PMTCT Services Research Articles

A Review to Identify the Gaps in Prevention of Mother to Child Transmission of HIV Services in Nigeria

Background: Nigeria has the second largest burden of maternal to child transmission of HIV (MTCT) in the world at a rate of 30% and has the largest burden of paediatric HIV infection globally at the rate of 10%. Effective prevention of mother to child transmission of HIV (PMTCT) can drastically reduce the paediatric HIV infection to 2%. However, recent evidence reveals yawning gaps in the PMTCT services in Nigeria, where out of estimated 9.2 million pregnancies, only about 3 million received HIV counselling and testing (HCT). This review is to unravel the unmet needs for PMTCT of HIV services in Nigeria.
 Methods: Keywords from objectives of review are MTCT and PMTCT which were used to search for related literatures through online libraries of national and international journals; Medline and PubMed including google. 62 related literatures/studies were initially generated and then narrowed down to 19 literatures were selected which met the inclusion criteria- less than 10 year and related to objective of review.
 Findings: There are unmet needs for PMTCT of HIV services in Nigeria due to challenges like low HCT/PMTCT service uptake (35.5%), low HCT/PMTCT service delivery facilities (27%), low ANC (58%) and low (35%) delivery in formal health setting.
 Conclusion: PMTCT target in Nigeria has not been met. Regular training of existing health workforce including the TBAs and the adoption of the recommendations for an HIV-free generation will bridge the HCT / PMTCT of HIV services gap identified in this review.

"At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania.

IntroductionDespite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services.MethodsWe conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis.ResultsWe observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement.ConclusionIn order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.

Willingness of antenatal care attendees towards voluntary HIV counseling and testing, Southern Ethiopia

Background: Voluntary counseling and testing (VCT) is an entry point for the prevention of HIV transmission from mother to child and accessing VCT benefit from PMTCT services. Even though, some pregnant women clearly know the benefits /advantages of PMTCT services, they are not willing to test and access the services. Hence, this study was aimed to assess the willingness of pregnant women attending antenatal care towards VCT/PMTCT at Adare general hospital in southern Ethiopia. Method: An institution-based cross-sectional study was conducted at Hawassa Adare hospital, southern Ethiopia from February to April/2018. A total of 338 randomly selected pregnant women who were attending antenatal care clinic were included. Data was collected using structured and pretested questionnaire; entered and analyzed using SPSS version 20 computer software. Important descriptive and logistic models were used for data analysis assuming statistical significance at p < 0.05. Result: A total of 338 mothers were interviewed with a response rate of 100%. The willingness towards voluntary HIV counseling and testing among study participants was 82.2%. Participants who attended primary and High school and above were 3.9 (AOR= 3.87, 95% CI- 1.705, 8.782) and 9.5 times (AOR 9.53 at 95% CI- 3.155, 28.76); those who had good knowledge about VCT/PMTCT were 3.47 times (AOR=3.47, 95% CI-1.721, 7.003); women who followed two to three ANC visit, were 5.1 times more likely have willingness towards VCT/PMTCT (AOR 5.11 at 95% CI -1.095, 23.81) more likely willing to be tested than their counterparts respectively. Conclusion: Willingness towards voluntary HIV counseling was encouraging however it needs advancement. Since boosted knowledge and awareness promote willingness to VCT/PMTCT uptakes, initiation of community-based information dissemination, increased quality of ANC service, and empowering women to be educated could be effective in order to promote high VCT and PMTCT program uptakes

Prevalence and factors associated with intimate partner violence after HIV status disclosure among pregnant women with depression in Tanzania

ABSTRACT Intimate partner violence (IPV) exacts a heavy burden on women, resulting in poor health outcomes. This study had the following aims: (1) estimate the prevalence of IPV post-disclosure of HIV status among pregnant women living with HIV and depression; and (2) evaluate risk and protective factors for IPV post-disclosure. Participants were women accessing PMTCT services at 16 health facilities in Dar es Salaam and screened at the threshold of 9 on the PHQ-9. Generalized linear equations with a log link and standard errors clustered at the facility level were used to calculate associations between predictors and IPV post-disclosure. Among 659 women who were in an intimate relationship, 10.2% had experienced physical violence and 11.6% had reported sexual violence from their partner in the past six months; 327 had disclosed their HIV status to their partners. After disclosure to their partners 279 women (85.3%) experienced IPV. HIV-related stigma was associated with increased risk of IPV following disclosure and appreciative relationships with partners and higher hope were associated with reduced risk of IPV. There is a need to identify and advance approaches to HIV disclosure that prevent IPV. Interventions should be developed based on known risk and protective factors for IPV following HIV disclosure in Tanzania and similar settings.

