Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

Benjamin, H.; Musonda, Patrick; Lembalemba, Mwila K.; Chintu, Namwinga; Gartland, Matthew G.; Mulenga, Saziso N.; Bweupe, Maximillian; Turnbull, Eleanor; Stringer, Elizabeth M.; Stringer, Jeffrey S. A.

doi:10.2471/blt.13.129833

Cited by 13 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only one IE of the current WHO guidelines has thus far been conducted and showed increased HIV-free survival at 24 months in Zambia, from 66% at baseline to 89% post-Option B (adjusted hazard ratio 0.52). [16] However, the Zambian evaluation was small scale and assessed a pilot program implementing Option B in four facilities. National-level assessments of the recent WHO guidelines are underway in Rwanda (Option B),[17] Malawi (Option B+),[18] and South Africa,[19] however only the baseline estimates of these evaluations have been published so far.…”

Section: Discussionmentioning

confidence: 99%

“…This study design, initially used in the four-country PEARL study[20], has also been used in the above-mentioned Zambian[16] and Rwandan[17] evaluations. In contrast, the Malawian and South African assessments consist of serial cross-sectional serosurveys of mother-infant pairs attending childhood immunizations,[18,19] which can only estimate early MTCT (<3 months) because they do not account for breastfeeding-related transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Community-based surveys such as ours are able to: assess both MTCT and HIV-free infant survival; include all mother-infant pairs, not just those who use health facilities; and account for HIV infections occurring through breastfeeding (e.g., we assessed these outcomes at 9–18 months of age, the Zambian and Rwandan evaluations assessed outcomes at 24 months). [16,17]…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Buzdugan

Dufour

McCoy

et al. 2016

Aids

View full text Add to dashboard Cite

Objective We evaluated the impact of Option A on HIV-free infant survival and mother-to-child transmission (MTCT) in Zimbabwe. Design Serial cross-sectional community-based serosurveys. Methods We analyzed serosurvey data collected in 2012 and 2014 among mother-infant pairs from catchment areas (CAs) of 132 health facilities from 5 of 10 provinces in Zimbabwe. Eligible infants (alive or deceased) were born 9–18 months before each survey to mothers ≥16 years old. We randomly selected mother-infant pairs and conducted questionnaires, verbal autopsies and collected blood samples. We estimated: 1) the HIV-free infant survival and MTCT rate within each CA and compared the 2012 and 2014 estimates using a paired t-test, 2) number of HIV infections averted due to the intervention. Results We analyzed 7,249 mother-infant pairs with viable maternal specimens collected in 2012 and 8,551 in 2014. The mean difference in the CA-level MTCT between 2014 and 2012 was −5.2 percentage points (95% confidence interval (CI)=−8.1, −2.3, p<0.001). The mean difference in the CA-level HIV-free survival was 5.5 percentage points (95%CI=2.6,8.5, p<0.001). Between 2012 and 2014, 1,779 infant infections were averted compared to the pre-Option A regimen. The association between HIV-free infant survival and duration of Option A implementation was not significant at the multivariate level (p=0.093). Conclusions We found a substantial and statistically significant increase in HIV-free survival and decrease in MTCT among infants aged 9–18 months following Option A rollout in Zimbabwe. This is the only impact evaluation of Option A and shows the effectiveness of Option A and Zimbabwe’s remarkable progress towards eMTCT.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Buzdugan

Dufour

McCoy

et al. 2016

Aids

View full text Add to dashboard Cite

show abstract

“…A full description of the primary methods has been published elsewhere. 24 Two survey rounds were conducted: the first was implemented prior to the pilot program and the second was implemented two years later. Households were eligible to be surveyed if a current member was reported to have given birth in the last 24 months.…”

Section: Methodsmentioning

confidence: 99%

“…Blood specimens were collected from eligible mothers and children for HIV testing. 24 For the current analysis, we evaluated only those data from the “post-implementation” survey, as it was the only round in which household Global Positioning Systems (GPS) coordinates were collected. This study was approved by ethical review committees at the University of Zambia (Lusaka, Zambia) and the University of North Carolina at Chapel Hill (Chapel Hill, NC, USA).…”

Section: Methodsmentioning

confidence: 99%

Implementation and Operational Research

Escamilla

Chibwesha

Gartland

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Background In rural settings, HIV-infected pregnant women often live significant distances from facilities that provide prevention of mother-to-child transmission (PMTCT) services. Methods We implemented a pilot project to offer universal maternal combination antiretroviral regimens in 4 clinics in rural Zambia. To evaluate the impact of services, we conducted a household survey in communities surrounding each facility. We collected information about HIV status and antenatal service utilization from women who delivered in the past two years. Using household global positing systems coordinates collected in the survey, we measured Euclidean (i.e., straight line) distance between individual households and clinics. Multivariable logistic regression and predicted probabilities were used to determine associations between distance and uptake of any PMTCT regimen and combination antiretroviral regimens specifically. Results From March to December 2011, 390 HIV-infected mothers were surveyed across four communities. Of these, 254 (65%) had household geographical coordinates documented. 168 women reported use of a PMTCT regimen during pregnancy, including 102 who initiated a combination antiretroviral regimen. The probability of PMTCT regimen initiation was highest within 1.9 km of the facility and gradually declined. Overall, 103 of 145 (71%) who lived within 1.9 km of the facility initiated PMTCT, versus 65 of 109 (60%) who lived farther away. For every kilometer increase, the association with PMTCT regimen uptake (adjusted odds ratio [AOR]: 0.90, 95%CI: 0.82—0.99) and combination antiretroviral regimen uptake (AOR: 0.88, 95%CI: 0.80—0.97) decreased. Conclusions In this rural African setting, uptake of PMTCT regimens was influenced by distance to health facility. Program models that further decentralize care into remote communities are urgently needed.

show abstract

Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review

et al. 2016

View full text Add to dashboard Cite

The continuum of care for successful HIV treatment includes HIV testing, linkage, engagement in care, and retention on antiretroviral therapy (ART). Loss to follow-up (LTFU) is a significant disruption to this pathway and a common outcome in sub-Saharan Africa. This review of literature identified interventions that have reduced LTFU in the HIV care continuum. A search was conducted utilizing terms that combined the disease state, stages of the HIV care continuum, interventions, and LTFU in sub-Saharan Africa and articles published between January 2010 and July 2015. Thirteen articles were included in the final review. Use of point of care CD4 testing and community-supported programs improved linkage, engagement, and retention in care. There are few interventions directed at LTFU and none that span across the entire continuum of HIV care. Further research could focus on devising programs that include a series of interventions that will be effective through the entire continuum.

show abstract

Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

Cited by 13 publications

References 26 publications

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

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

Implementation and Operational Research

Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review

Contact Info

Product

Resources

About