Evaluation of the prevention of mother-to-child transmission programme at a primary health care centre in South Africa

Viral suppression among adolescents on HIV treatment in the Sedibeng District, Gauteng province

Background

Progress has been made to increase access to antiretroviral therapy (ART) for adolescents living with HIV (ALHIV) to improve their survival, but ALHIV still have worse treatment adherence and viral suppression compared to adults and children.

Objective

To determine the prevalence of viral suppression and the associated factors among adolescents aged 10–19 years on ART at an urban public primary healthcare facility in the Sedibeng district, Gauteng.

Method

A cross-sectional survey was conducted among 192 adolescents who were on ART for at least six months between 2015 and 2018. A self-developed data extraction tool was used to collect data from the Tier.Net electronic database and clinical folders. Data were captured on Microsoft Excel, and descriptive and inferential analyses were performed using SPSS 27 statistical software.

Results

The median age at ART initiation of adolescents was 9.0 years (interquartile range [IQR]: 5.0–12.0), and the median duration on ART was 70.5 (IQR: 30.25–105.5) months. The prevalence of viral suppression (< 1000 copies/mL) among adolescents on ART was 74%, with 41% achieving full suppression (< 50 copies/mL). Those adolescents who reported optimal ART adherence were more likely to be virally suppressed compared to those who reported poor adherence (98.1% vs 25.0%; p ≤ 0.001).

Conclusion

Adolescent viral suppression of 74% is higher than in comparable sites, but still way too short of the UNAIDS target of 90%. We recommend adherence support for adolescents to achieve viral suppression.

Contribution

The study highlights the urgent need for targeted adherence support interventions for adolescents living with HIV on antiretroviral therapy to improve rates of viral suppression to meet UNAIDS target of 95%.

Health care costs associated with clinic visits for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania

Early and appropriate antenatal care (ANC) is key for the effectiveness of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). We evaluated the importance of ANC visits and related service costs for women receiving option B+ to prevent mother-to-child transmission (MTCT) of HIV in Tanzania.A cost analysis from a health care sector perspective was conducted using routine data of 2224 pregnant women newly diagnosed with HIV who gave birth between August 2014 and May 2016 in Dar es Salaam, Tanzania. We evaluated risk of infant HIV infection at 12 weeks postnatally in relation to ANC visits (<4 vs ≥4 visits). Costs for service utilisation were estimated through empirical observations and the World Health Organisation Global Price Reporting Mechanism.Mean gestational age at first ANC visit was 22 (±7) weeks. The average number of ANC/prevention of MTCT visits among the 2224 pregnant women in our sample was 3.6 (95% confidence interval [CI] 3.6-3.7), and 57.3% made ≥4 visits. At 12 weeks postnatally, 2.7% (95% CI 2.2-3.6) of HIV exposed infants had been infected. The risk of MTCT decreased with the number of ANC visits: 4.8% (95% CI 3.6-6.4) if the mother had <4 visits, and 1.0% (95% CI 0.5-1.7) at ≥4. The adjusted MTCT rates decreased by 51% (odds ratio 0.49, 95% CI 0.31-0.77) for each additional ANC visit made. The potential cost-saving was 2.2 US$ per woman at ≥4 visits (84.8 US$) compared to <4 visits (87.0 US$), mainly due to less defaulter tracing.Most pregnant women living with HIV in Dar es Salaam initiated ANC late and >40% failed to adhere to the recommended minimum of 4 visits. Improved ANC attendance would likely lead to fewer HIV-infected infants and reduce both short and long-term health care costs due to less spending on defaulter tracing and future treatment costs for the children.

Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis

BACKGROUND

This study describes the characteristics of pregnant women on antiretroviral therapy (ART) and the rate of peripartum virologic suppression in a large prevention of mother-to-child transmission cohort who delivered in some selected maternity centers in Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort.

METHODS

This multicenter, retrospective cross-sectional analysis included medical data of 1709 women with human immunodeficiency virus between September 2015 and May 2016 in Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression, defined as viral load (VL) <1000 copies/mL and undetectable viremia (VL <20 copies/mL). Correlates of peripartum virologic suppression and undetectable viremia were examined by fitting logistic regression model analysis.

