HIV testing and retention in care of infants born to HIV- infected women enrolled in ‘Option B+’, Thyolo, Malawi

Pérez, Guillermo Martínez; Metcalf, Carol; Garone, Daniela; Coulborn, Rebecca M.; Harries, A. D.; Hedt‐Gauthier, Bethany; Murowa, Michael; Mwenelupembe, G. S.; Bergh, Rafaël Van den; Durán, Laura Triviño

doi:10.5588/pha.14.0001

Cited by 15 publications

(13 citation statements)

References 2 publications

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“…Two studies from Malawi have described the risk of postpartum HIV transmission among HIV-exposed children who were retained in care and tested for HIV [25,26]. A cohort study from a large urban district hospital in Malawi’s capital Lilongwe showed that 6.2% of the enrolled children were diagnosed with HIV infection by age 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…A study from Thyolo district hospital in the Southern region of Malawi reported that 4.1% of the HIV-exposed children enrolled in the PMTCT programme were diagnosed as HIV infected at 12 months of age. Two thirds of the children were retained, but less than half of the children were tested for HIV at 12 months [26]. Neither of the two studies adjusted for missing data in children who were lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

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HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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Introduction: In Malawi, HIV-infected pregnant and breastfeeding women are offered lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage (Option B+). Their HIV-exposed children are enrolled in the national prevention of mother-to-child transmission (PMTCT) programme, but many are lost to follow-up. We estimated the cumulative incidence of vertical HIV transmission, taking loss to follow-up into account. Methods: We abstracted data from HIV-exposed children enrolled into care between September 2011 and June 2014 from patient records at 21 health facilities in central and southern Malawi. We used competing risk models to estimate the probability of loss to follow-up, death, ART initiation and discharge, and used pooled logistic regression and inverse probability of censoring weighting to estimate the vertical HIV transmission risk. Results: A total of 11,285 children were included; 9285 (82%) were born to women who initiated ART during pregnancy. At age 30 months, an estimated 57.9% (95% CI 56.6–59.2) of children were lost to follow-up, 0.8% (0.6–1.0) had died, 2.6% (2.3–3.0) initiated ART, 36.5% (35.2–37.9) were discharged HIV-negative and 2.2% (1.5–2.8) continued follow-up. We estimated that 5.3% (95% CI 4.7–5.9) of the children who enrolled were HIV-infected by the age of 30 months, but only about half of these children (2.6%; 95% CI 2.3–2.9) were diagnosed. Conclusions: Confirmed mother-to-child transmission rates were low, but due to poor retention only about half of HIV-infected children were diagnosed. Tracing of children lost to follow-up and HIV testing in outpatient clinics should be scaled up to ensure that all HIV-positive children have access to early ART.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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“…There is substantial body of literature from elsewhere on the effectiveness of the PMTCT programme in reducing transmission from mother to child, but data from Africa about the operational effectiveness of Option B+ in the PMTCT are sparse (17,(19)(20)(21)(22)(23)(24)(25)(26)(27). Particularly in Zambia the effectiveness of option B+ has not been evaluated, as far as we are aware, thereby raising concerns on its effectiveness in the elimination of MTCT.…”

Section: (Regardless Of Clinical Stage) Option a Regimen Included Aztmentioning

confidence: 99%

Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data

Muyunda

Musonda

Mee

et al. 2020

Front. Public Health

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Background: Mother to child transmission of HIV (MTCT) is a global challenge affecting many countries especially in sub-Saharan Africa. In 2009 about 370,000 infants were infected with HIV mainly through MTCT and most of them in sub-Saharan Africa. We aimed to determine the effectiveness of Option B+ compared to other options in reducing rates of early MTCT of HIV infections in Zambia. Methods: This was a retrospective cohort study based on routinely collected data using SmartCare in Zambia. Survival analysis with Cox Proportional Hazard regression was used to determine association between MTCT and regimen type of mothers. Kaplan-Meier (K-M) curves were used to compare MTCT for infants born to mothers option B+ to those on other options, and Wilcoxon (Breslow) test was used to establish statistical significance.

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“…12 , 13 However, little attention has focused on infant outcomes, 14 – 18 particularly HIV diagnosis, transmission, and treatment. 19 , 20 We assessed the impact of the change to B+ on the infant PMTCT cascade, by comparing service uptake pre- and post-B+ implementation (post-B+) at 2 large health centers in urban Lilongwe.…”

Section: Introductionmentioning

confidence: 99%

Brief Report

Kim

Ahmed

Hosseinipour

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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HIV testing and retention in care of infants born to HIV- infected women enrolled in ‘Option B+’, Thyolo, Malawi

Cited by 15 publications

References 2 publications

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Effectiveness of Lifelong ART (Option B+) in the Prevention of Mother-to-Child Transmission of HIV Programme in Zambia: Observations Based on Routinely Collected Health Data

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