Prevention Of Mother-to-child Transmission Research Articles

Strategic HIV Case Findings among Infants at Different Entry Points of Health Facilities in Cameroon: Optimizing the Elimination of Mother-To-Child Transmission in Low- and- Middle-Income Countries

Background: HIV case finding is an essential component for ending AIDS, but there is limited evidence on the effectiveness of such a strategy in the pediatric population. We sought to determine HIV positivity rates among children according to entry points in Cameroon. Methods: A facility-based survey was conducted from January 2015 to December 2019 among mother–child couples at various entry points of health facilities in six regions of Cameroon. A questionnaire was administered to parents/guardians. Children were tested by polymerase chain reaction (PCR). Positivity rates were compared between entry points. Associations were quantified using the unadjusted positivity ratio (PR) for univariate analyses and the adjusted positivity ratio (aPR) for multiple Poisson regression analyses with 95% confidence intervals (CIs). p-values < 0.05 were considered significant. Results: Overall, 24,097 children were enrolled. Among them, 75.91% were tested through the HIV prevention of mother-to-child transmission (PMTCT) program, followed by outpatient (13.27%) and immunization (6.27%) services. In total, PMTCT, immunization, and outpatient services accounted for 95.39% of children. The overall positivity was 5.71%, with significant differences (p < 0.001) between entry points. Univariate analysis showed that inpatient service (PR = 1.45; 95% CI: [1.08, 1.94]; p = 0.014), infant welfare (PR = 0.43; 95% CI: [0.28, 0.66]; p < 0.001), immunization (PR = 0.56; 95% CI: [0.45, 0.70]; p < 0.001), and PMTCT (PR = 0.41; 95% CI: [0.37, 0.46]; p < 0.001) were associated with HIV transmission. After adjusting for other covariates, only PMTCT was associated with transmission (aPR = 0.66; 95% CI: [0.51, 0.86]; p = 0.002). Conclusions: While PMTCT accounts for most tested children, high HIV positivity rates were found among children presenting at inpatient, nutrition, and outpatient services and HIV care units. Thus, systematic HIV testing should be proposed for all sick children presenting at the hospital who have escaped the PMTCT cascade.

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.

Strengthening Laboratory Systems for Ensuring Accurate Diagnoses in Mother-to-Child Transmission (MTCT) Prevention Programs in Uganda: A Narrative Review

Mother-to-child transmission (MTCT) of HIV remains a significant public health challenge in Uganda, necessitating a focused examination of the state of laboratory systems to ensure accurate diagnoses and effective prevention. The aim of this narrative review is to assess the current state of laboratory systems supporting Mother-to-Child Transmission (MTCT) prevention programs in Uganda, identify challenges hindering accurate diagnoses, and propose strategies for strengthening these systems to enhance the effectiveness of MTCT prevention efforts. This narrative review explores the current landscape of laboratory infrastructure in Uganda, addressing challenges unique to the country and proposing strategies for improvement. The discussion encompasses the integration of molecular testing, the role of point-of-care diagnostics, the implementation of quality assurance programs, and capacity-building initiatives for laboratory personnel. Additionally, technological innovations and their applicability in the Ugandan context are explored, alongside the crucial aspect of integrating laboratory services into antenatal care. Drawing on global lessons, the review provides tailored recommendations for Uganda, spanning policy considerations, funding mechanisms, infrastructure enhancements, and workforce development. Looking towards the future, the review outlines potential collaborations, technological advancements, and strategic investments that can further fortify laboratory systems, ultimately contributing to the elimination of MTCT in Uganda.

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.

Antiretroviral adherence among people living with HIV during the postpartum period: a retrospective cohort study at a PMTCT reference center in Rio de Janeiro before and during the COVID-19 pandemic

ABSTRACT Despite success in achieving viral suppression during pregnancy in people living with HIV (PLWH), postpartum adherence remains a challenge. We aimed to describe rates of adherence at a Prevention of Mother-to-Child HIV Transmission (PMTCT) Center before and during the COVID-19 pandemic. This study was conducted from a cohort of PLWH who received prenatal care and were virally suppressed near delivery. We tracked combined antiretroviral therapy (cART) pickups for 12 months and HIV viral load (VL) from 2 to 12 months after delivery. We defined flexible adherence as a monthly pickup of cART and strict adherence as also having VL < 200 copies/mL and at least one maternal HIV VL between two and twelve months postpartum. Pre-pandemic was defined as delivery from March 2017-February 2019 and pandemic as March 2020-February 2022. During the study, 1119 PLWH were followed, and 965 (86%) were suppressed near delivery. There were 511 pre-pandemic and 290 pandemic participants. Adherence rates were 66/511 (13%) and 38/290 (13%), respectively. During the pandemic, more participants conceived using cART and were undetectable at the start of prenatal care; nevertheless, postpartum adherence was no better than pre-pandemic underscoring the need to improve strategies for adherence specific to this subset of PLWH in the postpartum period.

HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study.

Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive. We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data. Of 797 children tested, 463(58.1%) were male and 630(79.1%) were ≤18months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother-infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66/188). Child age >18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11-3.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic. In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.

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.

Development and validation of an individualised nomogram to predict mother-to-child transmission in pregnant women with syphilis in China: a retrospective cohort study

ObjectivesThe elimination of mother-to-child transmission (MTCT) of syphilis has been set as a public health priority. However, an instrument to predict the MTCT of syphilis is not available. We aimed...

A Qualitative Study of Caregivers of Children Living with HIV/AIDS in Ghana: Diagnosis History, Health-seeking Behaviour, and Care Expectations

Caregivers of Children Living with HIV/AIDS experience severe burdens in Africa amidst unmet needs while seeking care from hospitals. This study aimed to explore the diagnosis history, health-seeking behaviour, and care provided by hospitals and whether the services meet caregivers’ expectations. We used a qualitative approach and conducted individual in-depth interviews among purposively sampled caregivers of children living with HIV/AIDS from three hospitals. We achieved data sufficiency after interviewing nine participants. Audio-recorded interviews were transcribed verbatim and thematically analyzed manually through Collaizi’s steps. Four themes developed including; history of pregnancy and poor HIV testing, effective care for caregivers and CLWH, attitude of healthcare providers, and unmet expectations of care. Healthcare providers showed positive attitudes towards caregivers and provided services (counselling, dispensing Anti-retrovirals, health monitoring, and coordination of clinical care). Expectations bordered on financial support (for food, education, health care), and treatment for opportunistic infections. Findings indicate gaps in HIV voluntary testing for pregnant women, enrollment in Prevention of Mother to Child Transmission (PMTCT), and unmet needs. It is imperative to improve coverage of testing for pregnant women and efforts made to meet their needs. Financial support, provision of food security, and assistance for caregivers are essential for care.

Toward the elimination of hepatitis B: networking to promote the prevention of vertical transmission of hepatitis B virus through population-based interventions and multidisciplinary groups in Africa.

The WHO African Region had 81 million people with chronic hepatitis B in 2019, which remains a silent killer. Hepatitis B virus (HBV), hepatitis delta virus (HDV), and HIV can be transmitted from the mother to child. If the HBV infection is acquired at infancy, it may lead to chronic hepatitis B in 90% of the cases. WHO reports that 6.4 million children under 5 years live with chronic hepatitis B infection worldwide. The prevention of mother-to-child transmission (PMTCT) of HBV is therefore critical in the global elimination strategy of viral hepatitis as we take lessons from PMTCT of HIV programs in Africa. We sought to create a network of multidisciplinary professional and civil society volunteers with the vision to promote cost-effective, country-driven initiatives to prevent the MTCT of HBV in Africa. In 2018, the Mother-Infant Cohort Hepatitis B Network (MICHep B Network) with members from Cameroon, Zimbabwe, and the United Kingdom and later from Chad, Gabon, and Central African Republic was created. The long-term objectives of the network are to organize capacity-building and networking workshops, create awareness among pregnant women, their partners, and the community, promote the operational research on MTCT of HBV, and extend the network activities to other African countries. The Network organized in Cameroon, two "Knowledge, Attitude and Practice" (KAP) surveys, one in-depth interview of 45 health care workers which revealed a high acceptability of the hepatitis B vaccine by families, two in-person workshops in 2018 and 2019, and one virtual in 2021 with over 190 participants, as well as two workshops on grant writing, bioethics, and biostatistics of 30 postgraduate students. Two HBV seroprevalence studies in pregnant women were conducted in Cameroon and Zimbabwe, in which a prevalence of 5.8% and 2.7%, respectively, was reported. The results and recommendations from the MICHep B Network activities could be implemented in countries of the MICHep B Network and beyond, with the goal of providing free birth dose vaccine against hepatitis B in Africa.

Costs of integrating hepatitis B screening and antiviral prophylaxis into routine antenatal care in Burkina Faso: Treat all versus targeted strategies.

