Improved Detection of Incident HIV Infection and Uptake of PMTCT Services in Labor and Delivery in a High HIV Prevalence Setting

Kieffer, Mary Pat; Nhlabatsi, Bonisile; Mahdi, Mohammed; Hoffman, Heather J.; Kudiabor, Kwashie; Wilfert, Catherine M.

doi:10.1097/qai.0b013e31821acc6e

Cited by 25 publications

(25 citation statements)

References 9 publications

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“…This first description of HIV incidence in this population is consistent with studies in similar populations in other sub-Saharan African countries [14–19]. Our study confirms an active epidemic in the Southern region of the country, which was suggested in the epidemic trend analysis conducted in 2009 [9] using the Estimation and Projection Package [20].…”

Section: Discussionsupporting

confidence: 91%

High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

Schacht

Mabunda

Ferreira

et al. 2014

Journal of the International AIDS Society

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IntroductionAcute infection with HIV in the postpartum period results in a high risk of vertical transmission through breastfeeding. A study was done to determine the HIV incidence rate and associated risk factors among postpartum women in Southern Mozambique, where HIV prevalence among pregnant women is 21%.MethodsA prospective cohort study was conducted in six rural health facilities in Gaza and Maputo provinces from March 2008 to July 2011. A total of 1221 women who were HIV-negative on testing at delivery or within two months postpartum were recruited and followed until 18 months postpartum. HIV testing, collection of dried blood spot samples and administration of a structured questionnaire to women were performed every three months. Infant testing by DNA-PCR was done as soon as possible after identification of a new infection in women. HIV incidence was estimated, and potential risk factors at baseline were compared using Poisson regression.ResultsData from 957 women were analyzed with follow-up after the enrolment visit, with a median follow-up of 18.2 months. The HIV incidence in postpartum women is estimated at 3.20/100 women-years (95% CI: 2.30–4.46), with the highest rate among 18- to 19-year-olds (4.92 per 100 women-years; 95% CI: 2.65–9.15). Of the new infections, 14 (34%) were identified during the first six months postpartum, 11 (27%) between 6 and 12 months and 16 (39%) between 12 and 18 months postpartum. Risk factors for incident HIV infection include young age, low number of children, higher education level of the woman's partner and having had sex with someone other than one's partner. The vertical transmission was 21% (95% CI: 5–36) among newly infected women.ConclusionsIncidence of HIV is high among breastfeeding women in Southern Mozambique, contributing to increasing numbers of HIV-infected infants. Comprehensive primary prevention strategies targeting women of reproductive age, particularly pregnant and postpartum women and their partners, will be crucial for the elimination of paediatric AIDS in Africa.

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Section: Discussionsupporting

confidence: 91%

High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

Schacht

Mabunda

Ferreira

et al. 2014

Journal of the International AIDS Society

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“…Most studies measured several outcomes on the PMTCT cascade. Most studies were conducted in sub-Saharan Africa: 13 in South Africa [5–17]; eight in Kenya [18–25]; two studies each in Malawi [26,27], Zambia [28,29] and Mozambique [30,31]; and one study each in Democratic Republic of Congo [32], Swaziland [33], Tanzania [34], Rwanda [35] and Ethiopia [36]. Only one study was conducted in United States of America [37].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies evaluated structural interventions [9,10,18,20,24,28–30,33,35,37]. Structural interventions were defined as interventions that aimed to improve PMTCT service delivery by modifying the structural context of a health facility.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

Ambia

Mandala

2016

Journal of the International AIDS Society

128

115

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IntroductionThe success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps.MethodsSelected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis.ResultsInterventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings.ConclusionsOur findings indicate that mobile phone-based reminders may increase the uptake of EID of HIV. Studies on male partner involvement in PMTCT reported reductions in infant HIV transmission. Stronger evidence is needed and future studies should determine the long-term effects of these interventions in improving retention throughout the PMTCT steps.

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“…Phone calls or SMS text messaging have proven to be effective in increasing retention in several studies. [26–28] Furthermore, assignment of community health workers [29], as well as adherence counselling training for health care staff [30] were previously used to increase adherence in pregnancy and early infant diagnosis; these strategies should be adapted to the breastfeeding period. For health service implementers, it is highly relevant to understand in which time interval after delivery it could be especially difficult for mothers to adhere to drug regimens or pick up their drugs from the health facility.…”

Section: Discussionmentioning

confidence: 99%

Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda

et al. 2017

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Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.

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Improved Detection of Incident HIV Infection and Uptake of PMTCT Services in Labor and Delivery in a High HIV Prevalence Setting

Abstract: In high HIV prevalence settings, such as Swaziland, the incidence of HIV during pregnancy is high. An on-site training intervention for maternity nurses significantly increases the identification of HIV infection and maximizes the provision of PMTCT interventions.

Cited by 25 publications

References 9 publications

High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

High HIV incidence in the postpartum period sustains vertical transmission in settings with generalized epidemics: a cohort study in Southern Mozambique

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda

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