-positive pregnant women from 2015 to 2019. We adjusted inputted PMTCT programme data to enable consistency of HIV prevalence among pregnant women from programmatic routine HIV testing at antenatal clinics with values typical for Western and central Africa. These ratios offer Spectrum-AIM users a tool to gauge the consistency of their HIV prevalence and treatment coverage estimates among pregnant women with other countries in the region.

Guidance for triangulating data and estimates of HIV prevalence among pregnant women and coverage of PMTCT using the Spectrum AIDS Impact Module.

Most countries use the Spectrum AIDS Impact Module (Spectrum-AIM), antenatal care routine HIV testing, and antiretroviral treatment data to estimate HIV prevalence among pregnant women. Non-representative programme data may lead to inaccurate estimates HIV prevalence and treatment coverage for pregnant women. 154 locations in 126 countries. Using 2023 UNAIDS HIV estimates, we calculated three ratios: (1) HIV prevalence among pregnant women to all women 15-49y (prevalence), (2) ART coverage before pregnancy to women 15-49y ART coverage (ART pre-pregnancy), and (3) ART coverage at delivery to women 15-49y ART coverage (PMTCT coverage). We developed an algorithm to identify and adjust inconsistent results within regional ranges in Spectrum-AIM, illustrated using Burkina Faso's estimates. In 2022, the mean regional ratio of prevalence among pregnant women to all women ranged from 0.68 to 0.95. ART coverage pre-pregnancy ranged by region from 0.40 to 1.22 times ART coverage among all women. Mean regional PMTCT coverage ratios ranged from 0.85 to 1.51. The prevalence ratio in Burkina Faso was 1.59, above the typical range 0.62-1.04 in western and central Africa. Antenatal clinics reported more PMTCT recipients than estimated HIV-positive pregnant women from 2015 to 2019. We adjusted inputted PMTCT programme data to enable consistency of HIV prevalence among pregnant women from programmatic routine HIV testing at antenatal clinics with values typical for Western and central Africa. These ratios offer Spectrum-AIM users a tool to gauge the consistency of their HIV prevalence and treatment coverage estimates among pregnant women with other countries in the region.

Participation of Cadres and Peer Support Groups in the PMTCT Program in Karo Regency North Sumatra Province Indonesia

Participation of Cadres and Peer Support Groups in the PMTCT Program in Karo Regency North Sumatra Province Indonesia

'When I receive ARVs through my group, my heart settles': Participants' perceptions and experiences of Friends for Life Circles for Option B+ in Kampala and Mityana Districts, Uganda.

The Friends for Life Circles (FLC) was a parallel randomized controlled trial testing the efficacy of a group peer support intervention to support long-term adherence to Option B+ in Kampala and Mityana districts in Uganda. We explored FLC participants' experiences and perceptions of the intervention on adherence to Option B+ for PMTCT and potential implications for strengthening the PMTCT program. We collected data from six focus group discussions with lactating women enrolled in the FLC intervention, and from 14 key informant interviews with health workers, district and national level stakeholders, as well as male partners of FLC participants. Data were analysed using a content thematic approach in a continuous and iterative process. Women described the FLC intervention as acceptable and beneficial in enhancing their understanding of HIV and the need for ART. The FLC helped women, especially those newly diagnosed with HIV infection to come to terms with their diagnosis and overcome the fear of death linked to testing HIV positive, and provided opportunities to enhance ART initiation, resumption and adherence. The FLC provided safe spaces for women, to learn about ART, and to receive support from peers including adherence reminders through home visits and 'coded' reminder messages. Receiving ART from support groups protected members from stigma and long lines at health facilities. Fear of stigma, health system challenges, the high cost of caring for animals and lack of money to save in groups were key challenges noted. The FLC support groups were crucial in providing needed support for women to initiate, resume and adhere to lifelong ART for Option B+. It is important that women who test HIV positive and start ART for life receive psychosocial support from peers and health workers to improve chances of preventing HIV transmission from mothers to children.

