Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

Buzdugan, Raluca; Dufour, Mi‐Suk Kang; McCoy, Sandra I.; Watadzaushe, Constancia; Dirawo, Jeffrey; Mushavi, Angela; Mujuru, Hilda; Mahomva, Agnes; Kangwende, Rugare Abigail; Anna, Hakobyan; Mugurungi, Owen; Cowan, Frances M; Padian, Nancy

doi:10.1097/qad.0000000000001111

Cited by 18 publications

(16 citation statements)

References 11 publications

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“…Compared to three studies of population-level MTCT rates, the 2016 modelled estimates are within the confidence intervals, or comparable, to the study results[21–23]. The modelled transmission rates for South Africa at age six weeks in the calendar year 2011 was 4.0% while the transmission rate from the South African Impact Assessment was 3.5% (2.9%–4.1%)[22] (see Figure 4).…”

Section: Resultssupporting

confidence: 64%

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

Mahy

Penazzato

Ciaranello

et al. 2017

Aids

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Objective Estimated numbers of children living with HIV determine programmatic and treatment needs. We explain the changes made to the UNAIDS estimates between 2015 and 2016 and describe the challenges around these estimates. Methods Estimates of children newly infected, living with HIV, and dying of AIDS are developed by country teams using Spectrum software. Spectrum files are available for 160 countries, which represent 98% of the global population. In 2016, the methods were updated to reflect the latest evidence on mother-to-child HIV transmission and improved assumptions on the age children initiate antiretroviral therapy. We report updated results using the 2016 model and validate these estimates against mother- to-child transmission rates and HIV prevalence from population-based surveys for the survey year. Results The revised 2016 model estimates 27% fewer children living with HIV in 2014 than the 2015 model, primarily due to changes in the probability of mother-to-child transmission among women with incident HIV during pregnancy. The revised estimates were consistent with population-based surveys of HIV transmission and HIV prevalence among children 5–9 years, but were lower than surveys among children 10–14 years. Conclusions The revised 2016 model is an improvement on previous models. Paediatric HIV models will continue to evolve as further improvements are made to the assumptions. Commodities forecasting and programme planning rely on these estimates and increasing accuracy will be critical to enable effective scale-up and optimal use of resources. Efforts are needed to improve empirical measures of HIV prevalence, incidence and mortality among children.

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Section: Resultssupporting

confidence: 64%

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

Mahy

Penazzato

Ciaranello

et al. 2017

Aids

View full text Add to dashboard Cite

show abstract

“…Mother-to-child-transmission risk Compared to two studies of population-level MTCT rates, the 2016 modelled estimates are within the confidence intervals (CIs), or comparable, to the study results [22,23]. The modelled transmission rates for South Africa at age 6 weeks in the calendar year 2011 was 4.0%, whereas the transmission rate from the South African Impact Assessment was 3.5% (2.9-4.1%) [22] (see Fig.…”

Section: Validation Of Spectrum Projectionssupporting

confidence: 55%

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

2017

Aids

View full text Add to dashboard Cite

Objective: Estimated numbers of children living with HIV determine programmatic and treatment needs. We explain the changes made to the UNAIDS estimates between 2015 and 2016, and describe the challenges around these estimates.Methods: Estimates of children newly infected, living with HIV, and dying of AIDS are developed by country teams using Spectrum software. Spectrum files are available for 160 countries, which represent 98% of the global population. In 2016, the methods were updated to reflect the latest evidence on mother-to-child HIV transmission and improved assumptions on the age children initiate antiretroviral therapy. We report updated results using the 2016 model and validate these estimates against mother-to-child transmission rates and HIV prevalence from population-based surveys for the survey year.Results: The revised 2016 model estimates 27% fewer children living with HIV in 2014 than the 2015 model, primarily due to changes in the probability of mother-to-child transmission among women with incident HIV during pregnancy. The revised estimates were consistent with population-based surveys of HIV transmission and HIV prevalence among children aged 5-9 years, but were lower than surveys among children aged 10-14 years. Conclusions:The revised 2016 model is an improvement on previous models. Paediatric HIV models will continue to evolve as further improvements are made to the assumptions. Commodities forecasting and programme planning rely on these estimates, and increasing accuracy will be critical to enable effective scale-up and optimal use of resources. Efforts are needed to improve empirical measures of HIV prevalence, incidence, and mortality among children.

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“…[7] In a community-based survey in Zimbabwe in 2014 (post-Option A rollout), HIV-free survival was reported as 95.1%. [11] In South Africa, results in a prospective facility-based cohort study showed an HIV-free survival rate of 93.7% at 18 months[12], while in Nigeria, HIV-free survival was reported to be 86.2% at 18 months in a facility-based retrospective cohort study. [13]…”

Section: Discussionmentioning

confidence: 99%

“…[7] In Zimbabwe, MTCT of HIV was estimated at 4.8% in the post-Option A implementation period. [11] Using Spectrum models, MTCT in 2015 in Swaziland is estimated at 6.72% by the end of breastfeeding. [18] The difference between our findings and the Spectrum estimates may be due to differences in methodology (i.e., use of models vs observational study) and the possibility that our study had inaccurate ascertainment of child death, as discussed earlier.…”

Section: Discussionmentioning

confidence: 99%

Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey

et al. 2018

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In Swaziland, no data are available on the rates of HIV infection and HIV-free survival among children at the end of the breastfeeding period. We performed a national crosssectional community survey of children born 18-24 months prior to the study, in randomly selected constituencies in all 4 administrative regions of Swaziland, from April to June 2015. Mother-to-child transmission (MTCT) of HIV and HIV-free survival rates were calculated for all HIV-exposed children. The overall HIV-free survival rate at 18-24 months was 95.9% (95% CI 94.1-97.2). The estimated proportion of HIV infected children among known HIV-exposed children was 3.6% (95% CI 2.4-5.2). Older maternal age, delivering at a health facility, and receiving antenatal antiretroviral drugs were independently associated with reduced risk for child infection or death. The Swaziland program for prevention of MTCT achieved high HIV-free survival (95.9%) and low MTCT (3.6%) rates at 18-24 months of age when Option A (infant prophylaxis) of the WHO 2010 guidelines was implemented.

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Option A improved HIV-free infant survival and mother to child HIV transmission at 9–18 months in Zimbabwe

Cited by 18 publications

References 11 publications

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

Improving estimates of children living with HIV from the Spectrum AIDS Impact Model

Mother-to-Child Transmission of HIV and HIV-Free Survival in Swaziland: A Community-Based Household Survey

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