Gaps in the Care Cascade among Human Immunodeficiency Virus-Exposed Infants Born in 2017 in Mashonaland East Province of Zimbabwe

Abstract

Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis

“…The studies published between January 2012 and March 2022 were carried out in a range of East African countries; namely, Burundi [ 57 ], Comoros [ 57 ], Ethiopia [ 25 , 45 , 57 – 74 ], Kenya [ 57 , 75 – 78 ], Malawi [ 25 , 45 , 57 – 74 , 79 ], Mozambique [ 57 , 76 – 78 , 80 ], Rwanda [ 57 ], South Sudan [ 81 ], Tanzania [ 82 , 83 ], Uganda [ 39 , 57 , 84 – 87 ], Zambia [ 57 , 88 – 90 ], and Zimbabwe [ 57 , 91 – 96 ]. Studies conducted among eligible pregnant/postpartum women, infants and service providers were included in the analysis.…”

“…Community and health care factors : Six studies [ 25 , 57 , 58 , 63 , 66 , 103 ] showed the presence of an association between place residence and maternal HIV testing. However, two studies on maternal HIV testing [ 65 , 75 ] and three studies on EID [ 62 , 91 , 92 ] revealed the absence of statistical association with place of residence. Women who lived in a community where there was no/low stigmatized attitude toward people living with HIV/AIDS [ 25 , 58 ] were more likely to be HIV tested than those who lived in a community that stigmatized HIV-positive patients [ 63 , 75 ].…”

“…Studies conducted among eligible pregnant/postpartum women, infants and service providers were included in the analysis. Almost all the studies (44/52) were facility-based [23,25,39,45,[58][59][60][61][62][64][65][66][67][68][69][70][71][72][73][74][76][77][78][79][80][81][82][83][84][85][86][87][88][89][91][92][93][95][96][97][98][99][100][101]. Furthermore, the study design varied across studies: cross-sectional studies (n = 28); prospective cohort (n = 2); retrospective cohort (n = 6), retrospective chart review (n = 4), qualitative studies (n = 8) and mixed methods studies (n = 4).…”