PMTCT Program Research Articles

Kajian Pencegahan Penularan HIVdari Ibu ke Anakpada Antenatal Care Oleh Bidan Praktik Mandiri di Yogyakarta

In 2013, DIY AIDS prevalence was 23,75 %. ODHA has touched 72,6%, based on age class 25-49 years old peak. PMTCT programs was done to prevent HIV to infect children from their mother. This research was qualitative descriptive research which have implement grounded theory. This research was conducted in Independent Midwifery Clinic in Kota Yogyakarta on March-June 2014. Research subject was midwifes in Independent Midwifery Clinic, mother pregnancy patient of the Independent Midwifery Clinic, midwife coordinator of primary public health care center, and family health care sector in health care Department of Kota Yogyakarta. The first respondent has been taken a sample by snowball sampling. Research instrument was use manual interview and the data were collect with in depth interview. Data analysis is done using content analysis and data validation using triangle source. Research result is that PMTCT in ANC doesn’t work effective in Independent Midwifery Clinic Yogyakarta because PMTCT couldn’t work their program without midwife and primary public health center. The mother pregnancy have been send to get ANC Terpadu in primary public health center. Counseling and bergaining about HIV diagnostic. Cadre and all of public sector of this region can involved in this program. Keywords: antenatal care, HIV, PPIA

EHealth and Prevention of Mother-to-Child Transmission of HIV.

The goal of this paper is to describe areas in prevention of mother-to-child transmission of HIV (PMTCT) programs that could benefit from ehealth and to summarize current evidence of ehealth effectiveness in PMTCT. PMTCT programs require maternal retention, adherence to antiretroviral treatment (ART), and return for infant diagnosis of HIV. eHealth systems for PMTCT could either be integrated within MCH ehealth systems or within HIV adherence ehealth systems. PMTCT ehealth messages need to balance maternal concerns about pregnancy, childbirth, and infant care with need for clinic retention and ART adherence for PMTCT. Health approaches currently being assessed for effects on PMTCT outcomes include SMS, phone reminders, and integration of laboratory results and health worker reminders. Randomized trials are ongoing to determine effect of PMTCT ehealth interventions on retention, adherence, viral suppression, and early infant diagnosis (EID). There is evidence that ehealth for PMTCT improves early retention and EID, while data on long-term outcomes are accruing. PMTCT ehealth interventions may be useful to enhance maternal retention and ART adherence and decrease risk of infant HIV infection. Ongoing clinical trials will be important to determine effectiveness of mhealth approaches in improving PMTCT outcomes.

Understanding women's uptake and adherence in Option B+ for prevention of mother-to-child HIV transmission in Papua, Indonesia: A qualitative study.

BackgroundDespite a more proactive approach to reducing new HIV infections in infants through lifelong treatment (Option B+ policy) for infected pregnant women, prevention of mother-to-child transmission of HIV (PMTCT) has not been fully effective in Papua, Indonesia. Mother-to-child transmission (MTCT) is the second greatest risk factor for HIV infection in the community, and an elimination target of <1% MTCT has not yet been achieved. The purpose of this study was to improve understanding of the implementation of Option B+ for PMTCT in Papua through investigation of facilitators and barriers to women’s uptake and adherence to antiretroviral therapy (ART) in the program. This information is vital for improving program outcomes and success of program scale up in similar settings in Papua.MethodsIn-depth interviews were conducted with 20 women and 20 PMTCT health workers at two main referral hospitals for PMTCT in Papua. Development of interview guides was informed by the socio-ecological framework. Qualitative data were managed with NVivo11 software and themes were analysed using template analysis. Factors influencing women’s uptake and adherence in Option B+ for PMTCT were identified through final analysis of key themes.ResultsFactors that motivated PMTCT uptake and adherence were good quality post-test HIV counselling, belief in the efficacy of antiretroviral (ARV) attained through personal or peer experiences, and a partner who did not prevent women from seeking PMTCT care. Key barriers for PMTCT participation included doubts about ARV efficacy, particularly for asymptomatic women, unsupportive partners who actively prevented women from seeking treatment, and women’s concerns about community stigma and discrimination.ConclusionsResults suggest that PMTCT program success is determined by facilitators and barriers from across the spectrum of the socio-ecological model. While roll out of Option B+ as current national policy for pregnant women in Papua has improved detection and enrolment of HIV-positive women, health facilities need to address various existing and potential issues to ensure long-term adherence of women beyond the current PMTCT program, including during pregnancy, childbirth and breastfeeding.

