Integrating prevention of mother-to-child HIV transmission (PMTCT) programmes with other health services for preventing HIV infection and improving HIV outcomes in developing countries

Car, Lorainne Tudor; van-Velthoven, Michelle HMMT; Brusamento, Serena; Elmoniry, Hoda; Car, Josip; Majeed, Azeem; Atun, Rifat

doi:10.1002/14651858.cd008741.pub2

Cited by 65 publications

(55 citation statements)

References 30 publications

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“…Delays or missed steps in this PMTCT cascade compromise efforts to reduce pediatric HIV infections. While HIV testing has been broadly expanded and time to ARV initiation has been expedited with Option B+, non-adherence and poor retention in PMTCT programs remain problematic (Stringer et al, 2013; Tudor Car et al, 2011; Turan & Nyblade, 2013). Moreover, individual and community-wide efforts are needed to reduce barriers and improve utilization of PMTCT services (Ferguson et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Areas of high HIV prevalence may have broader access to integrated services, more experience of health care providers and more maternal and community familiarity with HIV and PMTCT interventions, which may lead to improved programs and lower rates of infant HIV infection. Conversely, in settings with lower HIV prevalence, mothers may have less awareness or experience with HIV interventions, health providers may have limited experience in managing or counseling women, peer counselors may be less conversant with relevant issues, and systems may be more erratic if not frequently used, all leading to less effective programs (Tudor Car et al, 2011; Turan & Nyblade, 2013). To reach UNAIDS targets for elimination of infant HIV infection, it is important to define barriers to PMTCT implementation and to identify components or characteristics of effective PMTCT programs.…”

Section: Introductionmentioning

confidence: 99%

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Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

et al. 2017

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Health worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0-18.3%) in 6-week and 8.9% (3.2-22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 57% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4-5.3%) at 6-week and 5.1% (2.5-9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P=0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR=12.8 (3.0-54.3); aOR=5.6 (1.2-27.4); aOR=4.5 (1.0-20.0), aOR=2.5, (0.8-8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

et al. 2017

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“…Currently, public health officials are looking for strategies to eliminate vertical transmission of HIV and, despite a lack of compelling data, integration of care has been proposed as a key strategy in the fight for eMTCT. 1,4,20-22 …”

Section: Discussionmentioning

confidence: 99%

“…Despite limited evidence, 20,22 integration of ANC, PMTCT and HIV services has been promoted by the WHO and Ministries of Health across much of sub-Saharan Africa as a strategy to help achieve the elimination of MTCT. 4,26-32 In 2009, the NIH Office of AIDS Research identified as a top priority research on how to promote women's linkage to and retention in care at each step of the PMTCT cascade.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Operational Research

Washington

Owuor

Turan

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Many HIV-infected pregnant women identified during antenatal care do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. Methods We performed a cluster-randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, PMTCT, and HIV care delivered in the ANC clinic; n=6 intervention facilities), or standard ANC services (including PMTCT and referral to a separate clinic for HIV care; n=6 control facilities). Results There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was twelve month follow up data for 256/611 (41.8%) women, and postpartum data for only 325/1172 (28%) women. By 9 months of age, 382/568 (67.3%) infants at intervention sites and 338/594 (57.0%) at control sites had tested for HIV (OR 1.45, 95% CI 0.71-2.82); 7.3% of infants tested HIV-positive at intervention sites compared to 8.0% of infants at control sites (OR 0.89, 95% CI 0.56-1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1 %, OR 0.83, 95% CI 0.41 - 1.68). Conclusions Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk HIV transmission to infants and did not appear to affect short-term maternal health outcomes.

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“…HIV transmission from mother to baby can occur in utero during the intrapartum period or postnatally through breast-feeding. In high-income countries, the MTCT rate is less than 1% through perinatal prevention of mother-to-child HIV transmission (PMTCT) interventions (Tudor Car et al, 2011). In low-and middle-income countries, PMTCT programme coverage remains low and consequently transmission rate high (Byrne et al, 2012).…”

Section: Hiv and Infant Feeding: The Global Picturementioning

confidence: 99%

Breast-feeding and HIV transmission: An analysis of the factors influencing HIV positive mothers decision to breast-feed – A case study approach

Oliver¹,

Petty

2012

Journal of Neonatal Nursing

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Integrating prevention of mother-to-child HIV transmission (PMTCT) programmes with other health services for preventing HIV infection and improving HIV outcomes in developing countries

Cited by 65 publications

References 30 publications

Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

Implementation and Operational Research

Breast-feeding and HIV transmission: An analysis of the factors influencing HIV positive mothers decision to breast-feed – A case study approach

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