PMTCT Service Uptake Among Adolescents and Adult Women Attending Antenatal Care in Selected Health Facilities in Zimbabwe

Abstract

Background:Age-disaggregated analyses of prevention of mother-to-child transmission (PMTCT) program data to assess the uptake of HIV services by pregnant adolescent women are limited but are critical to understanding the unique needs of this vulnerable high-risk population.Methods:We conducted a retrospective analysis of patient-level PMTCT data collected from 2011 to 2013 in 36 health facilities in 5 districts of Zimbabwe using an electronic database. We compared uptake proportions for PMTCT services between adolescent (≤19 years) and adult (>19 years) women. Multivariable binomial regression analysis was used to estimate the association of the women's age group with each PMTCT service indicator.Results:The study analyzed data from 22,215 women aged 12–50 years (22.5% adolescents). Adolescents were more likely to present to antenatal care (ANC) before 14 weeks of gestational age compared with older women [adjusted relative risk (aRR) = 1.34; 95% confidence interval: 1.22 to 1.47] with equally low rates of completion of 4 ANC visits. Adolescents were less likely to present with known HIV status (aRR = 0.34; 95% confidence interval: 0.29 to 0.41) but equally likely to be HIV tested in ANC. HIV prevalence was 5.5% in adolescents vs 20.1% in adults. While >84% of both HIV-positive groups received antiretroviral drugs for PMTCT, 44% of eligible adolescents were initiated on antiretroviral therapy vs 51.3% of eligible adults, though not statistically significant.Conclusions:Pregnant adolescents must be a priority for primary HIV prevention services and expanded HIV treatment services among pregnant women to achieve an AIDS-free generation in Zimbabwe and similar high HIV burden countries.

Understanding the uptake of prevention of mother-to-child transmission services among adolescent girls in Sub-Saharan Africa: a review of literature

“…In Kenya, Ronen et al found that the proportion of women attending at least four ANC visits as recommended by the national guidelines was significantly lower in adolescents than adults (35.2% vs. 45.6%, P = 0.002) (Ronen et al, 2017). Similar rates of completion of four ANC visits were found among adolescents (38.9%) and adults (36.7%) by Musaradenga et al in Zimbabwe [aRR = 0.98 (0.94-1.031)] (Musarandega et al, 2017). Also, among women attending immunization clinics in South Africa, Horwood et found that a comparable number of adolescent mothers <20 years and older mothers attended ANC four times during their recent pregnancy, i.e.…”

“…Also, in the cross-sectional surveys in South Africa, Ramraj et al found that in the 2010 survey, the proportion of adolescents and adults who attended ANC in the first trimester were comparable; 25.7% vs 27.0%, p = 0.38 while the proportion of adolescents attending ANC in the first trimester was lower compared to adult women in the 2011-2012 survey; 24.9% vs.30.3%, p = 0.0002 and in the 2012-2013 survey, 27.8% vs 33.7% (Ramraj et al, 2018). The findings of the five studies (Helleringer, 2017;Horwood et al, 2013;Musarandega et al, 2017;Ramraj et al, 2018;Ronen et al, 2017) that assessed the frequency of ANC visits were variable. In Kenya, Ronen et al found that the proportion of women attending at least four ANC visits as recommended by the national guidelines was significantly lower in adolescents than adults (35.2% vs. 45.6%, P = 0.002) (Ronen et al, 2017).…”

“…In Kenya, Ronen et al found that of the 498 HIV-positive breastfeeding women, 21 (4.2%) were ≤19 years old (Ronen et al, 2017). In the study by Musaradenga et al in Zimbabwe, among the 3709 HIV-positive women accessing PMTCT services in ANC, 9.5% were adolescents <19 years (Musarandega et al, 2017).…”

“…Overall, seven studies assessed ANC attendance (Fatti, Shaikh, Eley, Jackson, & Grimwood, 2014;Helleringer, 2017;Horwood et al, 2013;Musarandega et al, 2017;Ramraj et al, 2018;Ronen et al, 2017;Woldesenbet et al, 2015); six compared timing of ANC and five compared frequency of ANC visits. Four of the six studies (Fatti et al, 2014;Helleringer, 2017;Musarandega et al, 2017;Ramraj et al, 2018;Ronen et al, 2017;Woldesenbet et al, 2015) that compared timing of ANC attendance found that adolescents attended ANC either earlier or at a comparable gestational age than adults, while two studies described mixed results. Musaradenga et al found that compared to older women, adolescents ≤19 years were more likely to present to ANC before 14 weeks gestational age (adjusted relative risk (aRR) = 1.34; 1.22-1.47) in primary health centres in Zimbabwe (Musarandega et al, 2017).…”

“…Four of the six studies (Fatti et al, 2014;Helleringer, 2017;Musarandega et al, 2017;Ramraj et al, 2018;Ronen et al, 2017;Woldesenbet et al, 2015) that compared timing of ANC attendance found that adolescents attended ANC either earlier or at a comparable gestational age than adults, while two studies described mixed results. Musaradenga et al found that compared to older women, adolescents ≤19 years were more likely to present to ANC before 14 weeks gestational age (adjusted relative risk (aRR) = 1.34; 1.22-1.47) in primary health centres in Zimbabwe (Musarandega et al, 2017). In South Africa, Fatti et al reported no differences in gestational age at ANC booking between adolescents ≤19 years, women 20-24 years old and older women (p = 0.76) (Fatti et al, 2014).…”