Analysis of the HIV Elimination of Mother-to-Child transmission policy Cascade in Suriname

Abstract

Background The calculation of the cascade for the Elimination Mother-to-Child-Transmission of HIV (EMTCT) enables the systematic evaluation of different steps in the health care system towards not transmitting HIV to the exposed infant. This study aims to calculate the EMTCT cascade and identify influencing sociodemographic and clinical factors for Suriname. Methods Descriptive analytical study using data regarding prenatal care for women 15–49 year collected in the Multi Indicator Cluster Survey (MICS) 2018. Furthermore, national data from infants and their HIV infected mothers born 2016 to 2018 were used. Multiple regression looking into sociodemographic and clinical factors effecting the transmission of HIV from mother-to-child was executed. Results In 89% (95%CI 85–92%) of the cases there was no transmission of HIV from mother-to-child. Earlier cascade steps show 38% unmet family planning needs and evaluating pregnant women 15% with no prenatal visit, 8% deliveries outside a health facility and 72% HIV test coverage during prenatal care. Of the 0.9% (95%CI 0.8-1.0) of pregnant women with HIV, the ART coverage was 84% (95%CI 80–88%). Their infants received HIV prophylactic treatment in 96% (95%CI 93–98%) and a PCR test after birth in 94% (95%CI 90–96%) of the cases. Increased odd of having a negative PCR result was linked with HIV treatment for mother (aOR 26.8, 95% CI 4.1–173.7) and child (aOR 33.9, 95% CI 2.7–419.7). This while living in the interior compared to urban living decreased the odds (aOR 0.8, 95% CI 0.6-1.0). Conclusions HIV medication for both HIV infected mothers and their infants remain key in the prevention of HIV mother-to-child-transmission. Prenatal care for pregnant women in general shows gaps reaching those important steps. Interventions with a particular focus on mothers living in the interior, guaranteeing the continuity of care are needed.