scholarly journals Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038311
Author(s):  
Angela Kelly-Hanku ◽  
Claire Elizabeth Nightingale ◽  
Minh Duc Pham ◽  
Agnes Mek ◽  
Primrose Homiehombo ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Papua New Guinea ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Mother To Child

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.MethodsWe conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme.Results763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test.ConclusionsOur study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

2020 ◽  
Author(s):  
Laurence Ahoua ◽  
Shino Arikawa ◽  
Thierry Tiendrebeogo ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
Retention Rates ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Mother To Child

Abstract Background : Failure to retain HIV-positive pregnant women on antiretroviral therapy (ART) leads to increased mortality for the mother and her child. This study evaluated different retention measures for women’s engagement along the continuum of care for prevention of mother-to-child transmission (PMTCT) option B+ services in Mozambique. Methods : We compared ‘point’ retention (patient’s presence in care 12-month post-ART initiation or any time thereafter) with the following definitions: alive and in care 12 month post-ART initiation (Ministry of Health; MOH); attendance at a health facility up to 15-month post-ART initiation (World Health Organization; WHO); alive and in treatment at 1-, 2-, 3-, 6-, 9-, and 12-month post-ART initiation (Inter-Agency Task Team; IATT); and alive and in care 12-month post-ART initiation with ≥75% appointment adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% of appointments met on time during follow-up (i.e. ‘on-time adherence’ retention). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as our reference to estimate sensitivity, specificity, and proportion of misclassified patients. Results : Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12-month post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion : More stringent definitions indicated lower retention rates for PMTCT programs. Policy makers and program managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scale-up, and monitoring of interventions.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programmes: the Mozambique experience

2019 ◽  
Author(s):  
Laurence Ahoua ◽  
Thierry Tiendrebeogo ◽  
Shino Arikawa ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
Retention Rates ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Mother To Child

Abstract Background Failure of retention of HIV-positive pregnant women on ART leads to increased mortality for the mother and her child. This study evaluated different retention measures intended to measure women’s engagement along the continuum of care for prevention of mother-to-child transmission (PMTCT) option B+ services in Mozambique. Methods We compared ‘point’ retention (patient’s presence in care at 12-months post-antiretroviral treatment (ART) initiation or any time thereafter) to the following definitions: alive and in care at 12 months post-ART initiation (Ministry of Health); attendance at a health facility up to 15 months post-ART initiation (World Health Organisation); alive and in treatment at 1, 2, 3, 6, 9, and 12 months post-ART initiation (Inter-Agency Task Team); and alive and in care at 12 months post-ART initiation with ≥75% appointment or on-time adherence during follow-up (‘appointment adherence’ and ‘on-time adherence’ retentions). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as a gold standard to estimate sensitivity, specificity, and proportion of misclassified patients. Results Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12 months post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘ ≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion More stringent definitions indicated lower retention rates for PMTCT programmes. Policy makers and programme managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scaling up, and monitoring of interventions.

scholarly journals Perilaku dan Persepsi Keyakinan Ibu Hamil Terhadap Screening HIV di Kota Pematangsiantar

2020 ◽  
Vol 11 (2) ◽  
pp. 202
Author(s):  
Dame Evalina Simangunsong ◽  
Kandace Sianipar ◽  
Juliani Purba
Keyword(s):  
Pregnant Women ◽  
Hiv Screening ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Women With Hiv ◽  
Mother To Child ◽  
Hiv Aids