Cost variations in prevention of mother-to-child HIV transmission services integrated within maternal and child health services in rural Tanzania

ABSTRACT We estimated the costs of Option B+ for HIV-infected pregnant women in 12 facilities in Morogoro Region, Tanzania, from a provider perspective. Costs of prevention of mother-to-child (PMTCT) HIV services were measured over 12 months to September 2017 to estimate the average costs per HIV testing episode, per HIV-positive case diagnosed, per patient-year on antiretroviral therapy (ART), and per neonatal HIV care. A one-way sensitivity analysis was undertaken to understand how staffing levels and other core resource inputs affected costs. The total number of HIV testing episodes was 25,593 with 279 HIV cases identified yielding a 1.1% positivity rate. The average cost per testing episode was US$5.49 (range US$2.13 to US$13.93), and the average cost per HIV case detected was US$503.29 (range US$230.61 to US$3330.38). The number of pregnant women initiated on ART was 278. The mean cost per patient-year on ART was US$159.89 (range US$100.91 to US$812.23). The average cost of neonatal HIV care was US$90.09 (range US$41.53 to US$180.26). PMTCT service costs varied widely across facilities due to variations in resource use, number of women testing, and HIV prevalence. The study provides further evidence against generalising cost estimates, and that budgeting and planning requires context specific cost information.

Bringing women\u2019s voices to PMTCT CARE: adapting CARE\u2019s Community Score Card\xa9 to engage women living with HIV to build quality health systems in Malawi

BackgroundCoverage of prevention of mother-to-child transmission of HIV (PMTCT) services has expanded rapidly but approaches to ensure service delivery is patient-centered have not always kept pace. To better understand how the inclusion of women living with HIV in a collective, quality improvement process could address persistent gaps, we adapted a social accountability approach, CARE’s Community Score Card© (CSC), to the PMTCT context. The CSC process generates perception-based score cards and facilitates regular quality improvement dialogues between service users and service providers.MethodsFifteen indicators were generated by PMTCT service users and providers as part of the CSC process. These indicators were scored by each population during three sequential cycles of the CSC process which culminates in a sharing of scores in a collective meeting followed by action planning. We aggregated these scores across facilities and analyzed the differences in first and last scorings to understand perceived improvements over the course of the project (z-test comparing the significance of two proportions; one-tailed p-value ≤ .05). Data were collected over 12 months from September 2017 to August 2018.ResultsFourteen of the fifteen indicators improved over the course of this project, with eight showing statistically significant improvement. Out of the indicators that showed statistically significant improvement, the majority fell within the control of local communities, local health facilities, or service providers (7 out of 8) and were related to patient or user experience and support from families and community members (6 out of 8). From first to last cycle, scores from service users’ and service providers’ perspectives converged. At the first scoring cycle, four indicators exhibited statistically significant differences (p-value ≤ .05) between service users and service providers. At the final cycle there were no statistically significant differences between the scores of these two groups.ConclusionsBy creating an opportunity for mothers living with HIV, health service providers, communities, and local government officials to jointly identify issues and implement solutions, the CSC contributed to improvements in the perceived quality of PMTCT services. The success of this model highlights the feasibility and importance of involving people living with HIV in quality improvement and assurance efforts.Trial registrationTrial registration: ClincalTrials.gov NCT04372667 retrospectively registered on May 1st 2020.

Infant Feeding Practice and Associated Factors Among HIV Positive Mothers at Health Institution of Shashemene Town, South Ethiopia.

