Reducing vertical HIV transmission in Kinshasa, Democratic Republic of Congo: trends in HIV prevalence and service delivery

Abstract

Scale-up of vertical HIV transmission prevention has been too slow in sub-Saharan Africa. We describe approaches, challenges, and results obtained in Kinshasa. Staff members of 21 clinics managed by public servants or non-governmental organizations were trained in improved basic antenatal care (ANC) including nevirapine (NVP)-based HIV transmission prevention. Program initiation was supported on-site logistically and technically. Aggregate implementation data were collected and used for program monitoring. Contextual information was obtained through a survey. Among 45,262 women seeking ANC from June 2003 through July 2005, 90% accepted testing; 792 (1.9%) had HIV of whom 599 (76%) returned for their result. Among 414 HIV+ women who delivered in participating maternities, NVP coverage was 79%; 92% of newborns received NVP. Differences were noted by clinic management in program implementation and HIV prevalence (1.2 to 3.0%). Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time. Scope and quality of service coverage should further increase; strategies to decrease loss to follow-up of HIV+ women should be identified to improve program effectiveness. The observed differences in HIV prevalence highlight the importance of selecting representative sentinel surveillance centers.

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

“…Of the 41 included studies, 17 described PMTCT programs in low-income [46]–[50], [52]–[55], [57]–[59], [61]–[63], [67], [80], 15 in lower-middle income [41], [43]–[45], [56], [64], [65], [70], [72], [74], [76]–[79], [81], and nine in upper-middle income countries [42], [51], [60], [66], [68], [69], [71], [73], [75]. The presented PMTCT programs were implemented at different time periods between years 1997 and 2006 (Figure S1).…”

“…Some studies reported that the confidentiality of counseling was not always achieved due to partially opened doors, interruptions during counseling and lack of space for counseling [50], [59], [60]. Several studies presented activities undertaken to ensure confidentiality of counseling, e.g.…”

“…Several studies identified lack of human, material, and financial resources (with stock-outs of HIV test kits, ARV prophylaxis and ART) as a key barrier to implementation of integrated care in low- and middle-income countries [50], [61]–[64], [67], [74], [76].…”

“…One study reported that health workers were reluctant to give ARV prophylaxis to women in antenatal care as they believed women would not take the medication provided [50].…”

Implementation and Operational Research

“…25 This package, instituted in June 2010 in 37 of the city’s highest volume facilities, has been described previously. 24–26 …”