Prevention Of Mother-to-child Transmission Programme Research Articles

Barriers to exclusive breastfeeding practice among HIV-positive mothers in Tanzania. An exploratory qualitative study.

Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. A case study design employing a qualitative approach was used. The study was executed at the Reproductive and Child Health (RCH) Clinic within Amana Regional Referral Hospital, Mnazi Mmoja Health Centre, and Buguruni Health Centre. Data collection ensued through the purposive sampling of healthcare providers and HIV-positive mothers, utilizing in-depth interview techniques. The textual data accrued were analyzed using inductive and deductive content analysis strategies, thereby enabling the delineation and formulation of principal thematic constructs. The study involved interviews with twenty-seven key informants, encompassing HIV-positive mothers, nurses, clinicians, and community-based healthcare workers. The analysis of these interviews resulted in the identification of three major themes. Firstly, individual barriers to exclusive breastfeeding were delineated, encompassing sub-themes such as occupation-related hectic schedules, early motherhood-related non-compliance to safe infant feeding directives, postpartum depression, and issues related to breast sores and abscesses. Secondly, household-level barriers were identified, highlighting challenges like food insecurity and inaccessibility to key resources, the influence of male partners and family members on decision-making, and barriers arising from non-disclosure of HIV status affecting Exclusive Breastfeeding (EBF) support. Lastly, community-level barriers were explored, revealing a sub-theme related to the low retentivity of HIV-positive women in the Prevention of Mother-to-Child Transmission (PMTCT) programs. Individual barriers encompass practical, psychological, and physical challenges, while household-level obstacles include food insecurity, limited resources, and family dynamics influencing decisions. At the community level, there's a concern about the low retentivity of HIV-positive women in PMTCT programs, indicating broader societal challenges in supporting exclusive breastfeeding. There is a need for tailored interventions at individual, household, and community levels to promote and support optimal infant feeding practices among HIV-positive women.

Approaches for prevention of mother-to-child transmission of HIV services during coronavirus disease 2019

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a reduction in access to prevention of mother-to-child transmission (PMTCT) of human Immunodeficiency virus (HIV) services globally, yet this programme is critical for reducing paediatric HIV incidence. To minimise the impact of COVID-19 and prevent disruptions to the PMTCT service provision, innovative strategies had to be developed and implemented.Aim: The study aimed to describe the approaches that were developed and utilised during the COVID-19 pandemic in enhancing PMTCT services in Tshwane primary healthcare facilities.Settings: Three primary healthcare facilities that were providing PMTCT services during the COVID-19 pandemic located in the Tshwane district, Gauteng province, South Africa.Methods: The study is part of a larger study that focused on the experiences of healthcare workers who were rendering PMTCT services during the COVID-19 pandemic. An interpretative phenomenological analysis (IPA) design was employed to gain insight into the experiences of 16 purposively sampled healthcare workers who were providing PMTCT services during the pandemic in Tshwane district facilities. In-depth individual audio-recorded interviews were conducted with study participants, following a semi-structured interview guide. Data analysis was performed using an IPA framework.Results: Three superordinate themes emerged: strategies utilised for providing care, community-based initiatives, and support systems to enhance the PMTCT service access.Conclusion: Strengthening community-based initiatives and support systems is important for the enhancement of the PMTCT programme during and beyond the pandemic.Contribution: Community-based initiatives are critical in continuity of PMTCT services, reducing HIV incidence, under-five child morbidity and mortality particularly during emergency situations.

Resistance Mutation Patterns among HIV-1-Infected Children and Features of the Program for Prevention of Mother-to-Child Transmission in Vietnam's Central Highlands and Southern Regions, 2017-2021.