Objective: To assess Infant feeding practice and associated factors among HIV positive mothers at health institution of Shashemene town, South Ethiopia. Materials and methods: Facility based cross sectional study was conducted. The study used all the study population as source of data since they are small in number hence sample size calculation was not needed. This study was conducted at health institutions which provide ART and PMTCT service at Shashemene town. Structured questionnaires were developed by reviewing different literatures. Data collectors were trained and data were collected from February to March 2018. The data were analyzed using statistical package for social science (SPSS) version 20, descriptive statistics as well as bivariate and multivariate analysis were computed to identify the independent predictor of infant feeding practice and to control effect of confounders. Results: On this study majority 175 (90.7%) of respondent breast feed their infants. Regarding feeding option about 154 (79.8%) chose EBF followed by complementary feeding. Concerning feeding practice majority of respondent 172 (89.1%) utilize safe feeding practice. On multivariate analysis only Counseling provided by health professional on infant feeding option was found as independent predictors of infant feeding practice with [AOR = 4.538 (CI = 1.099, 18.736)]. Conclusion: Higher proportion of HIV positive mothers follow safe infant feeding practice. Counseling by health professional was found as independent predictors of infant feeding practice. Further counseling by health professional needed to discourage mixed feeding practice.

Mother-to-child transmission of HIV and utilization of preventive services in Anambra South Senatorial Zone, Nigeria: Practice considerations for social workers

Low- and middle-income countries, including Nigeria, are often associated with poor health outcomes, such as the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Mother-to-child transmission (MTCT) is a dominant driver of HIV/AIDS in these countries, necessitating the need to prevent such mode of transmission. With the availability of prevention of mother-to-child transmission (PMCTC) services in Anambra State, Nigeria, it becomes important to investigate the utilization of these services. This is needful given the relatively high percentage of vertical transmission in the state. To conduct this study, data were sourced using six focus group discussions involving 15 health workers and 24 HIV-positive mothers selected from three health facilities that dispense PMCTC services. Findings revealed that PMTCT services in the study area had setbacks owing to facility-based inefficiencies, low-level awareness and-coverage of the services at the grass-roots level, weak social support and cultural/religious beliefs, among others. To contain these setbacks, social workers as welfare/human rights professionals were recommended to be engaged.

Influence on physical development of children aged 18 months from HIV-positive mothers for prevention mother to child transmission of HIV

Objective: To explore influence on physical development of children aged 18 months from HIV-positive mothers for prevention mother to child transmission of HIV (PMTCT) in Guangxi Zhuang autonomous region, and provide evidence for the improvement PMTCT program. Methods: This retrospective case control study was conducted in 554 HIV negative infants aged 18 months whose HIV positive mothers had received PMTCT services reported through PMTCT system database from January 1, 2010 to December 31, 2017 and 1 109 healthy infants born in 2017, whose mothers were healthy, in Lingshan, Luzhai, and Hengxian counties, ranking top three counties with high HIV infection prevalence, in Guangxi. PMTCT data and physical development data such as height, weight and head circumference of children aged 18 months were collected. The physical dysplasia in the infants was defined as at least one of the three main indicators of height, weight and head circumference below the normal range. Results: The number of HIV-positive mother and their infants in the case group were 667 and 554 respectively, and the PMTCT rates were 91.15% (608/667) and 96.57% (535/554) respectively. HIV positive rate, mortality rate and mother to child transmission rate of the infants aged 18 months were 1.44% (8/554), 3.07% (17/554) and 1.91% (8/418) respectively, and the physical examination results of the infants aged 18 months showed that the physical dysplasia rate was 30.51% (169/554). Among the 1 109 infants in the control group, the physical dysplasia rate was 9.83% (109/1 109). The difference between the case group and the control group was significant (P<0.01). Conclusion: The PMTCT rates of HIV positive mother and their children were more than 90.00%, respectively. However, poor physical development rate of infants aged 18 months were more than 30.00%. The possible influence of PMTCT on physical development of the infants aged 18 months of HIV positive mother's needs to be further studied.

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

BackgroundPerinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam.MethodsA cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973).ResultsAmong 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months.ConclusionsBaseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development.Trial registrationThe trial is registered under clinicaltrials.gov (NCT02039973). Retrospectively registered on January 20, 2014.

