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 ◽  
...  

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.

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.


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.


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 PMTCT option B+ services in Mozambique. Methods: We compared ‘point’ retention (patient’s presence in care at 12-months post-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 adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% appointment done 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 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.


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.


2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lisa L. Dillabaugh ◽  
Jayne Lewis Kulzer ◽  
Kevin Owuor ◽  
Valerie Ndege ◽  
Arbogast Oyanga ◽  
...  

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.


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


Author(s):  
Justin Mandala ◽  
Prisca Kasonde ◽  
Titilope Badru ◽  
Rebecca Dirks ◽  
Kwasi Torpey

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.


2021 ◽  
Vol 14 (1) ◽  
pp. 425-434
Author(s):  
Nompilo Dlamini ◽  
Busisiwe Ntuli ◽  
Sphiwe Madiba

Background: Eswatini has adopted the PMTCT Option B+ approach as a strategy for the prevention of mother-to-child transmission of HIV. Objective: This study aimed to explore how pregnant Swazi women perceived and experienced PMTCT Option B+ and examined challenges they faced in disclosing their HIV status to their male partners. Methods: We interviewed 15 HIV-positive pregnant women selected using purposeful sampling from the PMTCT programme in Manzini Region, Eswatini. The data were analysed thematically. Results: The women had to deal with the pregnancy, the HIV-positive test results, the immediacy of the antiretroviral treatment (ART), and disclosure issues, all in one visit. They perceived the mandatory HIV testing and the same-day ART initiation as coercive. Regardless, they perceived PMTCT in a positive manner and as a gateway to early treatment for them. The drive to enroll in and remain in PMTCT was motivated by the belief in the efficacy of ART and the desire to protect their unborn babies from HIV infection. Their anticipation of rejection and violence from their partners led to their delaying disclosure and initiation of ART. Following disclosure, some of them were stigmatised, blamed for the infection, and abandoned by their partners. Conclusion: As Eswatini continues to roll out Option B+, there is a need to consider providing individualised counselling sessions to meet the individual needs of women.


2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Fisseha Wudineh ◽  
Bereket Damtew

Since the scale-up for prevention of mother-to-child transmission (PMTCT) services, rates of HIV infection among exposed infants have significantly declined. However, current achievements fell short of achieving the target sets. We investigated mother-to-child transmission (MTCT) of HIV infection and its determinants among HIV-exposed infants on care at Dilchora Referral Hospital in Dire Dawa City Administration. A retrospective institutional cohort study was conducted by reviewing follow-up records of HIV-exposed infants who were enrolled into care. Infants’ HIV serostatus was the outcome measure of the study. Bivariate and multivariate logistic regressions were employed to identify significant determinants. Of the 382 HIV-exposed infants enrolled into care, 60 (15.7%) became HIV positive. Rural residence (AOR: 3.29; 95% CI: 1.40, 7.22), home delivery (AOR: 3.35; 95% CI: 1.58, 8.38), infant not receiving ARV prophylaxis at birth (AOR: 5.83; 95% CI: 2.84, 11.94), mixed feeding practices (AOR: 42.21; 95% CI: 8.31, 214.38), and mother-child pairs neither receiving ARV (AOR: 4.42; 95% CI: 2.01, 9.82) were significant independent determinants of MTCT of HIV infection. Our findings suggest additional efforts to intensify scale-up of PMTCT services in rural setting and improve institutional delivery and postnatal care for HIV positive mothers and proper follow-up for HIV-exposed infants.


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