The Vietnam Ministry of Health (MOH) has intensified efforts in its aim to eliminate AIDS by 2030. Expanding the program for prevention of mother-to-child transmission (PMTCT) is a significant step towards achieving this goal. However, there are still HIV-exposed children who do not have access to PMTCT services, and some who have participated in the program but still contracted HIV. This study focused on assessing the prevalence and profile of HIV mutations among children under 18 months of age who had recently tested positive for HIV, while gaining insights into the implementation of early infant diagnostic (EID) tests. Between 2017 and 2021, 3.43% of 5854 collected dry blood spot (DBS) specimens from Vietnam's Central and Southern regions showed positive EID results. This study identified a high prevalence of resistance mutations in children, totaling 62.9% (95% CI: 53.5-72.3). The highest prevalence of mutations was observed for NNRTIs, with 57.1% (95% CI: 47.5-66.8). Common mutations included Y181C and K103N (NNRTI resistance), M184I/V (NRTI resistance), and no major mutations for PI. The percentage of children with any resistance mutation was significantly higher among those who received PMTCT interventions (69.2%; 95% CI: 50.5-92.6%) compared with those without PMTCT (45.0%; 95% CI: 26.7-71.1%) with χ2 = 6.06, p = 0.0138, and OR = 2.75 (95% CI: 1.13-6.74). Mutation profiles revealed that polymorphic mutations could be present regardless of whether PMTCT interventions were implemented or not. However, non-polymorphic drug resistance mutations were predominantly observed in children who received PMTCT measures. Regarding PMTCT program characteristics, this study highlights the issue of late access to HIV testing for both mothers and their infected children. Statistical differences were observed between PMTCT and non-PMTCT children. The proportion of late detection of HIV infection and breastfeeding rates were significantly higher among non-PMTCT children (p < 0.05). Comparative analysis between children with low viral load (≤200 copies/mL) and high viral load (>200 copies/mL) showed significant differences between the mothers' current ART regimens (p = 0.029) and the ARV prophylaxis regimen for children (p = 0.016). These findings emphasize the need for comprehensive surveillance to assess the effectiveness of the PMTCT program, including potential transmission of HIV drug-resistance mutations from mothers to children in Vietnam.

Epidemiological and virological surveillance of the prevention of mother-to-child transmission of HIV among pregnant women in Togo

SummaryBackgroundIn 2015, Togo introduced the “test-and-treat” strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Pediatric HIV infection remains a public health problem in Togo, with a mother-to-child transmission (MTCT) rate of 3.6% in 2020. This study aimed to estimate cases of HIV seroconversion during pregnancy and to identify pregnant women at high risk of transmitting HIV to their children in Lomé, Togo.MethodsA descriptive cross-sectional study was carried out from 18 March to 22 May 2022 among women who had given birth in five maternity units providing PMTCT services in Lomé. Umbilical cord blood samples were taken from the maternal side by midwives after delivery. HIV serology was performed in the laboratory using the Alere™ HIV Combo SET and First Response HIV 1–2. Card Test version 2.0. A sample was considered positive if both tests were positive. The HIV-1 viral load in HIV-1-positive samples was measured using Cobas/Roche 4800 equipment. Information on the women was extracted from maternal antenatal records and antenatal consultation registers.ResultsA total of 3148 umbilical cord blood samples (median maternal age: 28 years (interquartile range [24–32]) were collected. Among them, 99.3% (3145/3148) had presented for at least one antenatal clinic visit before giving birth, and 78.7% (2456/3122) had presented for at least four visits. One hundred and twenty-one (121) cord samples were HIV-1 positive, representing a seroprevalence of 3.8% (95% CI = [3.2–4.6]). Among them, 67.8% (82/121) were known HIV-positive before the current pregnancy, 29.7 (36/121) were diagnosed as HIV-positive at the antenatal visits and 2.5% (3/121) were diagnosed as HIV-positive in the delivery room. Of the HIV-positive women, 85.9% (104/121) were on ARV treatment before delivery. The viral load was < 1000 copies/ml in 97.5% (118/121) cases.ConclusionThis study explored the virologic and epidemiological aspects of HIV among pregnant women in Togo. The results show significant viral suppression at delivery in women ART. Surveillance based on umbilical cord blood specimen screening is an interesting approach for monitoring the effectiveness of PMTCT programmes.

HIV Viral Load Patterns and Risk Factors Among Women in Prevention of Mother-To-Child Transmission Programs to Inform Differentiated Service Delivery.