Community Health Workers Engagement in Prevention of Mother-to-Child Transmission of HIV (PMTCT): A Cross-Sectional Study from Selected Fishing Communities in Tanzania

The prevalence of HIV infection is reported to be higher in fishing communities of Lake Victoria compared to non fishing neighboring communities. Besides, access to HIV/AIDS related services has been reported to be either inadequate or unavailable to some of these fishing communities particularly for those residing in islands. This study explored the engagement of Community Health Workers (CHWs) in provision of PMTCT services among the fishing communities of Sengerema and Musoma District Councils (DCs) in the Lake Zone of Tanzania. This was a cross sectional study using qualitative approach. Intrinsic and extrinsic motives were found to influence community members to be engaged as CHWs. The majority of CHWs were involved in Antenatal Care (ANC) and Reproductive and Child Health (RCH) as well as in health promotion activities as a strategy to cope with the shortage of trained health staff. CHWs were found to assist in HIV/AIDS Counseling and Treatment Center (CTC), generally, CHWs were not directly engaged in provision of PMTCT services. On the other hand, the National Health Policy does not clearly set roles of the CHWs and their incentives. Nevertheless, there are potentials of people willingness to volunteer in community health works that need to be better leveraged. Deploying CHWs is critical to enabling accessible primary health care services including HIV/AIDS particularly PMTCT services in remote areas such as fishing communities where human resource for health is reported to be inadequate.

Influences of Mobile Phones-Based Short-Message-Services Communications on the HIV Sexual Risk Behaviors among Pregnant Women’s Male Partners, Case Control Study Tanzania

Introduction: In the twenty-first century, Human Immunodeficiency Virus (HIV) continues to be among the major public health problem globally. The disease is implicated to the result of the over 32 million deaths, and in 2018 the disease caused over 770,000 deaths globally. The disease can be transmitted from an HIV-positive pregnant woman to her child during pregnancy and childbirth about 15% - 20%, and 5% - 15% in breastfeeding. Awareness of HIV infection sexual risk behaviors and practices among male partners of pregnant mothers, therefore, plays a greater role in reducing new infection to them and the prevention of mother-to-child transmission of HIV. Methods: We conducted a retrospective case-control study involving randomly selected 314 pregnant women’s male partners attending PMTCT services in the Tabora Municipality for from September 2018 to August 2019. The enrolled study participants were randomly allocated to cases and controls and, SMS communication was sent twice weekly with 5 standard key messages from the PMTCT community guide and followed up. Results: The awareness that HIV infected mothers can transmit HIV infection in labor and during breastfeeding among their male partners was raised to 73.3% and 61.8% from 55.4% and 47.5% to study and control groups respectively following intervention. Similarly, men aged below 35 years from the study group showed an 18.3% change and a 35.4% change for those who were over 35 years old compared to the control. The difference was tested and found to be statistically significant with a p-value of 0.001 (relative risk of 0.11) and less than 0.001 (relative risk of 0.07) respectively at a 95% confidence interval. This indicates that following SMS communication intervention men from the study group were less likely to practice HIV infection sexual risk behavior compared to the control group.

PMTCT Service Utilization and Associated Factors among Pregnant Women Attending Public Health Facilities in Hawassa City, Southern Ethiopia

BACKGROUND: Among various interventions to control HIV transmission, prevention of mother-to-childtransmission program have been implemented to offer a range of related services to the women and their infants.In Ethiopia, although the overall trend of the program coverage has shown improvements over time, studying itsutilization and identifying factors that influence the utilization among pregnant women could have paramountimportance for improving the service by addressing important bottlenecks. The aim of this study was to determinethe utilization of prevention of mother-to-child transmission service and its associated factors among pregnantwomen attending public health facilities in Hawassa City, Southern Ethiopia.METHOD: Institution based cross-sectional study was conducted among pregnant women who visited six publichealth facilities for Antenatal Care service. A sample of 588 pregnant women having at least two Antenatal Carevisits were included in the study using a systematic sampling technique. Trained nurses collected the data using theAmharic version structured questionnaire that was pretested before the actual data collection. The collected datawere entered and analyzed using Epi info version 7.0 and Statistical Package of Social Science version 20 statisticalsoftware respectively. Bivariable and multivariable logistic regression analysis was conducted and we reported bothcrude and adjusted odds ratios with 95% confidence intervals.RESULT: Among the study subjects, 531 (90.3%) utilized prevention of mother-to-child transmission service fortheir current pregnancy. Pregnant women having only two antenatal care visits were 76% less likely to utilize theservice as compared to pregnant women having three or more antenatal care visits [AOR= 024, 95% CI=0.11,0.53].Pregnant women who do not support the idea that every pregnant woman should be tested for HIV/AIDS were 91%less likely to utilize prevention of mother-to-child transmission service as compared to those who support the idea[AOR= 0.09, 95% CI= 0.03, 0.29]. Finally, pregnant women who don’t know the view of her partner regarding HIVtesting were 96% less likely to utilize the service as compared to pregnant women having a partner who supportscouple counseling [AOR=0.04, 95% CI= 01, 12].CONCLUSION AND RECOMMENDATION: Nearly all of the study subjects utilized preventionof mother-to-child transmission service for their current pregnancy. The number of antenatal care visits, the view ofthe women on supporting the idea that every pregnant should be tested for HIV and the view of husband regardingHIV screening were found to be the major predictive factors. Encouraging partner involvement on the importanceof HIV testing could have an important contribution to further improve the utilization of prevention of motherto-child transmission service. Further studies to document the best practice of the prevention of mother-to-childtransmission service should be undertaken.KEY WORDS: PMTCT, Utilization, Public Health Facilities, Hawassa, Southern Ethiopia

