scholarly journals Early retention among pregnant women on ‘Option B + ’ in urban and rural Zimbabwe

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anesu N. Chimwaza ◽  
Hannock Tweya ◽  
Owen Mugurungi ◽  
Angela Mushavi ◽  
Solomon Mukungunugwa ◽  
...  

Abstract Background In 2013, the World Health Organisation (WHO) recommended Option B+ as a strategy to prevent mother-to-child transmission (PMTCT) of HIV. In option B+ , lifelong antiretroviral therapy (ART) is offered to all HIV positive pregnant and breastfeeding women to reduce MTCT rate to less than or equal to 5%. Its success depends on retaining women on ART during pregnancy, delivery and breast-feeding period. There is limited data on early retention on ART among pregnant women in Zimbabwe. We therefore assessed early retention among women on Option B + from antenatal care (ANC) until 6 months post ANC booking and at delivery in Bulawayo city and Mazowe rural district of Zimbabwe. Methods We collected data for pregnant women booking for ANC between January and March 2018, comparing early retention among ART naïve women and those already on ART. The two cohorts were followed up for 6 months post ANC booking, and this was done in two districts. Data were collected from routine tools used at facility level which include ANC, delivery and ART registers. The Kaplan-Meier survival analysis was used to estimate retention probabilities at 1, 3 and 6 months post-delivery and for retention at delivery proportions were used. Poisson regression was used to investigate factors associated with non-retention at 6 months post ANC booking. Results A total of 388 women were included in the study with median age of 29 years (IQR: 25–34). Two-thirds booked in their second trimester. Retention at 3 and 6 months post ANC booking was 84% (95% CI 80–88) and 73% (95% CI 69–78) respectively. At delivery 81% (95% CI 76–84) were retained in care, 18% lost-to-follow-up and 1% transferred out. In this study we did not find marital status, gestation age, facility location, ART status at ANC booking, to be associated with loss to follow-up. Conclusion In this study, we found low retention at 3, 6 months and delivery, a threat to elimination of Mother-to-child Transmission of HIV in Zimbabwe. Our findings emphasize the need for enhanced interventions to improve early retention such as post-test counselling, patient tracing and visit reminders.

2020 ◽  
Author(s):  
Laurence Ahoua ◽  
Shino Arikawa ◽  
Thierry Tiendrebeogo ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  

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.


2020 ◽  
Vol 11 (2) ◽  
pp. 1729-1733
Author(s):  
Priyadarsini A ◽  
Priya O S

Human Immunodeficiency Virus (HIV) is an infection that assaults immune cells called CD4 cells, which are a kind of T cell. These are white platelets that move around the body, recognizing flaws and inconsistencies in cells just as contaminations. The present study aimed to effectiveness of interventional package on knowledge and attitude towards prenatal HIV testing and parent to child transmission among pregnant women in selected settings.60 pregnant women sample in Quantitative approach with Pre experimental one group pre-test and post-test design, sample selection was done by Non Probability – Purposive Sampling Technique, Effectiveness of structured teaching programme in meaning pregnant women gained 35% etiology and effects gained 31% in management and precautions in PCT pregnant women gained 41% prevention 36.8% overall they gained 37.28% and Attitude gained 23.3% after intervention. Pre-existing knowledge was assessed by using semi structured teaching programme, pregnant mothers gained 23.3% more knowledge score than pretest score and the mean difference is 12.80 by using generalized McNamara’s chi-square test, it is statistically significant. In pretest, mothers were having 10.77score whereas, in post-test they were having 23.57 score. Difference score is 12.80.The difference is large and it is statistically significant. Successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection is highly dependent on everyone; especially, women of child-bearing age should have accurate and up-to-date knowledge about HIV transmission, risk of transmission to babies, and possible interventions.


2019 ◽  
Author(s):  
Laurence Ahoua ◽  
Thierry Tiendrebeogo ◽  
Shino Arikawa ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  

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.