Differentiated service delivery (DSD) approaches decrease frequency of clinic visits for individuals who are stable on antiretroviral therapy. It is unclear how to optimize DSD models for postpartum women living with HIV (PWLH). We evaluated longitudinal HIV viral load (VL) and cofactors, and modelled DSD eligibility with virologic failure (VF) among PWLH in prevention of mother-to-child transmission programs. This analysis used programmatic data from participants in the Mobile WAChX trial (NCT02400671). Women were assessed for DSD eligibility using the World Health Organization criteria among general people living with HIV (receiving antiretroviral therapy for ≥6 months and having at least 1 suppressed VL [<1000 copies/mL] within the past 6 months). Longitudinal VL patterns were summarized using group-based trajectory modelling. VF was defined as having a subsequent VL ≥1000 copies/mL after being assessed as DSD-eligible. Predictors of VF were determined using log-binomial models among DSD-eligible PWLH. Among 761 women with 3359 VL results (median 5 VL per woman), a 3-trajectory model optimally summarized longitudinal VL, with most (80.8%) women having sustained low probability of unsuppressed VL. Among women who met DSD criteria at 6 months postpartum, most (83.8%) maintained viral suppression until 24 months. Residence in Western Kenya, depression, reported interpersonal abuse, unintended pregnancy, nevirapine-based antiretroviral therapy, low-level viremia (VL 200-1000 copies/mL), and drug resistance were associated with VF among DSD-eligible PWLH. Most postpartum women maintained viral suppression from early postpartum to 24 months and may be suitable for DSD referral. Women with depression, drug resistance, and detectable VL need enhanced services.

Analysis of the Level of Knowledge and Perceptions of Pregnant Women Regarding the PMTCT Program in Antenatal Services in Bukittinggi City

The problem with Prevention of mother to Child Transmission (PMTCT) among pregnant women in Bukittinggi City is that there are still many pregnant women who do not carry out HIV tests. In 2021 K1 coverage is 95% but HIV screening coverage is only 45%, this shows that there are still many pregnant women who do not know their HIV status even though they have visited a health service facility. The aim of this research is to analyze the relationship between the level of knowledge and perceptions of pregnant women regarding the implementation of PMTCT. This research is a mix method study with systematic random sampling of 100 respondents. The results of bivariate analysis show the level of knowledge (p = 0.199), perceived vulnerability (p = 0.054), perceived severity (p = 0.916), perceived benefits (p = 0.993), perceived barriers (p = 0.360), perceived threats (p = 0.669 ) is not related to the implementation of PMTCT. Perception of cues to action (p=0.035) and support from health workers (p=0.007) were related to the implementation of PMTCT. Meanwhile, the results obtained from the multivariate analysis showed that the most significantly related variable was health workers (p = 0.005). Conclusion: The support provided by health workers is socialization and counseling, but not all health workers providing antenatal care have implemented this. Suggestions for Community Health Centers to optimize the implementation of counseling before and after HIV testing and for the Health Service to actively monitor the implementation of integrated ANC for all health workers providing antenatal care. Keywords: Knowledge, perception, pregnant women

Growth and development of syphilis-exposed and -unexposed uninfected children during their first 18 months of life in Suzhou, China: a nested case-control study with propensity score matching.

With the successful implementation of Prevention of Mother-to-Child Transmission (PMTCT) policies, the proportion of infants with exposure to both syphilis and antibiotic medication in utero has increased in China, but there is limited evidence about the early growth and development of such infants. We conducted a retrospective nested case-control study based on data from the China PMTCT program conducted in Suzhou from 2016 to 2021. Propensity score matching (PSM) was employed to extract 826 syphilis-exposed but uninfected (SEU) infants and 1,652 syphilis-unexposed uninfected (SUU) infants from a total of 712,653 infants. Maternal characteristics were collected through questionnaires, such as parity, age, education level, smoking and drinking habits during pregnancy. Infantile characteristics were retrieved from medical records or via questionnaires, such as gestational age, gender, mode of delivery, Apgar scores, birth weight and length, outdoor time, vitamin D intake, and feed pattern. Mixed effects models, adjusting for potential influencing factors, were used to investigate the early infantile growth pattern of SEU and SUU infants. All statistical analysis were conducted using R (version 4.2.0). Length and weight were slightly higher in SEU infants than in the SUU infants at some time points (months 0 and 18 for length, p-values <0.05; months 0, 6, and 18 for weight, p < 0.05). In the mixed effects model, SEU group was found to be associated with higher weight [exponentiated beta exp.(β) = 1.15, 95% Confidence Interval (CI) = 1.06, 1.25], length [exp(β) = 1.42, 95% CI = 1.14, 1.77], and BMI z-score [exp(β) = 1.09, 95% CI = 1.00, 1.19]. With the effective prevention of congenital syphilis under the PMTCT program, SEU infants have non-inferior growth patterns during their first 18 months of life compared with SUU controls in Suzhou, China.