Assessing The Outcome Of Pmtct Of Hiv Therapy At The Eastern Regional Hospital, Ghana

The study assessed the outcome of the PMTCT of HIV therapy at the Eastern Regional Hospital. Specifically, the study sought to; determine the percentage of Retro-exposed babies infected with HIV; assess the health status of the Retro-exposed babies infected with HIV; determine the infant mortality rate of Retro-exposed babies infected with HIV; assess the PMTCT treatment options available and used at Eastern Region Hospital; and assess the demographic characteristics of the mother that may have influenced the outcomes of Retro-exposed babies infected with HIV. This is a descriptive study of HIV positive mothers enrolled on the PMTCT programme at Eastern Regional Hospital. Secondary data on demographic characteristics of the mothers, the treatment options in use and the outcome of the PMTCT programme after birth at Eastern Region Hospital were used. Data was analyzed descriptively using frequencies, percentages, means and standard deviations whereas relationship and difference were analyzed using t-test, ANOVA, chi-square techniques. Babies were protected from getting infected with HIV through PMTCT treatment while only 15 babies were infected with HIV. More females were infected. Also, aside the 2 babies who died, only few babies have health issues such as neonatal infection and low birth weight but the remaining were healthier. With infant mortality rate, out of the 15 babies who were infected with HIV, only 2 (13.3%) of them died. All the women (165, 100%) on the PMTCT were treated with TDF 300mg +3TC 300mg + EFV 600mg and they all tolerated it. There were differences between age, educational status of women and Retro exposed babies to infection of HIV. However, income of the women had nothing to do with the Retro exposed babies to infection of HIV. PMTCT treatment is key since it is the window through which babies born to women with HIV can be protected from being infected with HIV. Again, there were differences between age, educational status of women and Retro exposed babies to infection of HIV. However, the results of the study indicated that income of the women had nothing to do with the Retro exposed babies to infection of HIV.

Incidence and predictors of loss to follow-up among pregnant and lactating women in the Option B+ PMTCT program in Northwestern Ethiopia: a seven-year retrospective cohort study.

Although Ethiopia has implemented the Option B+ program over the past 7 years, loss to follow-up among HIV-positive women remains a major problem for antiretroviral therapy (ART) treatment. This study was conducted to investigate the number of women who dropped out of follow-up after the Option B+ program. A retrospective follow-up study was conducted among 403 pregnant and lactating women between June 2013 and December 2019 at health facilities in Northwest Ethiopia. The Cox proportional hazards regression model was used to identify predictors of loss to follow-up. The results were reported as hazard ratios with 95% confidence intervals (CIs) at a significance level of p = 0.05. The overall incidence rate of loss to follow-up was 9.4 per 1,000 person-months of observation (95% CI: 7.40-11.90). According to the multivariable Cox regression, rural residency [adjusted hazard ratio (AHR): 2.30; 95% CI: 1.08-4.88], being a Muslim religion follower (AHR: 2.44; 95% CI: 1.23-4.81), having no baseline viral load measurement (AHR: 4.21; 95% CI: 2.23-7.96), being on ART before enrolment (AHR: 0.30; 95% CI: 0.15-0.62), having drug side effects (AHR:1.82; 95% CI: 1.01-3.33), same-day ART initiation (AHR: 3.23; 95% CI: 1.53-6.84), and having suboptimal adherence level (AHR: 3.96; 95% CI: 2.18-7.19) were significant predictors of loss to follow-up. The incidence of loss to follow-up is lower as compared to evidence from most African countries but slightly higher than the WHO target. It is better to strengthen and expand viral load measurements for all women and to pay attention to women residing in rural areas with fair or poor adherence levels.

Predictors of Attrition from Care and Treatment Centres among HIV-positive Pregnant and Breastfeeding Adult Women in Dar es Salaam, Tanzania