FAMILY’S LIFE EXPERIENCE IN TAKING CARE CHILDREN WITH HIV/AIDS IN CIMAHI CITY

Introduction. Indonesia has increase in cases of HIV/AIDS significantly. HIV/AIDS incidence in children is increase too. Children with HIV infection are vulnerable to physical and psychosocial problems are complex. This raises the issue of the family in caring for children with HIV/AIDS. The purpose of this study was to explore in depth the experiences of family life in the care of children with HIV/AIDS. Methods. The study used a qualitative approach was phenomenological. This research was conducted during the months of July-August 2012 in Cimahi. The study was conducted on families who have children with HIV/AIDS. Method of data collection study using in-depth interviews. Analysis of the data used to describe the lived experience of families in caring for children with HIV/AIDS with Colaizi data analysis. Results. Children with HIV/AIDS had experience a variety of problems related to the infection opportunity, growth and development disability, education, social skills and acceptance in society. Discussion. Nurse can give information about caring children with HIV/AIDS, give the support to family to get VCT program, ARV supervision, motivation enhancement, child health, children need to learn and play, support family to join with PMTCT program to increase quality of life of the children and family. Keywords: Children with HIV/AIDS, Family’s Experience, Quality of Life

ASSESSMENT OF THE STATUS OF PMTCT SERVICES IN PRIVATE FOR-PROFIT HEALTH INSTITUTIONS IN ETHIOPIA

Abstract Background: Private health institutions are rapidly expanding in our country, making significant contributions to improve access to health care, particularly to the urban population. Provision of comprehensive PMTCT services by the sector is one potential and crucial area in the fight against HIV/AIDS. However, the involvement of the sector in the national PMTCT program in negligible. Objective: to assess the status of PMTCT service provision in private for-profit maternal and child health (MCH) special clinics, MCH hospitals and general hospitals in Ethiopia. Methods: A descriptive cross-sectional study was conducted from February to March 2008 in private health institutions in all regions and two city administrations of Ethiopia. Result: A total of 40 eligible health institutions were visited with a response rate of 97.5% Most facilities, 27 (69%.2%), were located in Addis Ababa, None of the facilities were providing comprehensive PMTCT service package of the 172 service providers directly involved in at least one of the reproductive health care services in the target facilities, none were providing a complete package of the PMTCT services to their clients and only 64(37.2%) of them had ever taken in service training on PMTCT. All institution, however, were willing to participate in future efforts and activates to initiate or improve the PMTCT services according to the national guideline. Conclusion and recommendations: the findings reflect the huge missed opportunity in addressing PMTCT service needs among the increasing number of women visiting private health facilities. It could have been also a good entry point to reach not only pregnant women who come for antenatal follow up but other family members who are in need of HIV/AIDS care/services also. There is high need and strong commitment for providing PMTCT services in the private health institutions. Immediate action, by all concerned governmental nongovernmental stake holders, should be taken to work together and meet the badly needed support if we are to achieve the national shared vision.