Assessment of Health Facilities Delivering HIV Services among Patients in Bonny, South-South Nigeria

Background: The growing spread of HIV and AIDS among the people of Bonny Kingdom and capacity of medical facilities and service providers to respond to the dire situation have long posed public health concern of immeasurable proportion right from the inception of the Ibani-Se HIV/AIDS Baseline Survey Initiative in 2006 to the implementation of a three-year (2008-2011) intervention programme and thereafter. The impact of the provision of ART and other medical services related to HIV on the quality of care and satisfaction of all, HIV and non-HIV patients is unknown, and any available evidence is limited and arguable. The survey sought to know the number of health facility in the locality, the services they offer and most importantly the number of qualified personnel in such health facilities.&#x0D; Methods: A standardized questionnaire was designed for facility assessment to measure the capacity of health facilities to undertake VCT and ART services. The survey was conducted in sixteen (16) health facilities; fourteen (14) public and two (2) private health facilities located within Bonny town and in the creeks. In each facility, the manager and health providers were surveyed, with at least one provider selected from the HIV/AIDS department; 10 randomly selected persons in the Outpatients Department/Unit including 5 from the HIV/AIDS services were interviewed. A standard health facility assessment checklist was developed to measure the quality of care, capacity of providers, developmental and training needs. Others included conformity to standard of practice and quality of medical equipment. Data was entered with Census and Survey Processing System (CSPro) and exported to SPSS or Stata for analysis.&#x0D; Results: Of the sixteen health facilities, only seven provided both VCT and PMTCT services (Abalamabia health centre, Comprehensive health centre, NLNG RA Hospital, General Hospital, Finima health centre, Good shepherd Health medical lab and Chanel clinic) while one (Island Medical lab) provided VCT services; the others provided neither of the two services. Although, there are fairly adequate number and distribution of health facilities in the LGA, utilization of the general health services was found to have improved when compared to the previous survey. However, lack of structured unit for the provision of VCT and PMTCT services, specifically trained and designated counselors; and poorly motivated public healthcare providers have given rise to concerns about poor access of rural dwellers and inequitable distribution of the few available services, particularly to people most in need.&#x0D; Conclusion: Implications of this survey were highlighted for a more effective HIV prevention and control programme for wide coverage.

Fertility Desire And Associated Factors Among HIV Positive Women Attending ART Clinics In Amhara Region Referral Hospitals In Northwest Ethiopia, 2017.