Nurse-patient relationship and its implications for retention in the PMTCT of HIV programme in Ghana: an appreciative inquiry

BackgroundRelationships established between nurses and midwives, and their patients have far-reaching implications; the most significant being their impact on the health-related outcomes of patients. These relationships are especially relevant in the Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) programme as women, diagnosed with HIV navigate the emotional and psychological effects of their diagnosis while carrying pregnancies. This study aimed to explore the relationships between nurses, midwives and mothers diagnosed with HIV and its impact on retention in the PMTCT Programme.MethodsAn Appreciative Inquiry approach that employed qualitative research methods was conducted among twenty-four participants made up of 12 HIV positive mothers, and eight midwives and four community health nurses engaged in the PMTCT programme. Individual generative interviews were conducted among the mothers while paired interviews were conducted among the health professionals. Thematic analysis guided by Colaizzi’s approach was conducted.ResultsThree main themes emerged each with its subthemes. Under Establishing Rapport, two sub-themes emerged; making the connection and building trusting relationships. The second theme, Journeying Together, describes how the nurse-patient relationship evolved as the participant engaged in the programme; sub-themes include developing mutual goals, impactful communication, and showing commitment and building self-worth. The third theme; Ending the professional relationship details two sub-themes; continuity of care across the cascade, and termination of care which proved unsuccessful in some relationships due to blurring professional boundaries.ConclusionsThe nurse-patient relationship in the PMTCT programme evolved as the relationship progressed along the PMTCT cascade. Strengthening of the nurse-patient relationships was underscored by building trust through the maintenance of confidentiality, setting mutual goals, shared emotional experiences and personal stories, and building clients’ self-worth. Therefore, there is a need to ensure that professional boundaries are set and maintained to reduce the occurrence of over-dependence of the clients and burnout of the nurses.

Using the RE-AIM Framework to Evaluate Implementation of Male Involvement Strategies to Optimize the PMTCT Program in Malawi: A Mixed-Methods Study.

Involvement of male partners has been shown to be key for the prevention of mother-to-child HIV transmission (PMTCT). Despite the recorded success, uptake and implementation of strategies to involve men in PMTCT continues to be low in Malawi. In this study, we used the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) implementation science framework to explore the implementation of male involvement (MI) strategies in Lilongwe, Malawi. We used a cross-sectional mixed-methods complementary-concurrent design from September to October 2020 in two health facilities. Qualitatively, we used a phenomenological approach and conducted seven focus group discussions (FGDs), three with women and four with men. We further conducted four key informant interviews (KIIs) among health care workers. Quantitatively, we conducted a cross-sectional study comprising 138 men presenting at an antenatal clinic (ANC). We used univariate analysis in Stata for the quantitative data, whereas a manual thematic analysis was applied to the qualitative data. Implementation and adoption of the strategies was high among health providers and there were indications of maintenance of the strategies. Provider's attitude, coordinated service provision, integrated training and service provision, information provision, and baby's HIV outcomes were driving factors in implementing the MI strategies. These factors have contributed to the sustained implementation of the strategies over time. In contrast, financial and time constraints, inadequate human resources, and male-friendly spaces impede the implementation of MI strategies. Improving MI will require a systems approach considering health system and individual-level factors for both providers and consumers.

HIV testing and knowledge on mother-to-child transmission among pregnant women attending antenatal care at Vanga Hospital, Democratic Republic of Congo.

Human immunodeficiency virus (HIV) causes an infectious disease that can be transmitted from an infected mother to her child. Prevention of Mother-to-Child Transmission (PMTCT) programs provide a range of services to women and children that can reduce the risk of vertical transmission of HIV. Unfortunately, PMTCT programs face many challenges in the rural Democratic Republic of Congo (DRC). A cross-sectional study was conducted among 460 pregnant women attending antenatal care at Vanga Hospital in the Vanga health zone, DRC from March 11th to June 25th, 2019. Serological tests were performed and a pre-tested questionnaire regarding HIV knowledge was given to all participants. Data were analyzed with STATA 13.0. Descriptive statistics of key variables were computed and logistic regression was used to assess the association between participant's characteristics and knowledge of MTCT. Among the participants, 95.4% (439/460) reported that they have heard about HIV, 82.4% (378/460) indicated sexual intercourse as one of the routes of HIV transmission but only 30.4% (139/460) mentioned MTCT as one of the routes. In addition, only 10.1% (46/460) had knowledge of the existence of PMTCT. Participants' age (>29 years), education level, previous antenatal care, and previous HIV tests were significantly associated with knowledge of MTCT. Also, age (>29 years) and education level were significantly associated with previous HIV test uptake. Most pregnant women 82.3% (376/460) reported that they have never been tested in the past for HIV infection and the prevalence was at 0.9% (4/460). Knowledge of MTCT of HIV, previous uptake of HIV testing, and prevalence was low. The rural setting of Vanga and insufficient HIV sensitization activities are considered contributors to this. While the low prevalence is a positive finding, much needs to be done to improve the uptake of HIV testing and knowledge of HIV MTCT.

