Prevention of mother-to-child transmission of HIV in rural Uganda: Modelling effectiveness and impact of scaling-up PMTCT services

Abstract

BackgroundThe reported coverage of any antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission (PMTCT) has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is subject to overestimations since it only considers enrolment and not completion of the PMTCT programme. The PMTCT programme is complex as it builds on a cascade of sequential interventions that should take place to reduce mother-to-child transmission (MTCT) of HIV: starting with antenatal care (ANC), HIV testing, and ARVs for the woman and the baby.ObjectiveThe objective was to estimate the number of children infected with HIV in a district population, using empirical data on uptake of PMTCT components combined with data on MTCT rates.DesignThis study is based on a population-based cohort of pregnant women recruited in the Iganga-Mayuge Health and Demographic Surveillance Site in rural Uganda 2008–2010. We later modelled different scenarios assuming increased uptake of specific PMTCT components to estimate the impact on MTCT for each scenario.ResultsIn this setting, HIV infections in children could be reduced by 28% by increasing HIV testing capacity at health facilities to ensure 100% testing among women seeking ANC. Providing ART to all women who received ARV prophylaxis would give an 18% MTCT reduction.ConclusionsOur results highlight the urgency in scaling-up universal access to HIV testing at all ANC facilities, and the potential gains of early enrolment of all pregnant women on antiretroviral treatment for PMTCT. Further, to determine the effectiveness of PMTCT programmes in different settings, it is crucial to analyse at what stages of the PMTCT cascade that dropouts occur to target interventions accordingly.

How are countries in sub-Saharan African monitoring the impact of programmes to prevent vertical transmission of HIV?

“…Setting sites up is expensive, however, making the use of existing sites for vertical transmission prevention monitoring easier and less expensive. Although demographic surveillance sites exist in four of the five countries (table 2), as far as we are aware these data have only been used to measure effectiveness of prevention of vertical transmission in Uganda 16. Using data from 68 000 people from 12 000 households, Larsson and colleagues modelled the risk of vertical transmission of HIV among 771 pregnant women in Uganda 16.…”

Low proportion of women who came knowing their HIV status at first antenatal care visit, Uganda, 2012–2016: a descriptive analysis of surveillance data

“…A known HIV status is the cornerstone for HIV prevention, treatment and support services [1,2] including services for Prevention of Mother to Child Transmission of HIV (PMTCT) [3][4][5]. Prevention of mother-to-child transmission of HIV (PMTCT) is contingent on four pillars that make up the global World Health Organization (WHO) strategy for PMTCT: 1) Primary prevention of HIV among women of reproductive age which can be achieved through behavioral interventions, 2) Prevention of unintended pregnancies in women who are HIV positive, which relies on meeting the family planning needs of this population group, 3) prevention of mother to child transmission of HIV (PMTCT) through offering antiretroviral therapy (ART) to HIV-infected pregnant women and their babies and 4) care and treatment for the children that turn HIV positive through follow-up of infants born to HIV-infected mothers as well as continued care and treatment for the mothers and support to their families [6].…”

“…In Uganda, where > 95% of women make at least one ANC visit, the first ANC visit has been promoted as a critical gateway for PMTCT. At first ANC visit, all women receive provider-initiated, opt-out HIV counseling and testing [5,9,10]. This measure has been effective in reducing mother-to-child transmission of HIV (MTCT) in Uganda [11,12] with an 86% reduction in the number of new paediatric HIV infections during 2010-2016.…”

Loss to follow-up and associated maternal factors among HIV-exposed infants at the Mbarara Regional Referral Hospital, Uganda: a retrospective study

“…HIV-1 can be transmitted from mother-to-child during pregnancy, labor and delivery and after birth through breastfeeding [5]. The risks of viral transmission during pregnancy ranges from 5 to 10%, during labor and delivery from 10 to 20%, and during mixed infant feeding from 10 to 20%.…”