Evaluation of a 5-year Programme to Prevent Mother-to-child Transmission of HIV Infection in Northern Uganda

Abstract

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.

Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India

“…These results were similar to those reported from Uganda[21]. Furthermore, the ORWs reported that women were reluctant to remain in care due to the rude behavior of PMTCT providers at ICTC clinics, lack of sufficient staff, lack of testing kits for babies, and drug stock-outs.…”

“…The ORWs reported that mothers were demotivated from bringing their babies for HIV testing due to lack of knowledge about baby’s HIV testing at four time points, lack of availability of testing kits, and lack of personnel trained to collect blood from babies for HIV testing. These results are consistent with those reported from South Africa [26] and Uganda [21]. Loss to follow up of HIV exposed infants is reported to be 29%, according to the Indian PMTCT program [27] A study in Nigeria [28] suggested the utility of cross-cutting interventions, including recruitment and retention of motivated healthcare workers in PMTCT implementation and training.…”

Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programme, Gulu-Uganda: a cohort study

“…However, in sub-Saharan Africa, up to 81% of mother-baby pairs are not retained in care six months after delivery [8, 9]. In Uganda, loss to follow-up (LTFU) of mother-baby pair has been reported to be 53.4% [10]. Literature shows that the majority of mother-baby pairs who are not retained in eMTCT programmes are due to LTFU and not death [11], suggesting that the infants remain alive, but at higher risk of acquisition of HIV from their mother than infants who remain in care.…”

Evaluación inicial del programa de prevención de la transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana en Guinea Ecuatorial

“…Se trata de una cifra muy elevada, muy superior a las de publicaciones similares sobre programas nacionales, bien implementados, que están en torno al 10-15%. Un trabajo en Uganda encontró una transmisión acumulada del 8% pero que aumentaba al 15% si se incluían los niños no confirmados fallecidos 16 . En Botswana, uno de los países donde se han realizado mayores esfuerzos en el control de la transmisión vertical de VIH, se han registrado tasas de infección del 7% 17 .…”