Patriarchy, couple counselling and testing in preventing mother-to-child transmission of HIV in Zimbabwe

The World Health Organization (WHO) recommends couple human immunodeficiency virus (HIV) counselling and testing (CHCT) as one of the beneficial and cost-effective means for the prevention of mother-to-child transmission (PMTCT) of HIV within couple’s relationships. However, CHCT within the PMTCT of HIV settings in Zimbabwe remains low. This study explored adult men and women’s views from a rural district of Zimbabwe regarding the possible factors that facilitate or inhibit the uptake of CHCT for the PMTCT of HIV. The study utilised qualitative methods. Data were collected by conducting eight focus group discussions among adult men and women, as well as eight in-depth interviews with pregnant women admitted in antenatal wards in local hospitals. Thematic analysis was used for analysing the data with the aid of NVivo software. The study revealed that CHCT initiatives were hampered by certain patriarchal behaviours and beliefs that make it acceptable for men to have multiple sexual partners, thereby exposing their marriages and relationships to HIV. Social constructions around gender roles tend to prescribe women as the sole custodians of children’s health, and this led to stigmatisation against men who participated in PMTCT programmes. In addition, certain religious practices do not allow the use of medicine, which makes CHCT a nonevent. However, engaging men on platforms that advocate for progressive masculinities and raising awareness of this practice through information dissemination were identified as enablers in increasing CHCT.Contribution: The significant contribution of this study is that it demonstrated the importance of acknowledging the societal, cultural and religious practices inherent in a community, as they are central to their responses to HIV prevention interventions.

Attempt to Optimize the Role of Peer Support Group (PSG) in Increasing the Quality-of-Life Persons Living With HIV/AIDS (PLWHA) Through the Revitalization of Peer Support Activities Program in Pati Regency

It is well-known that People Living With HIV/AIDS (PLWHA) are denied andavoided by their own families. This is a very heavy social burden that must beborne by PLWHA. Therefore, the role of Peer Support Groups (PSG) ascommunity empowerment is very important to improve the living quality ofPLWHA. In this study, community service activities were conducted tooptimize the role of PSG in improving the living quality of PLWHA in PatiRegency. Currently, Pati is the fourth highest city with PLWHA in Central Java,Indonesia. The community service utilized guidance participation, whichprioritizes the involvement of the community in the activities. Theimplementation involved analytical methods for problem-solving andcompletion of the study. Two meetings were held at the Voluntary Counsellingand Testing (VCT) Clinic of Soewondo Pati Hospital. In average, one activitywas attended by 5-8 participants. They are the volunteer members from PSGRumah Matahari. The meetings focused on brainstorming sessions and onproviding counselling about the Prevention of Mother to Child Transmission(PMTCT) program, which aimed to enhance knowledge about PMTCT amongPSG Rumah Matahari volunteers, especially in assisting pregnant women withPLWHA. The results show that the community service activities successfullyhighlighted the importance of PSG in improving the quality of life for PLWHA.The PMTCT program was well understood by the PSG Rumah Mataharivolunteers, indicating the effectiveness of the training.

Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test.

Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.

Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi—An Endline Evaluation

We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers’ retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.