In Tanzania, poor retention rates among pregnant and breastfeeding mothers continue to be a problem, contributing to a mother-to-child HIV transmission rate of 11% in 2019, compared to a global target of 5%. The goal of this study was to determine the influence of retention on clinical outcomes and identifying predictors of attrition among HIV-positive pregnant and breastfeeding women from follow-up care in Dar es Salaam. A retrospective cohort study included HIV-positive women who engaged in PMTCT services in public and private health facilities between January 2016 and December 2019. Secondary data were extracted from databases used for routine follow-up in care and treatment clinics (CTCs). The estimates of cumulative incidences of poor retention from date of enrollment or ART initiation were assessed using Kaplan–Meier method. The Cox regression model was used to identify the predictors of attrition. Among 20,225 HIV-infected pregnant and lactating women enrolled in PMTCT services, 93.35%, 89.07%, and 85.24% were classified as retained in care at 12, 24, and 36 months, respectively. The attrition rate at the end of the follow-up period was 15.82%, and WHO clinical stages 3 or 4 (aHR = 1.67, 95% CI: 1.46–1.89; p-value &lt; 0.001) and unsuppressed viral load (aHR = 3.79, 95% CI: 3.20–4.49; p-value &lt; 0.001) were predictors of increased risks of attrition. The maternal age group 25–34 years (aHR = 0.24, 95% CI: 0.18–0.32; p-value &lt; 0.001), being married or cohabiting (aHR = 0.45, 95% CI: 0.38–0.55; p-value &lt; 0.001), an efavirenz (EFV)-based regimen (aHR = 0.26, 95% CI: 0.19–0.35; p-value &lt; 0.001), and good adherence to ART (aHR = 0.61, 95% CI: 0.48–0.79; p-value &lt; 0.001) were factors associated with reduced risks of attrition. The study shows that a strong tracking system for lost to follow-up (LTFU), that is, patients who miss appointments to the same health facility for more than 3 months after the last scheduled clinical visit, should be prioritised for successive PMTCT programmes for better clinical outcomes.&#x0D; Keywords: Retention, Attrition, Treatment, Clinics, Loss-to-follow up

Incidence and predictors of loss to follow-up among women on option B+ PMTCT program in northwest Ethiopia. A retrospective follow-up study.

Loss to follow-up from lifelong antiretroviral therapy continued to be a major challenge affecting virtual elimination of mother-to-child transmission of human immunodeficiency virus, especially in Sub-Saharan Africa. Although there was a study conducted in Ethiopia, loss to follow-up was not clearly defined and some important variables were not addressed. Thus, this study was conducted to determine the incidence of loss to follow-up and its predictors among women on option B+ lifelong antiretroviral therapy program in Pawi district health facilities, northwest Ethiopia. An institutional-based retrospective follow-up study was conducted among 365 women who were enrolled for option B+ prevention of mother-to-child transmission service between June 2013 and March 2021 in Pawi district health facilities. A standard pretested checklist was used to extract data from all eligible women's records. The Kaplan-Meier survival curve for estimating survival probability and Cox proportional hazards model to identify independent predictors of loss to follow-up were employed after checking for proportional hazards assumptions using STATA-14 statistical software. The overall incidence of loss to follow-up was 12.04 (95% CI: 9.50, 15.20) per 1000 person-months of observation time. Residing outside the catchment area (adjusted hazard ratio (AHR): 3.08, 95% CI: 1.59, 5.98), lactating at enrollment (AHR: 2.43, 95% CI: 1.24, 4.77), living in a sero-discordant relationship (AHR: 2.5, 95% CI: 1.13, 5.53), lack of sero-status disclosure (AHR: 2.59, 95% CI: 1.15, 5.85), new enrollment to lifelong antiretroviral therapy (AHR: 2.07, 95% CI: 1.05, 4.11), and fair (AHR: 2.69, 95% CI: 1.2, 6.04) or poor (AHR: 5.78, 95% CI: 2.76, 12.12) antiretroviral drug adherence level were independent predictors of loss to follow-up. We found a higher incidence of loss to follow-up relative to previous studies in Ethiopia. Thus, strengthening adherence support interventions, and effective counseling on sero-status disclosure and male partner involvement are important to retain women in care.

Promoting Awareness of the Role of the District Clinical Specialist Team in the Amathole District, South Africa: A Valuable Specialty in Improving Healthcare Access and Quality.

This study explored the understanding of healthcare professionals on the role of the District Clinical Specialist Team (DCST) and how the team works together with the district personnel at different management levels to improve and strengthen the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme performance across four sub-districts in the Amathole district of the Eastern Cape Province, South Africa. An interpretive qualitative case study was used to understand the role played by the DCST in improving PMTCT programme performance in the district. We used a purposive sampling method to select eight participants involved in providing technical assistance to support the implementation of the quality improvement programme. We conducted in-depth interviews with all the participants; all were females in their mid-forties. Data were analysed thematically by identifying themes and reporting patterns within the data. Most interviewees were females in their mid-forties and had been at their respective facilities for at least five years. The findings were discussed based on three themes: capacity building, programme performance oversight and monitoring, and technical support. The DCST significantly enhances the staff's clinical skills, knowledge, and work performance to care for and manage the mother and baby pair. In addition, the DCST plays a vital role in providing programme oversight and complements the technical support provided by the Department of Health (DoH) managers and the quality improvement programme support by the South to South (S2S) team aimed at improving and achieving the PMTCT programme's desired outcomes. The DCST also provided additional support for data verification to identify gaps in the PMTCT programme. The role of DCST is essential in improving the quality and service provision of the PMTCT programme and is critical to assist the team at different levels in addressing challenges encountered and training and mentoring the needs of the staff. In addition, DCST's responsibilities cannot be fully achieved without a good working relationship with the quality improvement and district health teams because they work better together to ensure that the programme is performing optimally. This study showed that the District Clinical Specialist Team is vital for improving the quality and service provision of the PMTCT programme and it is essential for addressing challenges encountered by healthcare facilities and the staff providing PMTCT services.