Trends in HIV Prevalence among Pregnant Women in Lusaka Province, Zambia 1994-2008

Background: Human immunodeficiency virus infection can contribute to reduced maternal and child population based health outcomes. In certain regions of subSaharan Africa, new HIV infections have been reported to continue to rise in spite of PMTCT programs. We examined the trends of HIV prevalence among pregnant women aged 15-49 years attending antenatal care in Lusaka Zambia for the period 1994-2008. Methods: We conducted a retrospective cross sectional study on data nested on the six repeated national ANC sentinel surveillance cycles on HIV and syphilis at the four Lusaka sites namely, Chelstone, Chilenje, Kalingalinga and Matero. Pregnant women aged 15-49 years attending their first ANC clinic visit received syphilis testing as well as anonymous HIV testing. In this study we focused on the period 1994-2008 for Lusaka Province. All data analysis was conducted using Stata version 12.1. Logistic regression analysis was applied to assess the association between HIV infection and other predictor variables. Results: Overall 16,694 pregnant women were included in the study. HIV prevalence declined from 27.3% in 1994 to 24.1% in 2008 (P<0.001), contrasting differences by site and age group were observed. HIV prevalence was significantly lower in age group 15-24 years than the older age-groups (20.9% versus 32.1%, P-value <0.001). Site patterns showed that in Chelstone, HIV prevalence declined from 24.7% in 1994 to 20.9% in 2008 (P = 0.03), 35.3% to 24.2% (P<0.001) in Chilenje and from 28.4% to 24.4% (P=0.02) in Matero. In contrast, Kalingalinga recorded an increase from 21.7% to 26.7% (P<0.001) for the same period. HIV infection among pregnant women was associated with syphilis infection (aOR 2.12; 95%CI 1.67- 2.69). Conclusion: Overall HIV infection among pregnant women in Lusaka has declined over the years. The unchanging burden observed in selected age groups and site may suggest limitations of the PMTCT program in reaching these groups. The results of our study highlight the need to strengthen HIV prevention and control efforts to specific target groups.

Acceptability of Routine HIV Testing by Pregnant Women in Lusaka District Ante Natal Urban Clinics in Lusaka, Zambia

Background: Each year around 1.5 million women living with Human immuno deficiency Virus (HIV) become pregnant, and without antiretroviral drugs there is a chance that their child will become infected. Following the introduction of Routine Human immuno deficiency Virus testing policy in Zambia, the Human immuno deficiency Virus test is offered to all pregnant women unless they decline. However, more pregnant women are declining to be tested. Objective: The main objective of this study was to investigate factors that influence acceptability of routine HIV testing by pregnant women in Lusaka district urban clinics. Materials and Methods: A cross sectional study using a quantitative approach was conducted in Lusaka District clinics. The sample size was 366 ante natal pregnant women who were selected by simple random sampling, selected from three (3) selected research setting. The study population included pregnant women aged 15 to 49 years, coming for ante natal visit for the first time, before being tested for HIV, were eligible and agreed to participate in the study. A pretested semi structured interview schedule was used to collect data. Data were entered and analysed with Statistical Package for Social Sciences (SPSS) version 20 program. Chi-square was used to test for significant associations and Binary Logistic regression modelling was carried out to predict the outcome. A 5% level of significance (p value) 0.05 confidence interval was set. Results: Study findings revealed that majority 85.6% (317) of respondents indicated willingness to undergo routine HIV testing in pregnancy though 77.3% perceived it a compulsory test. Binary logistic regression revealed that maternal age, educational level and information education and communication (IEC) contributed significantly to the model. The odds revealed that acceptability of routine HIV testing by older pregnant women (37 - 49 years) were 8 times (OR = 7.67, p = 0.003) higher than the younger ones. The odds of acceptability by respondents with tertiary education were 141 times (OR-141.23, p-0.0001), likely to accept HIV testing than those with primary or no education. And the odds also revealed that acceptability by women who cited adequate IEC (OR-2.6, p-0.024) were 3 times higher than those who cited inadequate IEC. Conclusion: The study showed that majority of the pregnant women was willing to undergo Routine HIV testing however a percentage regarded the test as a mandatory test without any choice of denial. Therefore there is need to address some factors that are likely to affect the routine HIV testing and impede the success of implementation of the PMTCT programme in the country which goes beyond testing for HIV alone. Recommendations: Ministry of Health needs to provide health education messages in different tribes. MOH should also intensify male involvement in HIV Testing and Counselling. LDHO should consider training more community health care givers as Voluntary Counselling and Testing providers. The District should organize regular refresher courses and presentations on Routine HIV testing to health workers and Ministry of Health should consider conducting a country wide study.