Prevention of mother-to-child transmission of HIV in Kermanshah, west of Iran from 2014 to 2021

BackgroundThis study aimed to evaluate the implementation of the prevention of mother-to-child transmission (PMTCT) of the HIV-PMTCT program in Kermanshah, west of Iran, from 2014 to 2021.MethodsThe data of all HIV-infected mothers and their infants who were monitored by the Kermanshah behavioral diseases counseling center was extracted and recorded in a checklist.ResultsOut of 95 included infant, 45 (47.4%) were girls and 50 (52.6%) were boys. The mothers were mostly infected with HIV via their infected spouse. The pregnancies of 77 cases (82.1%) were in accordance with the national guideline. The average length of treatment for this group was 185 days. Of the 18 mothers who did not receive treatment, nine were diagnosed during childbirth and nine had no available information. All infants born from infected mothers underwent after-birth-antiretroviral prophylaxis, and all remained healthy. There was no statistically significant relationship between the birth weight and height of neonates with maternal age, maternal last viral load, disease stage, education, and maternal CD4 levels. Only a statistically significant relationship was observed between the duration of treatment and the infants’ weight.ConclusionThe results suggest the feasibility and effectiveness of the PMTCT program for HIV-positive mothers in Kermanshah. It seems that if pregnant HIV-positive women are diagnosed early and covered by a good prevention program on time, the risk of HIV to their babies will be reduced, significantly.

The Efficacy of the Prevention of Mother-to-Child Transmission (PMTCT) Program in Mitigating Pediatric HIV/AIDS Incidence in the Mansa District, Zambia

This qualitative study was set out to intricately explore the landscape of the Prevention of Mother-to-Child Transmission (PMTCT) program in the Mansa district in order to shed light on its multifaceted nature. Key informants, pivotal to the program, offered invaluable insights into its fundamental components, recent progress, encountered challenges, and proposed improvements. The study emphasized the paramount importance of early detection and timely intervention in preventing HIV transmission from mother to child. The study highlighted key areas of focus within the PMTCT program, as elucidated by informants, emphasizing the central role of antenatal care, HIV testing and counseling, provision of antiretroviral therapy (ART), and vigilant postnatal follow-up. Together, these elements constituted a comprehensive strategy for safeguarding maternal and child well-being, with a strong emphasis on early identification and effective intervention. Recent developments in the program portrayed an evolving landscape, including enhancements such as improved access to rapid testing, the integration of maternal and child health services, expanded community outreach efforts, and initiatives aimed at enhancing community awareness. These innovations underscored the program’s adaptability and unwavering commitment to extending its reach. However, the challenges that impeded the reduction of mother-to-child HIV transmission were deeply rooted and multifaceted, encompassing issues such as stigma, inadequacies in healthcare infrastructure, medication adherence challenges, geographic barriers, personnel shortages, and logistical complexities. In response to these challenges, key informants put forth practical recommendations to strengthen the PMTCT program. These recommendations included broader community awareness and education efforts, the fortification of peer support networks, increased allocation of resources for transportation, and continuous training and sensitization programs for healthcare providers. These measures were deemed vital for enhancing program effectiveness and improving the health outcomes of mothers and infants in the Mansa district.

Factors Influencing Male Involvement in the Prevention of Mother-to-Child Transmission of HIV: The Missing Component in Test and Start in Kumba Health District

Prevention of Mother to child Transmission (PMTCT) programs has been proven to be effective in reducing the risk of HIV transmission from mother to child. Men participation in PMTCT programs is likely to increase women’s uptake of PMTCT services. Unfortunately, men involvement in this intervention has been very minimal. Thus, identifying the factors that influences male involvement in the PMTCT programs is imperative. The study was a hospital and community base quantitative cross-sectional survey of 200 pregnant women attending antenatal clinic ANC/PMTCT clinic and 200 men in the Kumba Health District community using structured questionnaire. Ethical clearance was obtained from Faculty of health sciences University of Buea. Each health area in the district represented a stratum. Women were sampled at the clinics and men in the community. Written consent was obtained from all participants. Data was analyzed using SPSS version 26 at 95% confident interval and P&lt;0.05 for statistical significance. Result. 52(13%) of male respondents had attended PMTCT services in the district with their partners which is far below the 80% standard set by the ministry of Public Health of Cameroon. Of the 200 male respondents 94(47%) had heard about PMTCT programs (p=0.001). Knowledge on HIV transmission through breast feeding (P=0.001) were highly significant, likewise level of education (P=0.003) and employment of participants (P=0.001). Despite the successful implementation of the Test and START in Kumba Health District, eliminating MTCT of HIV remains a major challenge. Keywords. ANC, ARV, HIV, Male Involvement, MTCT, PMTCT.

Twenty years of Prevention of Mother to Child HIV Transmission: research to implementation at a national referral hospital in Uganda.