Association between service readiness and PMTCT cascade effectiveness: a 2018 cross-sectional analysis from Manica province, Mozambique

BackgroundDespite high coverage of maternal and child health services in Mozambique, prevention of mother-to-child transmission of HIV (PMTCT) cascade outcomes remain sub-optimal. Delivery effectiveness is modified by health system preparedness. Identifying modifiable factors that impact quality of care and service uptake can inform strategies to improve the effectiveness of PMTCT programs. We estimated associations between facility-level modifiable health system readiness measures and three PMTCT outcomes: Early infant diagnosis (polymerase chain reaction (PCR) before 8 weeks of life), PCR ever (before or after 8 weeks), and positive PCR test result.MethodsA 2018 cross-sectional, facility-level survey was conducted in a sample of 36 health facilities covering all 12 districts in Manica province, central Mozambique, as part of a baseline assessment for the SAIA-SCALE trial (NCT03425136). Data on HIV testing outcomes among 3,427 exposed infants were abstracted from at-risk child service registries. Nine health system readiness measures were included in the analysis. Logistic regressions were used to estimate associations between readiness measures and pediatric HIV testing outcomes. Odds ratios (OR) and 95% confidence intervals (95%CI) are reported.ResultsForty-eight percent of HIV-exposed infants had a PCR test within 8 weeks of life, 69% had a PCR test ever, and 6% tested positive. Staffing levels, glove stockouts, and distance to the reference laboratory were positively associated with early PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.73 [95%CI: 1.24–2.40] and OR = 1.01 [95%CI: 1.00–1.01], respectively) and ever PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.80 [95%CI: 1.26–2.58] and OR = 1.01 [95%CI: 1.00–1.01], respectively). Catchment area size and multiple NGOs supporting PMTCT services were associated with early PCR testing OR = 1.02 [95%CI: 1.01–1.03] and OR = 0.54 [95%CI: 0.30–0.97], respectively). Facility type, stockout of prophylactic antiretrovirals, the presence of quality improvement programs and mothers’ support groups in the health facility were not associated with PCR testing. No significant associations with positive HIV diagnosis were found.ConclusionSalient modifiable factors associated with HIV testing for exposed infants include staffing levels, NGO support, stockout of essential commodities and accessibility of reference laboratories. Our study provides insights into modifiable factors that could be targeted to improve PMTCT performance, particularly at small and rural facilities.

Social Determinants of Health that Influence the Uptake of the PMTCT Program

Social Determinants of Health that Influence the Uptake of the PMTCT Program

Experiences of Mothers Living With HIV in a South African Prevention of Mother-to-Child Transmission of HIV Programme: A Qualitative Descriptive Study.

More than 90% of all HIV infections in children result from mother to child transmission. Elimination of mother-child transmission is a global priority and vital for the improvement of child survival in high-burden, limited resource settings. Retention in HIV care is vital to reduce transmission risk. This qualitative study explored the experiences and adherence challenges of mothers living with HIV of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme in Khayelitsha, Cape Town, South Africa. Interviews were conducted with purposively selected participants enrolled in a PMTCT programme at a primary care facility. Thematic analysis generated six themes. Findings demonstrate the complexity of living as a woman with HIV in a socioeconomically disadvantaged and marginalized periurban community. For each woman, there is a set of concerns relating to person, home, community, and clinic which may affect her understanding, acceptance of, and adherence to the PMTCT programme.

Investigating the quality of HIV rapid testing practices in public antenatal health care facilities, South Africa.