Prevention of HIV transmission from mother to baby or Prevention of Mother to Child Transmission (PMTCT) is an effective and in achieving a broad objective in suppressing maternal and infant mortality related to the level of public health in a region.Public Health Center with VCT service in the city Pematangsiantar has not yet fully provide PMTCT to realize pregnant women for screening HIV/AIDS. Pregnant women with HIV/AIDS still have a loss to follow up, this is a threat to suppress the prevalence and incidence of HIV/AIDS. Obstetrics study Program which also integrates the promotion of HIV/AIDS and IMS into KIA service to be responsible in suppressing its spread. These research identified the behavior and perception of pregnant women's beliefs against HIV screening to determine the level of consciousness in conducted HIV screening. These research was a descriptive studied with cross sectional design. Pregnant women who were netted in the ANC Ministry were the populations in this study. Data analysis was conducted to see the behavior and perception of pregnant women's beliefs against HIV screening. Data processed with univariate analysis. Found 337 expectant mothers who perform ANC and as many as 194 people were not willing to do HIV screening. Found low-level, disagreement and low-action and low-confidence perception of HIV screening.It is necessary to conduct a strategy approach with personal counseling, peer-education and home visits in the net of pregnant women with HIV. Keywords: behavior; HIV; screening; perception ABSTRAK Pencegahan penularan HIV dari ibu ke bayinya atau Prevention of Mother to Child Transmission (PMTCT) adalah suatu cara yang efektif dan dalam mencapai tujuan yang luas dalam menekan angka kematian ibu dan bayi yang berkaitan dengan tingkat kesehatan masyarakat di suatu wilayah. Puskesmas dengan layanan VCT di kota Pematangsiantar belum sepenuhnya memberikan PMTCT untuk menyadarkan ibu hamil untuk screening HIV/AIDS. Ibu hamil dengan HIV/AIDS masih ada yang loss to follow up, hal ini menjadi ancaman dalam menekan prevalensi dan insiden HIV/AIDS. Program Studi Kebidanan Pematangsiantar yang turut mengintegrasikan Promosi HIV/AIDS dan IMS ke dalam pelayanan KIA ikut bertanggungjawab dalam menekan penyebarannya. Penelitian ini mengidentifikasi perilaku dan persepsi keyakinan ibu hamil terhadap screening HIV untuk mengetahui tingkat kesadarannya dalam melakukan screening HIV. Penelitian ini merupakan penelitian deskriptif dengan desain cross sectional. Ibu hamil yang terjaring dalam pelayanan ANCadalah populasi dalam penelitian ini. Analisis data dilakukan untuk melihat perilaku dan persepsi keyakinan ibu hamil terhadap screening HIV. Data diolah dengan analisis univariate. Ditemukan 337 ibu hamil yang melakukan ANC dan sebanyak 194 orang belum bersedia dilakukan screening HIV. Ditemukan pegetahuan yang rendah, sikap tidak setuju dan tindakan yang rendah serta persepsi keyakinan yang rendah terhadap screening HIV.Perlu melakukan strategi pendekatan dengan konseling pribadi, peer-edukasi dan kunjungan rumah dalam menjaring ibu hamil dengan HIV. Kata kunci: perilaku; HIV; screening; persepsi

scholarly journals HIV Retesting of HIV-Negative Pregnant Women in the Context of Prevention of Mother-to-Child Transmission of HIV in Primary Health Centers in Rural Zambia: What Did We Learn?

2019 ◽  
Vol 18 ◽  
pp. 232595821882353 ◽  
Author(s):  
Justin Mandala ◽  
Prisca Kasonde ◽  
Titilope Badru ◽  
Rebecca Dirks ◽  
Kwasi Torpey
Keyword(s):  
Pregnant Women ◽  
Hiv Positive ◽  
Antenatal Visit ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Hiv Test ◽  
Hiv Exposed ◽  
Mother To Child ◽  
Hiv Negative

Background: This observational study describes implementation of HIV retesting of HIV-negative women in prevention of mother-to-child transmission (PMTCT) services in Zambia. Methods: Uptake of retesting and PMTCT services were compared across age, parity, and weeks of gestation at the time of the first HIV test, antiretrovirals regime, and HIV early diagnosis results from infants born to HIV-positive mothers. Results: A total of 19 090 pregnant women were tested for HIV at their first antenatal visit, 16 838 tested HIV-negative and were offered retesting 3 months later: 11 339 (67.3%) were retested; of those, 55 (0.5%) were HIV positive. Uptake of the PMTCT package by women HIV positive at retest was not different but HIV-exposed infants born to women who retested HIV positive were infected at a higher rate (11.1%) compared to those born to women who tested HIV positive at their initial test (3.2%). Conclusion: We suggest rigorously (1) measuring the proportion of MTCT attributable to women who seroconvert during pregnancy and possibly adjust PMTCT approaches and (2) addressing the substantial loss to follow-up of HIV-negative pregnant women before HIV retesting.

