Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

Abstract

Background:To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets.Methods:Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU).Results:Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants.Conclusion:Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.

Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013–2016

“…2 Our findings align with other studies that suggest that greater focus is needed on service implementation across the infant cascade of care if progress towards global targets for infants is to be accelerated. 30 The introduction of Option B+ led to concerns that health systems may be insufficiently prepared for the resulting increase in client numbers. Our findings suggest that supplying sufficient HIV test kits to meet demand in these rural areas was a persistent challenge, with all sites still reporting stock-outs by round 2.…”

Smartphone usage and preferences among postpartum HIV-positive women in South Africa

“…There is growing evidence of women dropping out of HIV care during pregnancy and, more frequently, after delivery (Clouse et al, 2013;Gumede-Moyo et al, 2017;Shaffer, N., Abrams, E. J., & Becquet, 2014;Sibanda, Weller, Hakim, & Cowan, 2013;Wang et al, 2011). This raises concerns about whether current MTCT rates will reach the targeted zero mark (South African National AIDS Council, 2017).…”

Access to prevention of mother‐to‐child transmission of HIV along HIV services cascade through integrated active case management in 15 operational districts in Cambodia

“…It should also be acknowledged that the main focus of IACM approach was not pregnant women and PMTCT, as CMA had to deal with all new HIV‐positive cases among which pregnant women represented only a small proportion. The “post‐partum” gap remains a major challenge for PMTCT programmes in Cambodia, similarly to many other settings . Continuously declining external funds represent a challenge for further improvement in PMTCT cascade outcomes.…”

“…Monitoring and evaluation as well as operational research are crucial to adapting and improving PMTCT programmes . Moreover, cohort data collection, even on a subset of sites, has been recommended in order to get more reliable information and support in national data modelling systems .…”