Monitoring HIV prevalence using antenatal HIV sentinel surveillance is important for efficient epidemic tracking, programme planning and resource allocation. HIV sentinel surveillance usually employs unlinked anonymous HIV testing which raises ethical, epidemiological and public health challenges in the current era of universal test and treat. The World Health Organization (WHO) recommends that countries should consider using routine prevention of mother-to-child transmission of HIV (PMTCT) data for surveillance. We audited antenatal care clinics to assess the quality of HIV rapid testing practices as the first step to assess whether South Africa is ready to utilize PMTCT programme data for antenatal HIV surveillance. In 2017, we conducted a cross-sectional survey in 360 randomly sampled antenatal care clinics using the adapted WHO Stepwise-Process-for-Improving-the-Quality-of-HIV-Rapid-Testing (SPI-RT) checklist. We calculated median percentage scores within a domain (domain-specific median score), and across all domains (overall median percentage scores). The latter was used to classify sites according to five implementation levels; (from 0:<40% to 4: 90% or higher). Of 346 (96.1%) facilities assessed, an overall median percentage score of 62.1% (inter-quartile range (IQR): 50.8-71.9%) was obtained. The lowest domain-specific median percentage scores were obtained under training/certification (35% IQR: 10.0-50.0%) and external quality assurance (12.5% IQR: 0.0-50.0%), respectively. The majority (89%) of sites had an overall median score at level 2 or below; of these, 37% required improvement in specific areas and 6.4% in all areas. Facilities in districts implementing the HIV Rapid Test Quality Improvement Initiative and supported by the President's Emergency Plan for AIDS Relief (PEPFAR) had significantly higher median overall scores (65.6% IQR: 53.9-74.2%) (P-value from rank sum test: <0.001) compared with non-PEPFAR-supported facilities (56.6% IQR:47.7-66.0%). We found sub-optimal implementation of HIV rapid testing practices. We recommend the expansion of the PEPFAR-funded Rapid Test Continuous Quality Improvement (RTCQI) support to all antenatal care testing sites.

The roles of private practice midwives in Prevention of Mother-To-Child Transmission Program (PMTCT) in Bali Province, Indonesia

Background and purpose: Mother-to-child transmission of HIV has been one of the problems in HIV prevention. In Indonesia, private practice midwives (PPM) play an important role in maternal and child health services. The roles of PPM in HIV vertical transmission prevention through PMTCT have not yet clearly understood. This research aims to analyse the roles of PPM in Bali Province in the PMTCT program as well as the PPM’s characteristics, knowledge, and attitudes about the program. Methods: This study was a descriptive cross-sectional survey, conducted from March to May 2020. The study population was PPM in Bali Province. The samples obtained were 404 out of a total of 1,736 PPM (23% response rate). The variables studied included socio-demographic characteristics, services and resources characteristics, knowledge, attitudes, and the role of PPM in four PMTCT prongs. Data was collected via self-filled online questionnaires distributed through Indonesian Midwives Associations branches in every district/city in Bali Province. Data were analysed descriptively and differences in roles in PMTCT were analysed using the chi-square test. Results: Of the 404 PPM, 66.1% served childbirth (deliveries), 25.4% had served HIV-positive women, and 18.3% had served HIV-positive pregnant women. As many as 95.5% of PPM played a good role in prong 1, and 99.0% of PPM, who had served HIV positive patients, played a good role in prong 2, 3 and 4. Statistically significant determinants for good implementation of prong 1 of PMTCT by the PPM were indicated by ownership or access to PMTCT information media (p=0.026), experience of serving HIV positive women (p&lt;0.00), and having served higher number of PMTCT patients (p=0.019). Conclusion: The PPM in Bali Province has played a good role inPMTCT, with a significant difference for good PMTCT implementation in prong 1 determined by the availability of information media, a history of serving HIV-positive women, and the number of PMTCT patients who have been served.