scholarly journals Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Matilda Kweyamba ◽  
Esther Buregyeya ◽  
Joy Kusiima ◽  
Vianney Kweyamba ◽  
Aggrey David Mukose
Keyword(s):  
Health Facilities ◽  
Hiv Positive ◽  
Peer Educators ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Lactating Mothers ◽  
Lost To Follow Up ◽  
Mother To Child

Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37%) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95% CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95% CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95% CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

2020 ◽  
Author(s):  
Laurence Ahoua ◽  
Shino Arikawa ◽  
Thierry Tiendrebeogo ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
Retention Rates ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Mother To Child

Abstract Background : Failure to retain HIV-positive pregnant women on antiretroviral therapy (ART) leads to increased mortality for the mother and her child. This study evaluated different retention measures for women’s engagement along the continuum of care for prevention of mother-to-child transmission (PMTCT) option B+ services in Mozambique. Methods : We compared ‘point’ retention (patient’s presence in care 12-month post-ART initiation or any time thereafter) with the following definitions: alive and in care 12 month post-ART initiation (Ministry of Health; MOH); attendance at a health facility up to 15-month post-ART initiation (World Health Organization; WHO); alive and in treatment at 1-, 2-, 3-, 6-, 9-, and 12-month post-ART initiation (Inter-Agency Task Team; IATT); and alive and in care 12-month post-ART initiation with ≥75% appointment adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% of appointments met on time during follow-up (i.e. ‘on-time adherence’ retention). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as our reference to estimate sensitivity, specificity, and proportion of misclassified patients. Results : Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12-month post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion : More stringent definitions indicated lower retention rates for PMTCT programs. Policy makers and program managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scale-up, and monitoring of interventions.

scholarly journals Mortality and Loss to Follow-Up Among HIV-Exposed Infants After Option B+ Guideline Implementation in Amhara Regional State Referral Hospitals, Ethiopia

2021 ◽  
Vol 9 ◽  
Author(s):  
Mesfin Wudu Kassaw ◽  
Ayele Mamo Abebe ◽  
Biruk Beletew Abate ◽  
Mikiyas Amare Getu ◽  
Ayelign Mengesha Kassie
Keyword(s):  
Cumulative Incidence ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Regional State ◽  
Hiv Positive Mothers ◽  
Referral Hospitals ◽  
Mother To Child

Background: Prevention of mother-to-child transmission of HIV program (PMTCT) is a comprehensive approach that aimed for the wellbeing of all HIV-infected women, to prevent new HIV infection among infants born to HIV-positive mothers, and providing management for HIV-positive women and infants. Nevertheless, there was considerably high attrition within the prevention of mother-to-child transmission programs that was merely because of loss to follow-up (LTFU) followed by mortality. In resource-limited countries, one-third of infected children die before 1 year, and more than half of them die before 2 years. The aim of this study was to assess the prevalence or incidence of mortality and LTFU among infants born from HIV-positive mothers in the Amhara regional state referral hospitals, Ethiopia.Methods: This study was conducted in five Amhara regional state referral hospitals' prevention of mother-to-child transmission departments. A simple random sampling technique with proportional allocation was used to assess the outcomes of 221 exposed infants. A retrospective cohort design was used in selecting the 221 exposed infants' document from the referral hospitals of the region, Amhara. The exposed infants' profiles were documented between January 1, 2014 and May 30, 2017.Results: This study described attritions (death and loss-to-follow-up) of exposed babies in PMTCT departments of Amhara regional state referral hospitals in Ethiopia. In this study, low LTFU with zero death was reported. Residence, immunization status of babies, and place of delivery were independent factors of LTFU.Conclusions: The cumulative incidence of mortality in this study was zero. This assured that the recommended option is substantial for the elimination of HIV-caused death in 2030 as per WHO plan. However, the cumulative incidence of LTFU was not zero.

