Early Identification and Care of HIV-Exposed and HIV-Infected Children in Rural Africa

Baets, Anniek J. De; Sifovo, Sibongile; Pazvakavambwa, Isidore E.

doi:10.1097/qai.0b013e31816e398b

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…In this study, baseline characteristics did not effectively identify women at risk of loss, so interventions toward improving retention should be applied uniformly. A variety of strategies to improve retention have been studied including, but not limited to, decentralization of services [33,34], integration of services [35-38], use of treatment partners [39], male involvement [18,40,41], accompaniment between clinics [42], active patient tracking [43], nutritional supplements [44,45], reimbursement of transportation costs [46], use of mobile technology for reminders [35], and reduced pill burden [47,48]. Additionally, streamlining treatment protocols has the potential to reduce loss by increasing the number of women initiated on treatment early, and the full impact of the 2013 WHO guidelines remains to be seen.…”

Section: Discussionmentioning

confidence: 99%

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Rawizza

Chang

Chaplin³

et al. 2015

CHR

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Background The 2013 WHO guidelines incorporated simplified and more effective antiretroviral regimens for the purposes of preventing mother-to-child transmission of HIV. With ideal implementation of these recommendations, perinatal HIV transmission could be reduced to less than 2%. However, loss to follow-up (LTFU) has the potential to erode the success of programs and a number of studies report high rates of LTFU within the prevention of mother-to-child transmission (PMTCT) care cascade. We evaluated the timing and magnitude of LTFU in a large programmatic PMTCT cohort in Nigeria in order to focus future efforts to reduce loss in this high burden setting. Methods From 2004-2014, the APIN/Harvard PEPFAR program supported antenatal HIV screening for nearly one million pregnant women and provided PMTCT care to over 30,000 women. The care cascade for women enrolling in the PMTCT program includes antenatal, delivery, and infant follow-up services through 12-18 months of life. In this retrospective cohort analysis, we examined data collected between 2004-2014 from 31 clinical sites in Nigeria and assessed the numbers of mothers and infants enrolled and LTFU at various points along the care cascade. Results Among 31,504 women (median age 30, IQR: 27-34) entering PMTCT care during the antenatal period, 20,679 (66%) completed the entire cascade of services including antenatal, delivery, and at least one infant follow-up visit. The median gestational age at presentation for antenatal care services was 23 weeks (IQR: 17-29). The median infant age at last follow-up visit was 12 months (IQR: 5-18). The greatest loss in the PMTCT care cascade occurred prior to delivery care (21%), with a further 16% lost prior to first infant visit. Of the 38,223 women who entered at any point along the PMTCT cascade, an HIV DNA PCR was available for 20,202 (53%) of their infants. Among infants for whom DNA PCR results were available, the rate of HIV transmission for infants whose mothers received any antenatal and/or delivery care was 2.8% versus 20.0% if their mother received none. Conclusions In this large cohort analysis, the proportion of women LTFU in the PMTCT care cascade was lower than that reported in previous cohort analyses. Nevertheless, this proportion remains unacceptably high and inhibits the program from maximally achieving the goals of PMTCT care. We also provide the largest analysis to date on rates of perinatal HIV transmission, with low rates among women receiving NNRTI- or PI-based regimens, approaching that reported in clinical trials. However, among mothers who received any antenatal care, infant outcomes were unknown for 48%, and women presented later in pregnancy than that recommended by current guidelines. Implementation research to evaluate ways to improve integration of services, particularly transitions from antenatal to delivery and pediatric care, are critically needed to reduce LTFU within PMTCT programs and achieve the ultimate goal of eliminating pediatric HIV infection.

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Section: Discussionmentioning

confidence: 99%

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Rawizza

Chang

Chaplin³

et al. 2015

CHR

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“…22 Reinforcing the follow-up care of highrisk infants born to HIV-positive mothers especially needs to be addressed, preferably through HIV-specific services integrated into maternal and child health clinics or primary health care centers or family-friendly services in HIV clinics. 23 Integrating HIV screening into WHO Expanded Programs on Immunization in high-prevalence settings may be an option to increase HIV screening at very early ages.…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children <5 Years of Age

Sauvageot¹,

Schaefer

Olson

et al. 2010

Pediatrics

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Predictors of Attrition among Children Born in a PMTCT Programme in Zimbabwe Followed up over 5 Years

Kurewa¹,

Gumbo

Mapingure

et al. 2012

Journal of Tropical Pediatrics

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Eliminating of paediatric HIV within prevention of mother to child transmission (PMTCT) interventions rests on complete follow-up of all children. We report on predictors of child attrition in the PMTCT cascade over 5 years where 1050 pregnant women were enrolled at 36 gestational weeks. Mother and child pairs were followed up at birth, 6 weeks, 4 months, 9 months, and every 6 months thereafter for 60 months. Higher attrition was observed for children of economically advantaged, socially stable mothers regardless of HIV status, whereas compliance was observed for children whose mothers tested positive for HIV-1, HSV-2 and Syphilis. Low birthweight was associated with attrition regardless of maternal HIV status. Five years predictors of attrition did not differ by maternal HIV status, as HIV-exposed children succumbed to mortality and those not exposed were loss to follow-up (LFU). Child follow-up is influenced more by maternal lifestyle and health risks leading to retention of high-risk children in PMTCT programmes.

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Early Identification and Care of HIV-Exposed and HIV-Infected Children in Rural Africa

Cited by 6 publications

References 5 publications

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children <5 Years of Age

Predictors of Attrition among Children Born in a PMTCT Programme in Zimbabwe Followed up over 5 Years

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Early Identification and Care of HIV-Exposed and HIV-Infected Children in Rural Africa

Cited by 6 publications

References 5 publications

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Loss to Follow-Up within the Prevention of Mother-to-Child Transmission Care Cascade in a Large ART Program in Nigeria

Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children &lt;5 Years of Age

Predictors of Attrition among Children Born in a PMTCT Programme in Zimbabwe Followed up over 5 Years

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Antiretroviral Therapy Outcomes in Resource-Limited Settings for HIV-Infected Children <5 Years of Age