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Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE).

Woldesenbet S, Jackson D, Lombard C, Dinh TH, Puren A, Sherman G, Ramokolo V, Doherty T, Mogashoa M, Bhardwaj S, Chopra M, Shaffer N, Pillay Y, Goga A, South African PMTCT Evaluation (SAPMCTE) Te - PLoS ONE (2015)

Bottom Line: The population attributable fraction associated with dropouts at each service point are estimated.In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status.Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5-3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa.

ABSTRACT

Objectives: We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa.

Methods: A cross-sectional survey was conducted among 4-8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants' dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated.

Results: Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5-3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade.

Conclusion: A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities.

No MeSH data available.


Related in: MedlinePlus

The increase in cumulative PAF as cumulative dropout rate increases (red and blue lines), and reduction in infant HIV incidence if dropout is eliminated (purple bar*).
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pone.0132425.g002: The increase in cumulative PAF as cumulative dropout rate increases (red and blue lines), and reduction in infant HIV incidence if dropout is eliminated (purple bar*).

Mentions: In the cumulative PAF, overall we observed an increasing trend in PAF as cumulative dropout rates increased (Fig 2). The PAF of dropouts for all steps in the cascade combined is 33.8% (95% CI: 14.9, 48.8)– 6.5% of the cumulative PAF was attributable to the CD4 count step whilst the remaining 27.3% PAF was attributable to the HIV testing, maternal and infant ARV steps. The HIV transmission rate predicted for two scenarios indicate the HIV transmission could be reduced from 3.4% (95% CI: 2.8, 4.1) in the observed data scenario (i.e. with 34.9% overall dropout rate) to 2.2% (95% CI: 1.6, 3.1) in an ideal scenario where no dropout occurs in the four key PMTCT cascade steps. Transmission could be reduced from 3.4% in the observed data to 2.8%, 2.6%, and 2.4% if missed opportunity at HIV status knowledge, CD4 count test and maternal ARV points, respectively, is prevented. In the cumulative PAF of 33.8%, maternal HIV status knowledge contributes nearly half of this fraction and thus half of the reduction in transmission from 3.4% to 2.2% (Table 2 and Fig 2).


Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE).

Woldesenbet S, Jackson D, Lombard C, Dinh TH, Puren A, Sherman G, Ramokolo V, Doherty T, Mogashoa M, Bhardwaj S, Chopra M, Shaffer N, Pillay Y, Goga A, South African PMTCT Evaluation (SAPMCTE) Te - PLoS ONE (2015)

The increase in cumulative PAF as cumulative dropout rate increases (red and blue lines), and reduction in infant HIV incidence if dropout is eliminated (purple bar*).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492960&req=5

pone.0132425.g002: The increase in cumulative PAF as cumulative dropout rate increases (red and blue lines), and reduction in infant HIV incidence if dropout is eliminated (purple bar*).
Mentions: In the cumulative PAF, overall we observed an increasing trend in PAF as cumulative dropout rates increased (Fig 2). The PAF of dropouts for all steps in the cascade combined is 33.8% (95% CI: 14.9, 48.8)– 6.5% of the cumulative PAF was attributable to the CD4 count step whilst the remaining 27.3% PAF was attributable to the HIV testing, maternal and infant ARV steps. The HIV transmission rate predicted for two scenarios indicate the HIV transmission could be reduced from 3.4% (95% CI: 2.8, 4.1) in the observed data scenario (i.e. with 34.9% overall dropout rate) to 2.2% (95% CI: 1.6, 3.1) in an ideal scenario where no dropout occurs in the four key PMTCT cascade steps. Transmission could be reduced from 3.4% in the observed data to 2.8%, 2.6%, and 2.4% if missed opportunity at HIV status knowledge, CD4 count test and maternal ARV points, respectively, is prevented. In the cumulative PAF of 33.8%, maternal HIV status knowledge contributes nearly half of this fraction and thus half of the reduction in transmission from 3.4% to 2.2% (Table 2 and Fig 2).

Bottom Line: The population attributable fraction associated with dropouts at each service point are estimated.In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status.Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5-3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa.

ABSTRACT

Objectives: We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa.

Methods: A cross-sectional survey was conducted among 4-8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants' dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated.

Results: Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5-3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade.

Conclusion: A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities.

No MeSH data available.


Related in: MedlinePlus