Background“Fertility desire” is the intention of people to have more children despite being diagnosed with HIV, whereas intentions denote a commitment to implement that desire. Despite the overwhelming effects of HIV on a fetus, there is a desire for fertility among people positive for the virus/disease worldwide. Therefore, this study aimed to assess fertility desires and factors associated with sexually active HIV positive reproductive-age women attending ART clinics at Amhara region referral hospitals, Northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted on reproductive-age women attending the clinics at the hospitals. A total of 427 eligible women were systematically included in the study. A semi-structured questionnaire was used to collect data via interviewer-administered techniques. EpiInfo7 and STATA 14 software was used for data entry and analysis, respectively. The logistic regression analysis method was used to identify factors associated with fertility desire. Factors that had p-values of ≤0.05 were considered statistically significant.ResultsThe findings indicated that 40.3% (95% CI; 35.7%, 45.0%) of the participants reported they had the desire to have children in the future. Variables such as women in the age group of 25–34 years (AOR= 2.80, 95% CI; 1.68, 4.68), participating with their sexual partner (AOR=3.52, 95% CI; 1.36, 9.13) and married women (AOR=2.32, 95% CI; 1.05, 5.10) had a positive association with the outcome variable, whereas having one or more live children (AOR=0.19, 95% CI; 0.09, 0.39) and having no formal education (AOR= 0.51, 95% CI; 0.29, 0.89) had a negative association with fertility desire.ConclusionThe proportion of sexually active HIV-positive women with desire for children was high among women visiting referral hospitals. Therefore, programmers and policymakers need to expand new PMTCT services throughout the region and consider the effects of these factors on HIV-positive women, as they develop interventions.

Maternal and fetal outcome in HIV infected pregnant women-A two year study at tertiary hospital

Introduction: At present scenario Acquired immunodeficiency syndrome is currently one of the worst global health concerns. HIV has a dramatic impact on the health of women and their children. Objective: To find out the prevalence of HIV status among pregnant women in a tertiary care hospital to determine maternal and fetal outcome in HIV infected pregnant women. Materials and Methods: A retrospective study conducted in Cheluvamba Hospital a tertiary care hospital attached to MMCRI during January 2014 to December 2016. The case records of pregnant women with HIV positive status were selected from hospital records. Follow up details of both mother and babies were obtained from ICTC Centre. Results: Total deliveries during the study period were 19641. Of these the incidence of HIV Status was 80, the Incidence being 0.4%. primigravidas were found to be 43.75%. HIV seropositivity rate was more between 21 to 25years of age group, contributing to 56.25% of the total cases. CD4 count of >200 was found in 37.5% of cases, of which 25% were primigravida. Among all cases 31.25% were not put on Antiretroviral Therapy (ART). Vaginal deliveries were 83.5% and caesarean sections were 16.5%. Birth weight of >2.5 kg were seen in more than 50% of cases. Breast feeding was opted by 81.75 %. 93.8% neonates received nevirapine of the babies admitted in NICU 4 babies died (11.2%). 2 babies were found to be positive. Conclusion: Adverse outcomes were associated with untreated maternal HIV infection in pregnancy. PMTCT services were utilized sub optimally by the women with low level of education. Awareness and information is important for programs designed to increase access to PMTCT services including HAART from early pregnancy. Keywords: Antiretroviral Therapy (ART), Pregnancy with HIV.

Factors Associated With Success in Reducing HIV Mother-to-child Transmission in Sub-Saharan Africa: Interviews With Key Stakeholders

PurposeA key global health challenge is the persistence of new pediatric HIV infections due to mother-to-child transmission (MCTC), particularly in sub-Saharan Africa. The purpose of this study was to identify the key strategies that some sub-Saharan African countries have used to successfully reduce new pediatric HIV infections. MethodsA qualitative study utilizing semistructured interviews with key stakeholders in 6 sub-Saharan African countries (Burundi, Malawi, Mozambique, South Africa, Swaziland, and Uganda) was conducted from September 2017 to September 2018. These stakeholders were situated in the National Department of Health or in international health-funding bodies relating to the provision of the HIV/AIDS implementation program in these countries. The countries were selected based on considerable success achieved with HIV treatment in pregnant women. Audio-recorded interviews were transcribed verbatim and thematic analysis was undertaken. FindingsIn all, 6 interviews were conducted, and the mean time of the interviews was 62 min. There were similar numbers of men and women, and most were in the 35- to 45-year age group. Five in six were either a medical doctor or held a doctorate degree. Four in six had >10 years of experience working in the prevention of HIV (PMTCT). Four key strategies that contributed to significant reductions in pediatric HIV infection in the respective countries were identified: (1) committed political leadership; (2) support structures within the community; (3) innovation in service delivery; and (4) robust monitoring and evaluation systems. Stakeholders spoke about how their governments played a leading role in engagement with communities, and in the dissemination of services. Innovative service delivery comprising task-shifting initiatives and the integration of maternal, newborn, and child health and HIV PMCTC services played an important role in reducing the burdens experienced by women and health care workers, leading to improved health outcomes. Peer support also helped mothers to adhere to their treatment during and after pregnancy. The capacity of national programs to monitor and evaluate the PMTCT services and the importance of regular viral-load monitoring were highlighted by the stakeholders. ImplicationsThese strategies can be reviewed for possible implementation by other sub-Saharan African countries as possible means of reducing new pediatric HIV infections.