Elimination of the transmission mother-to-child HIV and syphilis: the progress and challenges to Ukraine

Цель этого иссследования – проанализировать индикаторы воздействия и процессов ликвидации передачи матери ребенку (ПМР) ВИЧ инфекции и сифилиса в системе профилактики врожденного сифилиса и программе профилактики ПМР ВИЧ в Украине на основе данных ретроспективного исследования, способствуя, таким образом, подготовке к двойной валидации этих процессов в соответствии с целями и критериями ВОЗ

Child Bearing Decisions among Women Enrolled In PMTCT Programme: A Comparative Study of the Rural and Semi-Urban Setting of Malawi Chiradzulu District

Child Bearing Decisions among Women Enrolled In PMTCT Programme: A Comparative Study of the Rural and Semi-Urban Setting of Malawi Chiradzulu District

Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review.

Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low- and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade. Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour. CRD42017063816. Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n=4) and those using lay cadres (n=3) were most common. Other interventions included quality improvement (n=2), mHealth (n=1), and counselling (n=1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants. Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are effective in improving outcomes in Option B+ programmes.

Non-disclosure of HIV-positive status to a partner and mother-to-child transmission of HIV: Evidence from a case-control study conducted in a rural county in Kenya.

BackgroundMany factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition.ObjectiveTo determine whether failure to disclose an HIV-positive status to a male partner is associated with increased risk of infant HIV acquisition, and whether part of the association is explained by exclusion of male partner in PMTCT programmes.MethodsUsing a case–control study design, we identified a total of 180 mother–baby pairs with HIV-exposed infants. Thirty-six pairs with HIV-positive babies (cases) were compared to 144 pairs with HIV-negative babies (controls) on whether the mothers had disclosed their HIV status to their partner in order to determine whether a disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT). Each case pair was matched to four control pairs from the same facility.ResultsOverall, 16.7% of mothers had not disclosed their HIV status to their partners, the proportion being significantly more among cases (52.8% vs. 7.6%, p < 0.001). Non-disclosure was significantly associated with infant HIV acquisition (aOR 9.8 (3.0–26.3); p < 0.001) and male partner involvement partially mediated the effect of non-disclosure on infant HIV acquisition (indirect coefficient = 0.17, p < 0.005).ConclusionsFailure of an HIV-positive woman to disclose her status to her male partner and exclusion of male partners in PMTCT programmes are two social factors that may curtail success of interventions towards the goal of eliminating MTCT.

Prevention of Mother-to-Child Transmission of HIV in Yaounde: Barrier to Care

ABSTRACTMost HIV-infected children in Sub-Saharan Africa are born where programs for the prevention of mother-to-child transmission of HIV (PMTCT) exist but are not universally operational. The expansion of PMTCT programs in Cameroon was among the largest in francophone Africa, but despite highly variable estimates of PMTCT uptake (ranging from 20% to 66%), it is clear that not enough HIV-infected pregnant Cameroonian women benefit from treatment to prevent HIV transmission to their children. The reasons why HIV-infected women in Cameroon do not use treatments to prevent this transmission remain partially unidentified. We conducted a qualitative study of the therapeutic itineraries (treatments taken and motivations) followed by HIV-infected pregnant women in Cameroon to understand the barriers to accessing high-quality PMTCT care. Here we construct the therapeutic itinerary for HIV-infected pregnant women, and identify the barriers at each step. Lack of financial independence, personal support, and empowering information were the primary obstacles at multiple steps.