Over 90% of new paediatric HIV infections are acquired through mother to child transmission. Prevention of mother to child HIV transmission (PMTCT) research in sub-Saharan Africa informed WHO guidelines which enabled implementation of PMTCT programs globally. To describe Makerere University-Johns Hopkins University (MU-JHU) perinatal HIV prevention research and implementation of the Mulago National Referral Hospital (MNRH) PMTCT program. Perinatal HIV prevention studies conducted at MU-JHU between 1997-2016 were summarized. Program aggregated data was extracted and analyzed using STATA 15. In 1999, the HIVNET 012 study demonstrated that single-dose nevirapine (sdNVP) to the mother at onset of labor and to her newborn, reduced MTCT by nearly 50%. In 2016, the PROMISE study documented the safety and efficacy of ART during pregnancy and breastfeeding period. Program implementation at MNRH started in 2000. Uptake of HIV testing increased from 70% to 99% from 2006 onwards. sd NVP was the initial ARV regimen but by 2012, MOH recommended Option B+(triple therapy). MTCT rates reduced from 16.9% in 2001 to 2.3% in 2020. Perinatal HIV prevention clinical trials conducted at MU-JHU provided evidence to inform WHO PMTCT guidelines. MNRH program evaluation demonstrated the significant decline in MTCT rates over the last two decades.

Can Social Innovation advance the PMTCT programme? A South African reflection

The prevention of mother to child transmission (PMTCT) programme is an initiative developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of HIV to their infants. However, the PMTCT programme has not been reaching its intended prevention objectives. This paper identifies the social issues that elucidate the gap between PMTCT program goals and the role that Social Innovation could play in improving the status quo. Supporting Social Innovation in health helps reduce infectious diseases by empowering communities to become active participants in their health challenges through local adaptation of global strategies that facilitate the reduction of health system limitations. The article combines a review of the literature with empirical evidence extracted from research that has analyzed the postpartum experiences of mothers living with HIV in the context of the PMTCT program in Khayelitsha, Cape Town, South Africa in 2021. To address the research question, exploratory research has been adopted through a case study. The research is qualitative, exploratory and descriptive based on a case study constructed with secondary data. The results show that Social Innovation contributes to addressing healthcare challenges by providing more personal, analytical and preventive healthcare pathways. In addition, Social Innovation makes a critical contribution to addressing demographic challenges by helping those who are unable to access healthcare. This paper argues that Social Innovation in health is most effective when it occurs from the bottom up, as it is a process that engages the community and connects social change and health improvement through the diverse efforts of local actors. The article demonstrates that having local beneficiaries drive the development of a Social Innovation programme in health results in more viable and sustainable solutions. It also demonstrates that Social Innovation harnesses the ingenuity and willingness of community members, strengthening conventional health service systems and helping to achieve improved and sustainable health services.

A risk measurement tool for targeted HIV prevention measures amongst young pregnant and lactating women in South Africa

BackgroundWe aimed to develop and validate a tool to identify which pregnant/lactating young South African women (≤ 24 years) are at risk of HIV infection.MethodsData from three national South African Prevention of Mother-to-Child Transmission (PMTCT) evaluations were used to internally validate three HIV acquisition risk models for young postpartum women. We used univariate and multivariable logistic regression analysis to determine which risk factors were significant. Model coefficients were rounded and stratified into risk groups and the area under the receiver operating curve (AUROC) was computed. Models were developed to determine which risk factors provided the most predictive accuracy whilst remining clinically meaningful.ResultsData from 9 456 adult and 4 658 young pregnant and lactating women were included in the development and validation data sets, respectively. The optimal model included the following risk factors: age (20–24 years old), informal house structure, two or more pregnancies, mothers who had knowledge of when they received their last HIV test result, no knowledge of the infant’s father’s HIV status, no knowledge of breastfeeding as a mode of MTCT and knowledge of PMTCT programme. The mean AUROC was 0.71 and 0.72 in the development and validation datasets respectively. The optimum cut off score was ≥ 27, having 84% sensitivity, 44% specificity, and identifying 44% of high-risk women eligible for PrEP.ConclusionThe optimal model to be used as a possible risk scoring tool to allow for early identification of those pregnant/lactating women most at-risk of HIV acquisition included both statistically as well as clinically meaningful risk factors. A field-based study is needed to test and validate the effectiveness of this targeted approach.