Acceptability of community-based mentor mothers to support HIV-positive pregnant women on antiretroviral treatment in western Kenya: a qualitative study

BackgroundOption B+ is a comprehensive antiretroviral treatment (ART) designed for HIV-infected pregnant/ postpartum women. However, barriers to implementing Option B+ and establishing long-term ART adherence while facilitating retention in prevention of mother to child transmission of HIV (PMTCT) services remain. Community-based mentor mothers (cMMs) who can provide home-based support for PMTCT services may address some of the barriers to successful adoption and retention in Option B+. Thus, we evaluated the acceptability of using cMMs as home-based support for PMTCT services.MethodsGender-matched in-depth interviews were conducted between September–November 2014 for HIV-infected pregnant/postpartum women and their male partners living in southwestern Kenya (n = 40); additionally, we conducted four focus groups involving 30 health workers (n = 70) within four health facilities. Audio-recordings were transcribed, translated, and then coded using a thematic analytical approach in which data were deductively and inductively coded with support from prior literature, identified themes within the interview guides, and emerging themes from the transcripts utilizing Dedoose software.ResultsOverall, the study results suggest high acceptability of cMMs among individual participants and health workers. Stigma reduction, improvement of utilization of health care services, as well as ART adherence were most frequently discussed potential benefits of cMMs. Participants pictured a cMM as someone acting as a role model and confidant, and who was over 30 years old. Many respondents raised concerns about breaches of confidentiality and inadvertent disclosure. Respondent suggestions to overcome these issues included the cMM working in different communities than where she lives and attending home-visits with no identifying clothing as an HIV-related health worker.ConclusionsThe home-based cMM approach may be a beneficial and acceptable strategy for promoting ART adherence and retention within PMTCT services for pregnant/postpartum women living with HIV. Considering the risks of inadvertent disclosure of HIV-infected status and related negative consequences for pregnant/postpartum women living with HIV, similar cMM program designs may benefit from recognizing and addressing these risks.Trial registrationThe MOTIVATE! study was registered on July 7, 2015 at the ClinicalTrials.gov (NCT02491177).

Attitudes Toward Long-Term Use of Antiretroviral Therapy Among HIV-Infected Pregnant Women in Moshi, Tanzania: A Longitudinal Study.

Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.

Utilization of Provider-Initiated HIV Testing and Counseling as an Intervention for PMTCT Services Among Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Ethiopia.

Purpose: Little is known about acceptance of provider-initiated HIV testing and counseling (PICT) as an intervention for prevention of mother to child transmission of HIV (PMTCT) in many parts of sub-Saharan Africa including Ethiopia. This study aimed at assessing the utilization and acceptance rate of PICT as an intervention for PMTCT among pregnant women attending University of Gondar referral and teaching hospital (UoGRTH), Ethiopia.Methods: A hospital-based cross-sectional study was conducted on 364 pregnant women attending antenatal care clinic at UoGRTH through an interviewer-administered questionnaire. Frequencies, means, and percentages were used to report different variables. Univariate analysis and multivariate logistic regression analysis were used to come up with factors associated with acceptance of PICT services.Results: Out of 364 respondents, 298 330 (81.7%) of them accepted provider-initiated HIV testing and counseling. Rural residency (AOR: 364, 95% CI: 2.17–6.34), higher educational status (AOR: 3.15, 95% CI: 1.86–6.82), planning of HIV test disclosure to male partners (AOR: 7.81, 95% CI: 3.17–13.14), and a higher average monthly income (AOR: 4.01, 95% CI: 2.32–7.61) were found to be strong predictors of acceptance of provider-initiated HIV testing and counseling.Conclusions: The present study revealed a higher rate of acceptance of PICT among pregnant women. Enhancing access to and consistent use of antenatal care service among pregnant women and encouraging the active involvement of male partners are recommended to further increase the uptake of provider-initiated HIV testing and counseling.