Effectiveness of prevention of mother‐to‐child <scp>HIV</scp> transmission programmes in <scp>K</scp>ilimanjaro region, northern <scp>T</scp>anzania

Mwendo, Emanuel; Mtuy, Tara; Renju, Jenny; Rutherford, George W.; Nondi, Joseph; Sichalwe, Aifello W.; Todd, Jim

doi:10.1111/tmi.12255

Cited by 18 publications

(24 citation statements)

References 7 publications

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“…Comparative to rates reported in Tanzania and Ethiopia, the rate of MTCT in this study cohort is low. Mwendo and colleagues [10] reported a 9.6% MTCT rate in Kilimanjaro region, Tanzania. The variation in rate of transmission between this study and the one carried out in Tanzania could be attributed to accessibility of health services by study participants in both studies.…”

Section: Discussionmentioning

confidence: 98%

Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

et al. 2020

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Background: Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-tochild HIV-transmission (MTCT) and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. Methods: Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not completed their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers' characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. Results: Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother's clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU by 18 months of age while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as "waiting time" which would not be found in routine client databases.

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Section: Discussionmentioning

confidence: 98%

Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

et al. 2020

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“…One study of 561 infants who received care between 2009 and 2012 in the Kilimanjaro Region of Tanzania reported 10% mother-to-child HIV transmission [25], despite the provision of prophylactic regimens that were expected to reduce vertical transmission to below 5% [12]. Another study of 311 mother–infant pairs in Malawi was able to reduce transmission to 3%, but 14% of infants died by 24 months of age [26].…”

Section: Introductionmentioning

confidence: 99%

Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007–2013)

Feinstein

Edmonds²,

Chalachala

et al. 2014

Aids

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Objective Guidelines for prevention of mother-to-child transmission of HIV have developed rapidly, yet little is known about how outcomes of HIV-exposed infants have changed over time. We describe HIV-exposed infant outcomes in Kinshasa, Democratic Republic of Congo, between 2007 and 2013. Design Cohort study of mother–infant pairs enrolled in family-centered comprehensive HIV care. Methods Accounting for competing risks, we estimated the cumulative incidences of early infant diagnosis, HIV transmission, death, loss to follow-up, and combination antiretroviral therapy (cART) initiation for infants enrolled in three periods (2007–2008, 2009–2010, and 2011–2012). Results 1707 HIV-exposed infants enrolled at a median age of 2.6 weeks. Among infants whose mothers had recently enrolled into HIV care (N = 1411), access to EID by age two months increased from 28% (95% confidence limits [CL]: 24,34%) among infants enrolled in 2007-2008 to 63% (95% CL: 59,68%) among infants enrolled in 2011–2012 (Gray's p-value <0.01). The 18-month cumulative incidence of HIV declined from 16% (95% CL: 11,22%) for infants enrolled in 2007–2008 to 11% (95% CL: 8,16%) for infants enrolled in 2011–2012 (Gray's p-value = 0.19). The 18-month cumulative incidence of death also declined, from 8% (95% CL: 5,12%) to 3% (95% CL: 2,5%) (Gray's p-value = 0.02). LTFU did not improve, with 18-month cumulative incidences of 19% (95% CL: 15,23%) for infants enrolled in 2007-2008 and 22% (95% CL: 18,26%) for infants enrolled in 2011–2012 (Gray's p-value = 0.06). Among HIV-infected infants, the 24-month cumulative incidence of cART increased from 61% (95% CL: 43,75%) to 97% (95% CL: 82,100%) (Gray's p-value < 0.01); the median age at cART decreased from 17.9 to 9.3 months. Outcomes were better for infants whose mothers enrolled before pregnancy. Conclusions We observed encouraging improvements, but continued efforts are needed.

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“…Collection of high-quality routine data on these services and outcomes for HIV-positive mothers and HIV-exposed infants is not only essential for monitoring and evaluation of PMTCT programmes relative to local, national, and international targets, but also paramount in the clinical management of patients and in managing stocks of HIV test kits and drugs. Recording and using data from each service component is important, as one component may suggest high coverage and impact, but may mask dropouts further along the cascade ( 4 ).…”

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confidence: 99%

Challenges with routine data sources for PMTCT programme monitoring in East Africa: insights from Tanzania

Gourlay

Wringe

Todd

et al. 2015

Global Health Action

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Routinely collected clinic data have the potential to provide much needed information on the uptake of services to prevent mother-to-child transmission (PMTCT) of HIV, and to measure HIV prevalence in pregnant women. This article describes the methodological challenges associated with using such data, based on the experiences of researchers and programme implementers in Tanzania and drawing from other examples from East Africa. PMTCT data are routinely collected in maternal and child health (MCH) clinics in East Africa using paper-based registers corresponding to distinct services within the PMTCT service continuum. This format has inherent limitations with respect to maintaining and accurately recording unique identifiers that can link patients across the different clinics (antenatal, delivery, child), and also poses challenges when compiling aggregate data. Recent improvements to recording systems include assigning unique identifiers to HIV-positive pregnant women in MCH clinics, although this should ideally be extended to all pregnant women, and recording mother and infant identifiers alongside each other in registers. The use of ‘health passports’, as in Malawi, which maintains the same antenatal clinic identifier over time, also holds promise. Routine data hold tremendous potential for clinic-level patient management, surveillance, and evaluating PMTCT/MCH programmes. Linking clinic data to community research datasets can also provide population-level estimates of coverage with PMTCT services, currently a problematic but vital statistic for monitoring programme performance and negotiating donor funding. Enhancements to indexing and recording of routine PMTCT/MCH data are needed if we are to capitalise on this rich data source.

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Effectiveness of prevention of mother‐to‐child HIV transmission programmes in Kilimanjaro region, northern Tanzania

Cited by 18 publications

References 7 publications

Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

Temporal changes in the outcomes of HIV-exposed infants in Kinshasa, Democratic Republic of Congo during a period of rapidly evolving guidelines for care (2007–2013)

Challenges with routine data sources for PMTCT programme monitoring in East Africa: insights from Tanzania

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