Attitudes toward Family Planning among HIV-Positive Pregnant Women Enrolled in a Prevention of Mother-To-Child Transmission Study in Kisumu, Kenya

SummaryIn Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26·4%), low knowledge of HIV status and a total fertility rate of 3·5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15–49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.

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

AIDS Research and Treatment ◽

10.1155/2012/602120 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 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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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

10.21203/rs.2.12007/v3 ◽

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.

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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

10.21203/rs.2.12007/v1 ◽

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.

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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?

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958218823530 ◽

2019 ◽

Vol 18 ◽

pp. 232595821882353 ◽

Cited By ~ 3

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.

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Disclosure experience to partner and its effect on intention to utilize prevention of mother to child transmission service among HIV positive pregnant women attending antenatal care in Addis Ababa, Ethiopia

BMC Public Health ◽

10.1186/1471-2458-13-765 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 20

Author(s):

Endalew Gemechu Sendo ◽

Amsale Cherie ◽

Tadese Asfaw Erku

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Addis Ababa ◽

Hiv Positive ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mother To Child

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The yield of HIV testing during pregnancy and postnatal period, Uganda, 2015–2018: analysis of surveillance data

AIDS Research and Therapy ◽

10.1186/s12981-021-00360-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Yvette Wibabara ◽

Ivan Lukabwe ◽

Irene Kyamwine ◽

Benon Kwesiga ◽

Alex R. Ario ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Hiv Testing ◽

Postnatal Period ◽

Surveillance Data ◽

Hiv Positive ◽

Health Management Information System ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mother To Child

Abstract Background Uganda has registered a reduction in new HIV infections among children in recent years. However, mother-to-child transmission of HIV still occurs, especially among pregnant women who present late. To eliminate this transmission, all HIV-positive pregnant women should be identified during antenatal HIV testing. We described women newly identified HIV-positive during pregnancy and postnatal period 2015–2018. Methods We extracted surveillance data for women identified as HIV-positive during pregnancy and the postnatal period reported through the Health Management Information System from 2015–2018. We calculated proportions newly positive at antenatal, labor, and postnatal periods nationally and at district levels. We disaggregated data into ‘tested early’ (during antenatal care) and ‘tested late’ (during labor or postnatal period) and calculated the proportion positive. We evaluated trends in these parameters at national and district levels. Results Overall, 8,485,854 mothers were tested for HIV during this period. Of these, 2.4% tested HIV-positive for the first time. While the total number of mothers tested increased from 1,327,022 in 2015 to 2,514,212 in 2018, the proportion testing HIV-positive decreased from 3.0% in 2015 to 1.7% in 2018 (43% decline over the study period, p < 0.001). Of 6,781,047 tested early, 2.2% tested HIV-positive. The proportion positive among those tested early dropped from 2.5% in 2015 to 1.7% in 2018. Of 1,704,807 tested late, 3.2% tested HIV-positive. The proportion positive among those tested late dropped from 5.2% in 2015 to 1.6% in 2018. At the district level, Kalangala District had the highest proportion testing positive at 13% (909/11,312) in 2015; this dropped to 5.2% (169/3278) in 2018. Conclusion The proportion of women newly testing HIV-positive during pregnancy and postnatal declined significantly during 2015–2018. A higher proportion of mothers who tested late vs early were HIV-positive. Failure to identify HIV early represents an increased risk of transmission. Ministry of Health should strengthen Elimination of Mother to Child Transmission (eMTCT) services to sustain this decrease through targeted interventions for poorly-performing districts. It should strengthen community-based health education on antenatal care and HIV testing and enhance the implementation of other primary prevention strategies targeting adolescents and young women.

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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 ◽

10.1136/bmjopen-2020-038311 ◽

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.

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Predictors of Unmet Need for Family Planning among HIV Positive Women in Care in Federal Teaching Hospital Gombe, Nigeria

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2020/v18i330191 ◽

2020 ◽

pp. 26-33

Author(s):

A. Mohammed ◽

D. Chiroma ◽

C. H. Laima ◽

M. A. Danimoh ◽

P. A. Odunze

Keyword(s):

Family Planning ◽

Unmet Need ◽

Hiv Care ◽

Hiv Positive ◽

P Value ◽

Mother To Child Transmission ◽

Child Transmission ◽

Hiv Positive Women ◽

History Of ◽

Mother To Child

Background: Elimination of mother-to-child transmission (EMTCT) of Human Immunodeficiency Virus (HIV) requires adequate and continuous use of family planning commodities among women of reproductive age. This can be made possible by reducing the proportion of HIV positive women with unmet need for family planning. The study aims to determine the factors associated with having unmet need among women in HIV care. Methods: A cross sectional study was conducted using an interviewer administered questionnaire to study 325 women on HIV care. Cluster sampling technique was used to select the study respondents from the clinic. Results: Less than half of the respondents (40%) were currently using family planning, 35% had unmet need for family planning with 53.6% having unmet need for spacing while 46.4% having unmet need for limiting. Women with no history of previous use of family planning were fifteen times more likely to have unmet need for family planning than those with history of previous use of family planning (p value <0.001, CI 2.511-15.770). Also women with more than five deliveries were eight times more likely to have unmet need for family planning (p value 0.004, CI 0.001-0.279) while women with 2-5 deliveries are four times likely to have unmet need for family planning (p value 0.035, CI 0.005-0.832). Conclusion: A high proportion of women receiving ART care still have unmet need for family planning despite incorporating this service in HIV care. It is therefore important to target high risk groups to reduce the proportion of women with unmet need for family planning which will invariable reduce mother to child transmission of HIV.

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