The impact of “Option B” on HIV transmission from mother to child in Rwanda: An interrupted time series analysis

Abimpaye, Monique; Kirk, Catherine M.; Iyer, Hari S.; Gupta, Neil; Remera, Eric; Mugwaneza, Placidie; Law, Michael R.

doi:10.1371/journal.pone.0192910

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…Many studies worldwide showed that the adoption of Option B+ had contributed to a decrease in the rate of MTCT of HIV. 16,[25][26][27][28][29] During the 12-year follow-up of this cohort, of 229 women who were on ART before or during pregnancy, only one child (0.43%) whose mother received AZT monotherapy (Option A) had HIV-positive at the age of 18 months. This finding is consistent with the study of Kesho Bora Group; they found that the mothers who received AZT monotherapy were less effective in PMTCT than those receiving triple ARV.…”

Section: Discussionmentioning

confidence: 99%

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<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

Nguyen¹,

Ton²,

Tran³

et al. 2020

HIV

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Background: Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. The purpose of this study is to determine the evolution of the HIV transmission rate in infants from 2007 to 2018 and to identify the risk factors of HIV transmission among HIV-exposed infants in Vietnam. Patients and Methods: A prospective cohort study of 608 HIV-exposed infants was conducted at the Pediatric Outpatient Clinic (pOPC) of the Women and Children Hospital of An Giang, Vietnam between September 2007 and December 2019. A follow-up registration book was used to collect data, which were entered into Microsoft Excel and analyzed by SPSS version 22.0. Both bivariate and multivariate analyses were carried out to identify associations. Results: A total of 608 HIV-exposed infant were enrolled in the study, of which 472 were included in the final analysis. The median age of infants at enrollment to follow-up was 6.3 weeks (interquartile range [IQR]=6.0-6.9 weeks). A total of 42 infants out of 472 were infected with HIV, giving an overall MTCT rate of 8.9% (95% confidence interval (CI)=6.4-12.0). The transmission rate decreased from 27.9% in 2007 to 0% in 2018. Absence of maternal ARV (antiretrovirals) intervention before or during pregnancy (AOR=40.6, 95% CI=5.5-308) and absence of ARV prophylaxis for HIV-exposed infants (AOR=3.4, 95% CI=1.1-10.3) were significantly and independently associated with MTCT of HIV in this study. Conclusion: There is a significant progress on the reduction of MTCT rate in An Giang, Vietnam. Absence of ART interventions for mothers and infants are significant factors associated with HIV transmission. Providing free ARV and increasing the coverage of ARV intervention for pregnant women are keys for reducing the MTCT rate in the future.

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Section: Discussionmentioning

confidence: 99%

“…Many studies worldwide showed that the adoption of Option B+ had contributed to a decrease in the rate of MTCT of HIV. 16 , 25 – 29 …”

Section: Discussionmentioning

confidence: 99%

<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

Nguyen¹,

Ton²,

Tran³

et al. 2020

HIV

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“…The shifts toward universal HIV testing in antenatal care and immediate initiation on treatment for those who test positive, as recommended in the Option B+ policy, have significantly decreased rates of mother-to-child transmission of HIV [1,2]. This success has been facilitated by increases in the identification and enrollment of HIV positive pregnant women into HIV care [15,21].…”

Section: Discussionmentioning

confidence: 99%

“…Early initiation of antiretroviral therapy (ART) during pregnancy, followed by lifelong adherence to treatment, has shown to be effective in preventing mother-to-child transmission of HIV (PMTCT) and improving maternal health outcomes [1,2]. This clinical protocol, referred to as Option B+, was first recommended by the World Health Organization (WHO) in 2012 following successful implementation in Malawi [3].…”

Section: Introductionmentioning

confidence: 99%

“At home, no one knows”: A qualitative study of retention challenges among women living with HIV in Tanzania

et al. 2020

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Introduction Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. Methods We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. Results We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patientprovider interactions, and peer treatment supporters would have a positive effect on care engagement.

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“…Rwanda has made remarkable strides in increasing the coverage of health facilities providing prevention of mother-to-child transmission (PMTCT) services. In 2012, it became one of the rst African countries to recommend the initiation of lifelong antiretroviral therapy (ART) in all pregnant women regardless of CD4 cell count (known as Option B+) 5 . By June 2019, 98% of health facilities were offering PMTCT services, 99% of pregnant women attended at least one antenatal care visit, and 96.9% of HIV-infected pregnant women received ART for PMTCT.…”

Section: Introductionmentioning

confidence: 99%

Towards Elimination of Mother-To-Child Transmission of HIV in Rwanda: A Nested Case-Control Study of Risk Factors for Transmission

Remera

Mugwaneza

Chammartin³

et al. 2020

Preprint

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Background: Mother-to-child HIV transmission (MTCT) has substantially declined since the scale-up of prevention programs around that world, including Rwanda. To achieve full elimination of MTCT, it is important to understand the risk factors associated with residual HIV transmission, defined as MTCT at the population-level that still occur despite universal access to PMTCT+; .Methods: We performed a case control study of children born from mothers with HIV with known vital status at 18 months from birth who were followed in three national cohorts between October and December 2013, 2014, and 2015 in Rwanda. Children with HIV were matched in a ratio of 1:2 with HIV-uninfected children and a conditional logistic regression model was used to investigate risk factors for MTCT.Results: In total, 84 children with HIV were identified and matched with 164 non-infected children. The median age of mothers from both groups was 29 years (interquartile range (IQR): 24-33). Of these mothers, 126 (51.4%) initiated antiretroviral therapy (ART) before their pregnancy on record. In a multivariable regression analysis, initiation of ART in the third trimester (Adjusted Odds Ratio [aOR]: 7.71; 95% Confidence Interval [95% CI]: 2.19-27.10) and during labor or post-partum (aOR: 9.42; 95% CI: 3.15-28.19), compared to initiation of ART before pregnancy increased the risk of MTCT. Similarly, offspring of single mothers (aOR: 4.81; 95% CI: 1.60-14.46), and absence of postpartum neonatal ART prophylaxis (aOR: 5.64; 95% CI: 1.81-17.53) were factors significantly associated with MTCT.Conclusion: Late presentation for antenatal care and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda.

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The impact of “Option B” on HIV transmission from mother to child in Rwanda: An interrupted time series analysis

Cited by 13 publications

References 20 publications

<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

<p>Mother-to-Child Transmission of HIV and Its Predictors Among HIV-Exposed Infants at an Outpatient Clinic for HIV/AIDS in Vietnam</p>

“At home, no one knows”: A qualitative study of retention challenges among women living with HIV in Tanzania

Towards Elimination of Mother-To-Child Transmission of HIV in Rwanda: A Nested Case-Control Study of Risk Factors for Transmission

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