scholarly journals Involvement of Male Partners of Pregnant Women in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Haiti: A Mixed-Methods Study

2021 ◽  
Vol 15 (2) ◽  
pp. 155798832110060
Author(s):  
Patrice Ngangue ◽  
Middle Fleurantin ◽  
Rheda Adekpedjou ◽  
Leonel Philibert ◽  
Marie-Pierre Gagnon
Keyword(s):  
Mixed Methods ◽  
Pregnant Women ◽  
Male Involvement ◽  
Mixed Methods Study ◽  
Mother To Child Transmission ◽  
Male Partners ◽  
Hiv Status ◽  
Child Transmission ◽  
Factors Associated ◽  
Mother To Child

This mixed-methods study aimed to determine the level of male involvement in the prevention of mother-to-child transmission (PMTCT) services in Haiti and identify barriers and associated factors. From May to June 2018, a questionnaire was used to measure the level of male involvement. Semistructured interviews with pregnant women were also conducted. Multivariate linear regression and qualitative content analyses were performed to explore factors associated and barriers to male partners’ involvement in PMTCT services. One hundred and two pregnant women living with HIV completed the questionnaire. About 47% of male partners had a high level of involvement. Specifically, 90% financially supported their spouse, and 82% knew her appointment date at the antenatal clinic (ANC). Only 25% of male partners accompanied their spouse to the ANC, and 19% routinely used a condom during sexual intercourse. Factors associated with male involvement in PMTCT were being married and sharing HIV status with the male partner. Male partners with a positive HIV status were more likely to be involved in PMTCT. Qualitative findings revealed that barriers to male involvement included the conflict between opening hours of the ANC and the male partner’s schedule, waiting time at the ANC, and the perception of antenatal care as being women’s business. Overall male partners’ involvement in PMTCT services is moderate. Gender relations, sociocultural beliefs, and care organization are likely to hinder this involvement. Developing and implementing contextually and culturally accepted strategies for male partners of pregnant women could contribute to strengthening their involvement in the PMTCT program.

scholarly journals Towards Elimination of Mother-to-Child Transmission of HIV: The Impact of a Rapid Results Initiative in Nyanza Province, Kenya

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lisa L. Dillabaugh ◽  
Jayne Lewis Kulzer ◽  
Kevin Owuor ◽  
Valerie Ndege ◽  
Arbogast Oyanga ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Highly Active Antiretroviral Therapy ◽  
Cohort Analysis ◽  
Hiv Positive ◽  
Maternal Child Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Nyanza Province ◽  
The Impact ◽  
Mother To Child

Many HIV-positive pregnant women and infants are still not receiving optimal services, preventing the goal of eliminating mother-to-child transmission (MTCT) and improving maternal child health overall. A Rapid Results Initiative (RRI) approach was utilized to address key challenges in delivery of prevention of MTCT (PMTCT) services including highly active antiretroviral therapy (HAART) uptake for women and infants. The RRI was conducted between April and June 2011 at 119 health facilities in five districts in Nyanza Province, Kenya. Aggregated site-level data were compared at baseline before the RRI (Oct 2010–Jan 2011), during the RRI, and post-RRI (Jul–Sep 2011) using pre-post cohort analysis. HAART uptake amongst all HIV-positive pregnant women increased by 40% (RR 1.4, 95% CI 1.2–1.7) and continued to improve post-RRI (RR 1.6, 95% CI 1.4–1.8). HAART uptake in HIV-positive infants remained stable (RR 1.1, 95% CI 0.9–1.4) during the RRI and improved by 30% (RR 1.3, 95% CI 1.0–1.6) post-RRI. Significant improvement in PMTCT services can be achieved through introduction of an RRI, which appears to lead to sustained benefits for pregnant HIV-infected women and their infants.

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