Gender, Health and Change in South Africa

This article addresses the question of how to "think about" and to "do" gender change in the context of HIV and public health interventions in South Africa. The issue of gender has been closely intertwined with the HIV epidemic in Southern Africa since the beginning of the epidemic. The need for more gender equitable practices and relationships has been a central theme of the response to the crisis. While much of this work has focused on efforts to reduce the uneven impact of HIV has on women and girls, there have also been important interventions with men and boys around gender and HIV. This article synthesizes findings from research projects with three such interventions. The findings presented here are drawn from three separate research projects conducted in South Africa in the last 10 years. The first was an ethnographic research project with the Khululeka Men's Support Group in Cape Town. The second was an independent program evaluation of the "One Man Can" campaign that was commissionned by Sonke Gender Justice, a gender transformation NGO in South Africa. The third project was a qualitative process evaluation of a trial that used male lay health workers to provide support and care to pregnant and postpartum women who were enrolled in a PMTCT program. Gender and gender change were understood and promoted in contrasting ways across the three case studies. In the case of Khululeka, HIV-positive men were encouraged to become "better men" within the context of existing gender norms by doing things that would protect their health and allow them to achieve socially valued roles as strong family leaders and financial providers. They began with a conventional HIV support group model but adapted it to better suit local gender norms around masculinity. In Sonke's One Man Can (OMC) campaign, the focus was on the ways men and women could address the underlying gender inequities in their families and communities. Participants were encouraged to raise their awareness and critical understandding of gender-related rights issues and mobilize for progressive gender change. Sonke staff struggled, however, to find ways of sustaining the changes they witnessed in OMC workshops and an ideological tension persisted between "culture talk" and "rights talk" about gender. Finally, in the PMTCT program, men were recruited to serve as lay counselors for HIV-positive pregnant women. By carefully training and supporting men in the daily practice of providing care for these women, male counselors developed trusting relationships, offered effective services, and in general, undertook a form of gender-transformed practice that exceeded much of what was observed in the other two case studies. There are many potential paths to gender transformation, and the HIV epidemic in Southern Africa has operated as a powerful catalyst for exploring and pursuing some of these paths. In the process, however, a number of political and conceptual limitations of gender transformation work emerged. There is a need to find ways of thinking about and acting on gender that isn't over-determined by the logics of public health and biomedicine. There is also a need to complement ideological arguments for "gender transformation" with more embodied opportunities for transformed gendered practice.

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years.

ObjectiveTo describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage.DesignCross-sectional analysis of national early infant diagnosis (EID) database.Methods365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression.Results11.1% of infants tested HIV positive in 2007–2010 and 6.9% in 2014–2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05–1.11), older children (18–24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87–4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79–2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51–3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30–1.49). In 2014–2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs.ConclusionDespite impressive gains in Kenya’s PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

BackgroundIn 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia.MethodsRetrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association.ResultThree hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%–7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn’t get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096).ConclusionsThere is significant progress on the reduction of the rate of HIV transmission from mother to child in Ethiopia. Age of the mother, status of the mother at an entry to PMTCT program and presence of PMTCT interventions were significant factors associated with HIV transmission. Hence, the above factors should be given due emphasis on controlling HIV transmission from mother to child.

Health Utility of Pregnant Women Living with HIV/AIDS: Prevention of Mother-to-Child Transmission of HIV (PMTCT) Programs in Yunnan Province: A Cross-Sectional Study