Assessment of Predictors and Effect of Disclosure of HIV Seropositive Status to Sexual Partner among HIV Positive Pregnant Women Attending Antenatal Care in Four Teaching Hospitals in Addis Ababa

Background: It is very crucial that women have the ability to disclose safely the status of being HIV-positive to male partners for the uptake as well the continued use of methods of mother-to-child transmission (PMTCT) services. The majority of the women are afraid to disclose their serostatus to their partners due to denial, blame, physical violence, and lack of financial support. Because of these reasons they discontinue the ANC follow-up and ARV medication for them as well as the baby. In Ethiopia, there are not many studies done to exploring HIV positive status disclosure to partners, the predictors, and the effects of disclosure of HIV positive status among HIV positive women during pregnancy. Method: A cross-sectional study was conducted among 328 HIV-positive pregnant women who were attending ANC in four teaching Hospitals in Addis Ababa. Data was collected using a pretested structured questionnaire and SPSS- 21 version was used to analyze the data. Result: Among the study participants 80% of the women had disclosed their HIV status to their partner. Presence of partner discussion before HIV test, the duration of the relationship between the couples, and knowing partner’s HIV status were found to be strongly associated with their disclosure and those with status disclosure to the partners are 12 times more likely to utilize the PMTCT services than those with no disclosure (COR 12.01(3.64-39.81). Conclusions: The HIV-positive status disclosure among pregnant women is found to be high in our study. It is showed that those women with no disclosure were found to have less in PMTCT programs. It is very important to note that proper uptake of and continued utilization of all PMTCT programs is hugely affected by women's disclosure of their HIV-positive status to their partners.

Comparison of Anxiety and Depression Among HIV-Positive and HIV-Negative Pregnant Women During COVID-19 Pandemic in Ekiti State, Southwest Nigeria.

PurposeCoronavirus disease 2019 (COVID-19) pandemic is the significant public health crisis of the 21st century that has disrupted personal, local, and international territorial relationships. Earlier studies have shown that people with HIV were at least twice at risk of dying from COVID-19 than the general population. There are also deep concerns about the indirect impact of COVID-19 on women within the reproductive age group in Sub-Saharan Africa who were already struggling to access reproductive healthcare services. In addition, pregnant HIV-positive women have an increased rate of anxiety and depression. This study, therefore, examined depression and anxiety disorders in pregnant HIV-positive women in response to the COVID-19 pandemic.Patients and MethodsThis cross-sectional study used a structured questionnaire containing sociodemographic information, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7) assessment tools. Data obtained were analyzed using Statistical Package for Social Science version 26.ResultsNinety-nine (99) representing 78% of 127 pregnant HIV-positive women enrolled in the PMTCT program were eligible for this study. This number matched 99 randomly selected pregnant HIV-negative in the study areas as controls. Major depressive disorder (MDD) and severe anxiety disorder were significantly higher among the HIV-positive group than in the HIV-negative group (PHQ-9 Mean ± SD 8.0 ± 5.4 vs 2.3 ± 2.9; p = 0.000) and (GAD-7 Mean ± SD 5.9 ± 4.6 vs 1.2 ± 2.2; p = 0.000).ConclusionGiven the high prevalence of major depressive disorder and severe anxiety disorder among pregnant HIV-positive women, mental health care should be incorporated into the prevention with positive interventions and strategies to reduce the indirect consequences of the COVID-19 pandemic.

Probable perinatal depression and social support among women enrolled in Malawi's Option B+ Program: A longitudinal analysis

BackgroundMalawi's PMTCT Option B+ program has expanded the reach of ART services among pregnant and breastfeeding women, but retention in lifelong HIV care remains challenging. Given that depression can undermine retention, it is important to understand how depression changes over the perinatal period, varies across treatment and retention groups, and could be buffered by social support. MethodsData are from an observational study conducted among women enrolled in Malawi's PMTCT Option B+ program. We used multilevel generalized linear models to estimate the odds of probable depression by time, treatment and retention group, and social support. Probable depression was assessed with the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9. ResultsOf 468 women, 15% reported probable depression at antenatal enrollment and prevalence differed across newly diagnosed individuals, second line therapy users, and previous defaulters (18%, 21%, 5%, p = 0.001). Odds of probable perinatal depression decreased over time (OR per month: 0.87, 95% CI: 0.82–0.92) but were higher among those newly diagnosed (OR: 3.25, 95% CI: 1.59–6.65) and on second line therapy (OR: 3.39, 95% CI: 1.44–7.99) as compared to previous defaulters. Odds of probable postpartum depression were lower for participants with high social support (OR: 0.19, 95% CI: 0.09–0.39). LimitationsLack of diagnostic psychiatric evaluation precludes actual diagnosis of depression. ConclusionsProbable depression varied across the perinatal period and across treatment and retention groups. Social support was protective for postpartum depression among all participants. Depression screening and provision of social support should be considered in PMTCT programs.