Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

Abstract

BackgroundThe prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013.ObjectiveThe objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam.MethodsThis community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp).ResultsA total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%.ConclusionsA combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed.

<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

“…In our study, the rate of MTCT has been decreasing through time in parallel with the increased coverage of ART intervention for women during pregnancy. Similar results were observed in Thai Nguyen, Vietnam 11 and in other Asian countries. In a prospective study during 2004–2011 in eight counties in China, Wang et al 19 reported that vertical transmission of HIV declined from 11.2 to 1.2%, corresponding to an increase in ART coverage for pregnant women from 61% to 96%.…”

“…In one study conducted in Thai Nguyen, Vietnam, the authors reported that the rate of transmission decreased from 27.3% in 2008 to 6.7% in 2012. 11 The purpose of this study is to determine the evolution of the HIV transmission rate in infants from 2007 to 2018 and to identify risk factors of HIV transmission among HIV-exposed infants at one pOPC in An Giang province, Vietnam.…”

“…In one study conducted in Thai Nguyen, Vietnam, the authors reported that the rate of transmission decreased from 27.3% in 2008 to 6.7% in 2012. 11 …”

Feasibility, benefits, and cost-effectiveness of adding universal hepatitis B and syphilis testing to routine antenatal care services in Thai Nguyen province, Vietnam

“…ART coverage in pregnant women in the province increased from 18.2% in 2008 to 70% in 2011. 27 A national assessment of HIV MTCT rates among children who were diagnosed in early infancy also showed a decrease but rates remained high at 8.3% in 2012. 28 Vietnam aims to achieve an MTCT rate of less than 2% by 2020.…”

Know Your Epidemic, Strengthen Your Response: Developing a New HIV Surveillance Architecture to Guide HIV Resource Allocation and Target Decisions

“…Concluding that integration or linkage is possible, the authors presented an approach to align the two streams of strategic information. Linkage across health sectors is something Nguyen et al call for in their analyses of a community-based retrospective cohort study among pregnant women diagnosed with HIV infection in Vietnam [ 11 ]. To bridge serious gaps in efforts to eliminate mother-to-child transmission, the authors endorsed data linkage across HIV and maternal and child health programs.…”