BackgroundHealth utility (HU) is essential to understanding the effects of HIV infection as a chronic disease. No HU data on pregnant women living with human immunodeficiency virus (HIV) in Yunnan Province are available. This study aims to construct a database on HU and explore factors associated with HU by pregnant women living with HIV/acquired immunodeficiency syndrome (AIDS) who were enrolled in the Prevention of mother-to-child transmission of HIV (PMTCT) programs in Yunnan Province. MethodsA cross-sectional study was conducted in Yunnan Province on pregnant women living with HIV who were selected by convenience sampling. Sociodemographic, HIV-related, social support, and HU data were collected through face-to-face interviews. The European quality of life five-dimensional three-level (EQ-5D-3L) questionnaire and the social support rate scale (SSRS) were applied. ResultsOne hundred and one pregnant women (mean age of 30.4 ± 5.1 years) participated in the survey. The mean EQ-5D index score and the EQ visual analogue scale (EQ-VAS) score of participants were 0.77 (95% confidence interval [CI] 0.74–0.79) and 75.77 (95% CI 75.00–80.00), respectively. The effect of social support on HU was maintained significant difference even after adjusting for such factors as education level, household income per year, and HIV disclosure, demonstrating a significant difference within EQ-5D index scores and EQ-VAS scores. ConclusionsPregnant women living with HIV/AIDS who were enrolled in PMTCT programs reported the same level of HU as other patients living with HIV/AIDS. Integrating measurements of HU by using the EQ-5D-3L questionnaire could be helpful for economic evaluation of the PMTCT program. This study also suggests a potential benefit of appropriate social support.

The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria: Results of a Cluster Randomized Controlled Study.

Retention in care is critical for improving HIV-infected maternal outcomes and reducing vertical transmission. Health systems' interventions such as continuous quality improvement (CQI) may support health services to address factors that affect the delivery of HIV-related care and thereby influence rates of retention-in-care. We evaluated the effect of a CQI intervention on retention-in-care at 6 months postpartum of pregnant women and mothers living with HIV who had been started on lifelong antiretroviral treatment. Thirty-two health care facilities were randomized to either implement the intervention or not. We considered women fully retained in care when they attended the 6-month postpartum visit and did not miss any previous scheduled visit by more than 30 days. Five hundred eleven women living with HIV attending antenatal clinics at 26 facilities were included in the analysis. Median age at enrolment was 27 years and gestational age was 20 weeks. Seventy-one percent of women were seen at 6-month postpartum irrespective of missing any scheduled visit. However, 43% of women were fully retained at 6-month postpartum and did not miss any scheduled visit based on our stringent study definition of retention. There was no significant difference in retention at 6 months between the intervention and control arms [44% vs. 41%, relative risk: 1.08; 95% confidence interval (CI): 0.78 to 1.49]. Initiation of ARV prophylaxis among infants within 72 hours was not different by study arm (66.0% vs. 74.7%, relative risk = 0.95; 95% CI: 0.84 to 1.07) but rates of early infant testing at 4-6 weeks were higher in intervention sites (48.8% vs. 25.3%, adjusted relative risk: 1.76; 95% CI: 1.27 to 2.42). CQI as implemented in this study did not differ across study arms in the rates of retention. Several intervention design or implementation issues or other contextual constraints may explain the absence of effect.

Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.

Addressing Early Retention in Antenatal Care Among HIV-Positive Women Through a Simple Intervention in Kinshasa, DRC: The Elombe "Champion" Standard Operating Procedure.

This cluster-randomized study aimed to assess the Elombe ("Champion") standard operating procedure (SOP), implemented by providers and Mentor Mothers, on HIV-positive pregnant women's retention between first and second antenatal visits. Sixteen facilities in Kinshasa were randomly assigned to intervention (SOP) or comparison (no SOP). Effect of the SOP was estimated using relative risk. Women in comparison facilities were more likely to miss second visits (RR 2.5, 95% CI 1.05-5.98) than women in intervention facilities (30.0%, n=27 vs. 12.0%, n=9, p<0.002). Findings demonstrate that a simple intervention can reduce critical early loss to care in PMTCT programs providing universal, lifelong treatment.

Quality Assessment of PMTCT Data Documentation among User and Non-User Data Clerks in a Nigerian PMTCT Program

Quality Assessment of PMTCT Data Documentation among User and Non-User Data Clerks in a Nigerian PMTCT Program