Economic feasibility of eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in highly endemic African countries remains uncertain. Prevention of MTCT (PMTCT) involves screening pregnant women for hepatitis B surface antigen (HBsAg), identifying those with high viral loads or hepatitis B e antigen (HBeAg), and administering tenofovir prophylaxis to high-risk women. We estimated the costs of integrating PMTCT services into antenatal care in Burkina Faso, based on four different strategies to select women for tenofovir prophylaxis: (1) HBV DNA (≥200 000 IU/mL), (2) HBeAg, (3) hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) and (4) all HBsAg-positive women. Using a micro-costing approach, we estimated the incremental economic cost of integrating each strategy into routine antenatal care in 2024, compared to neonatal vaccination alone. Sensitivity analyses explored variations in prevalence, service coverage, test and tenofovir prices. HBcrAg-RDT strategy was the least expensive, with a total economic cost of US$3959689, compared to HBV DNA (US$6128875), HBeAg (US$4135233), and treat-all (US$4141206). The cost per pregnant woman receiving tenofovir prophylaxis varied from US$61.88 (Treat-all) to US$1071.05 (HBV DNA). The Treat-All strategy had the lowest marginal cost due to a higher number of women on tenofovir (66928) compared to HBV DNA (5722), HBeAg (10020), and HBcrAg-RDT (7234). In sensitivity analyses, the treat-all strategy became less expensive when the tenofovir price decreased. HBcrAg-RDT minimizes resource use and costs, representing 0.61% of Burkina Faso's 2022 health budget. This study highlights the potential economic feasibility of these strategies and provides valuable resources for conducting cost-effectiveness analyses.

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

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

Understanding Fijian health system challenges in the prevention of mother-to-child transmission of HIV services in the three tertiary hospitals in Fiji

ABSTRACT Mother-to-child transmission is the most common route of human immunodeficiency virus transmission in children, which could be prevented with proper treatment and access to care. Health system challenges can impede the effectiveness of prevention of mother-to-child transmission (PMTCT) programmes. We aim to understand the health system challenges to the provision of PMTCT services for pregnant women in three tertiary hospitals in Fiji. Data were collected using in-depth interviews in the three tertiary hospitals and associated health clinics in Fiji between April–May 2013 and February–March 2014. Ethical approvals were obtained. A total of 58 healthcare providers were interviewed including doctors (n = 12), midwives (n = 19), nurses (n = 14), laboratory technicians (n = 5) and counsellors (n = 8). The data were analysed using thematic analysis. We found that the healthcare workers faced a wide range of health system challenges including institutional and human resource challenges. Staff shortage, limited PMTCT training and shortage of supplies were barriers to the quality of PMTCT services. Our findings would be useful in developing strategies to overcome barriers as it would be imperative in improving the quality of PMTCT service provision in Fiji and other similar settings.

Effectiveness of telemedicine for the prevention of mother-to-child transmission of HIV in low-income and middle-income countries: a systematic review and meta-analysis

ObjectivesWe aimed to estimate the effectiveness of telemedicine for the prevention of mother-to-child transmission (PMTCT) program of HIV in low- and middle-income countries (LMICs). MethodsWe did a systematic literature search of 15 databases for articles published from database inception to October 26, 2022, and performed meta-analyses to estimate the pooled risk ratio of intervention effect (RR) and its 95% confidence interval (CI). We used subgroup analyses and meta-regressions to explore variation in the RRs. Funnel plots and Egger regression tests were also performed to assess publication bias. ResultsSeventeen studies were included in the systematic review, with a total sample size of 9118 participants. We found that telemedicine was beneficial for early infant diagnosis (EID) in the sixth week (RR 1.04 [95% CI 1.00-1.09]), exclusive breastfeeding (RR 1.12 [95% CI 1.01-1.24]) and PMTCT retention (RR 1.34 [95% CI 1.16-1.55]). However, we did not find a significant effect of telemedicine on infant prophylaxis, HIV transmission, and ART adherence. Besides, the heterogeneity of ART adherence was associated with enrollment time, while retention was related to ART initiation. ConclusionsOur meta-analysis demonstrated the benefits of telemedicine in improving PMTCT, especially for EID, exclusive breastfeeding, and PMTCT retention.

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.

Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality

BackgroundOver the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization’s (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda’s rapid uptake of these two EBIs developed or adapted during the study period.MethodsWe conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research.ResultsWe found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors.ConclusionImplementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.