Author(s):  
Dame Evalina Simangunsong ◽  
Kandace Sianipar ◽  
Juliani Purba

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


BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038311
Author(s):  
Angela Kelly-Hanku ◽  
Claire Elizabeth Nightingale ◽  
Minh Duc Pham ◽  
Agnes Mek ◽  
Primrose Homiehombo ◽  
...  

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.


2020 ◽  
Author(s):  
Laurence Ahoua ◽  
Shino Arikawa ◽  
Thierry Tiendrebeogo ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  

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.


2021 ◽  
Vol 27 (4) ◽  
pp. 381-389
Author(s):  
Ali Elgalib ◽  
Fatma Al-Hinai ◽  
Jamila Al-Abri ◽  
Samir Shah ◽  
Zeyana Al-Habsi ◽  
...  

Background: In January 2016, the National AIDS Programme (NAP) in Oman introduced a package of interventions, including capacity building for service providers, to improve the quality of HIV services. Aims: To report the impact of these interventions on the rate of vertical HIV transmission in the period from January 2016 to December 2019. We also describe the virological and obstetric outcomes for HIV-infected pregnant women. Methods: This was a medical record review of 94 HIV-positive pregnant women (median age 32 years; interquartile range 25-34 years) reported to NAP in 2016–2019. Results: There were 110 pregnancies in 94 women. The majority (75.3%, 61/81) of women were diagnosed with HIV infection from routine antenatal screening, with 60% (66/110) of pregnancies occurring in women who knew their HIV status at conception. Caesarean section was the most common (50%) mode of delivery. The preterm labour and low birth weight rates were 21.2% and 15.9%, respectively. The antiretroviral coverage during pregnancy was 95.5%, with most (87.8%) women reporting excellent or good adherence. The majority (81.6%) of women achieved HIV viral load of < 400 copies/ml at or near delivery. Almost all infants (99%) were given prophylactic antiretrovirals. The rate of mother-to-child transmission of HIV was 1%. Conclusion: The obstetric and virological outcomes for HIV-infected pregnant women delivered in 2016–2019 were favourable, with a low rate of mother-to-child transmission of HIV. Oman is now in the process of finalizing application of World Health Organization validation of elimination of mother-to-child transmission of HIV.


2021 ◽  
Vol 10 (2) ◽  
pp. 269-279
Author(s):  
EBELECHUKU FRANCESCA UGOCHUKWU ◽  
CHINYERE UKAMAKA ONUBOGU ◽  
EMEKA STEPHEN EDOKWE ◽  
UCHENNA EKWOCHI ◽  
KENNETH NCHEKWUBE OKEKE ◽  
...  

Background and Objective: Above 90% of childhood HIV infections result from mother-to child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria. Methods: This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client’s folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status. Results: Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative. Conclusion and Global Health Implications: Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.   Copyright © 2021 Ugochukwu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Manal Hamdy El-Sayed ◽  
Fatma Soliman Elsayed Ebeid ◽  
Aya Mostafa Kamal El-Din ◽  
Rania Hassan Mostafa ◽  
Belal Khaled Abd El-Monem Mohammed

Abstract Background The World Health Organization (WHO) has an ambitious plan to eliminate HCV by 2030. This new approach was fueled by increased appreciation of the global morbidity and mortality caused by hepatitis C, and the remarkable recent treatment developments. Objectives To assess the mother-to-child transmission of hepatitis C virus in Egyptian pregnant women to inform on screening policies and strategy development. To measure prevelance of hepatitis C virus infection in pregnant women Methods The current study was conducted to six thousand and seven hundred and thirty four (6734) women delivered in El Demerdash Maternity Hospital in the period from January 2018 till June 2018. Collection of detailed data from Patients files and divided them into non screened and screened by antibodies and who do PCR for HCV and data of their neonatal outcome Results Comparison according to HCV PCR regarding labor characteristics show that cases with positive HCV PCR significantly had more frequent CS. Logistic regression for risk factors for HCV PCR among the studied cases show that only Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR. Conclusion Previous hospitalization and previous transfusion were significant risk factors for positive HCV PCR. Pregnants with positive HCV PCR significantly had more lower hemoglobin than non-infected pregnant one and previous abortion and hospitalization may play a role in that.


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