Outcome of HIV exposed infants towards prevention of mother to child transmission (PMTCT) program and its associated factors in selected health facilities of Addis Ababa, Ethiopia, 2020. Retrospective cross sectional study

BackgroundGlobally, an estimated 36.9 million (31.1–43.9 million) people were living with HIV in 2017, of whom 17.8 million were women and 1.8 million (1.3–2.4 million) children under 15 years of age. Ethiopia has developed an HIV/AIDS prevention, care, and treatment strategic plan in an investment case approach that has been implemented from 2015 to 2020. The study aim was to assess the outcome and risk factors for HIV-exposed infants receiving Prevention of Mother to Child Transmission (PMTCT) follow-up. MethodA cross-sectional retrospective study was done. All HIV-exposed infants who were on follow-up in the ART and (PMTCT) clinics of St Paul’s Hospital Millennium Medical College, Yekatit 12 Hospital Medical College, and Selam Health Center beginning from September 2016 to January 2019 were included. Data collection was done using a well-designed questionnaire and a review of mothers’ and infants’ medical record charts and HMIS log book. Descriptive and logistic regression analysis was performed to assess the association between dependent and independent variables. Differences are considered statistically significant at p < 0.05, and their strength is presented using an odds ratio and 95% confidence interval. ResultAmong the 302 enrolled HIV-exposed infants, 27 (8.9%) were diagnosed as HIV positive. Maternal ART initiation during labor and delivery (AOR = 3.468, 95% CI: 1.22, 13.34, p = 0.04), frequent hospital admission of the infant (AOR = 17.49, 95% CI: 5.41, 56.2, p = 0.001), and mixed feeding option (AOR = 8.25, 95% CI: 2.212, 30.77, p = 0.02) were the major factors associated with positive HIV serostatus among HIV-exposed infants. Conclusionand Recommendation: The level of HIV infection among infants born to HIV-positive mothers is high as compared to the national and WHO goals. Exclusive breastfeeding should be advocated for all HIV-exposed infants, especially in resource-limited settings like Ethiopia due to the increased prevalence of diarrheal illness.

Effect of Nurse-Led PMTCT Health Education on HIV Disclosure among HIV-Positive Women in Mombasa County: A quasi-experimental study

Background: This study investigated the impact of nurse-led PMTCT (Prevention of Mother-toChild Transmission) health education on enhancing HIV status disclosure among HIVpositive women in Mombasa County, Kenya. HIV status disclosure is crucial for the prevention of mother-to-child transmission and the overall well-being of affected individuals and their families.&#x0D; Methods: A quasi-experimental design was employed, with participants divided into an intervention group of 107 receiving nurse-led PMTCT health education and a control group of 107 receiving standard care. Demographic information, knowledge, attitudes, and practices related to HIV status disclosure were collected at baseline and post-intervention phases. Descriptive statistics were computed and a chi-square test was used to compare the level of self-disclosure of HIV status to sexual partners across the groups. Difference in differences (DID) analysis was used to evaluate the effectiveness of the intervention. Results: The study initially found that at baseline, 60.4% of HIV-positive women in the control group did not disclose their status to sexual partners, compared to 55.4% in the intervention group. However, there was no significant difference between the two groups at this stage. In the end-line survey, the control group had 64% non-disclosure, while the intervention group showed a significant improvement, with only 20% not disclosing. Chi-square analysis revealed a substantial difference (p &lt; 0.001) in disclosure rates between the intervention and control groups. Additionally, a Difference-in-Differences (DID) analysis indicated a significant improvement in self-disclosure (23.1% net intervention effect, p &lt; 0.0001). Overall, the nurse-led health education intervention notably increased HIV status disclosure among HIV-positive women in selected Mombasa County health facilities.&#x0D; Conclusion: Nurse-led PMTCT education enhances HIV disclosure in Mombasa County, improving PMTCT outcomes and curbing mother-to-child transmission. Tailored interventions are vital in addressing HIV challenges in diverse contexts.

The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors.

Mother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission. We collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas. Overall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27-0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89-1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12-1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10-1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80-1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15-49 years) in 2022. Maternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.

"Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy": COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe.

The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal health services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers. Longitudinal in-depth interviews were conducted with 20 pregnant and breastfeeding women aged 20-39 years living with HIV and 20 healthcare workers in two maternity polyclinics in low-income suburbs of Harare, Zimbabwe. Semi-structured interviews were held after the second and third waves of COVID-19 in March and November 2021, respectively. Data were analysed using a modified grounded theory approach. While eight antenatal care contacts are recommended by Zimbabwe's Ministry of Health and Child Care, women reported only being able to access two contacts. Although HIV testing, antiretroviral therapy (ART) refills and syphilis screening services were accessible at first contact, other services such as HIV-viral load monitoring and enhanced adherence counselling were not available for those on ART. Closure of clinics and shortened operating hours during the second COVID-19 wave resulted in more antenatal bookings occurring later during pregnancy and more home deliveries. Six of the 20 (33%) interviewed women reported giving birth at home, assisted by untrained traditional midwives as clinics were closed. Babies delivered at home missed ART prophylaxis and HIV testing at birth despite being HIV-exposed. Although women faced multiple challenges, they continued to attempt to access services after delivery. These findings underline the importance of investing in robust health systems that can respond to emergency situations to ensure continuity of essential HIV prevention, treatment, and care services.