RESULTS

Of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viremia was 56.9%. Being aged 24 years or younger (adjusted odds ratio [AOR], 0.68 [95% confidence interval {CI}, .48-.94]), smoking during pregnancy (AOR, 0.50 [95% CI, .28-.90]), and starting ART in the first trimester were associated with lower odds of viral suppression (<1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable VL (AOR, 3.09 [95% CI, 2.12-4.49]) and virologic suppression (AOR, 3.88 [95% CI, 2.62-5.74]) compared to those who defaulted.

CONCLUSIONS

More than half of the women achieved undetectable VL, and 4 in 5 women achieved viral suppression at delivery in the region. Early antenatal booking, combined with enhanced adherence support for pregnant women on ART, would be crucial toward achieving the goal of elimination of mother-to-child transmission in the region.

Barriers to the management of children under five exposed to HIV in the rural areas of South Africa

BACKGROUND

South Africa has made enormous progress in reducing mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), however, MTCT and AIDS related death persist among children particularly in the rural areas. Lack of adherence to health policies and guidelines implementation remain one of the contributory factors to poor management of HIV-exposed children. Hence, the need to deeply explore the complexity of the problems and understand the barriers to the management of HIV exposed children in the rural areas.

OBJECTIVES

To explore and synthesise the barriers to the management of children under 5 years old exposed to HIV in rural areas in South Africa.

METHOD

An integrative literature review was conducted. An electronic search was conducted on several databases. The researchers applied the Boolean ' AND'/'OR' in combination with phrases such as 'HIV infection*', 'HIV transmission', 'HIV-exposed infant*, child*, and neonate*' and 'South Africa*'. Included studies were limited to South Africa, and articles were written in English and published in peer-reviewed journals from 2005 to 2018. Both qualitative and quantitative studies between 2005 and 2018 were utilised.

RESULTS

The findings highlighted that healthcare institution-related barriers, healthcare provider-related barriers, patient-related barriers and Socio-economic-related barriers were the significant barriers to the management of HIV-exposed children in the rural areas.

CONCLUSION

Continuous engagement with all relevant stakeholders should remain a priority in protecting HIV-exposed children. It is evident that there exist gaps in the current implementation of prevention of mother-to-child transmission (PMTCT), especially in rural areas. Therefore, intervention strategies that could improve implementation of PMTCT policy guidelines for HIV-exposed children in rural areas are needed.

Cotransmission of Malaria and HIV to Infants of Mothers Coinfected With Malaria and HIV in the HAART Era in Benin City, Nigeria

INTRODUCTION

Malaria and HIV are vertically transmitted to infants. In an era where specific interventions are available to reduce the burden of malaria in pregnancy and vertical transmission of HIV, we examined the transmission and cotransmission of HIV and malaria to infants of mothers coinfected with malaria and HIV.

METHODS

A cross-sectional analytic study performed on 101 HIV/malaria-coinfected mothers and their infants for whom DNA polymerase chain reaction results were available. Blood film for malaria parasites was performed on cord blood and peripheral blood on days 1, 3, and 7 in the newborns. Maternal peripheral blood film for malaria parasite was performed at delivery, and placental tissue was obtained for confirmation of placental malaria by histology. All infants received DNA polymerase chain reaction testing for HIV at 6-8 weeks of life.

RESULTS

Cotransmission of malaria and HIV occurred in 2 (1.98%) infants. Vertical transmission of HIV occurred in 7 (7%) babies, whereas congenital malaria was present in 32 (31.7%) babies. The transmission of HIV and presence of congenital malaria were not significantly associated with each other P = 1.000. Of the 88 babies of mothers who commenced highly active antiretroviral treatment (HAART) before pregnancy, 5 (5.7^) had HIV, which was significantly less than 2 (40%) of 5 babies of mothers who commenced HAART during pregnancy P = 0.04.

CONCLUSIONS

Among mothers coinfected with malaria and HIV, vertical transmission of malaria and HIV was not associated with each other. HAART reduces vertical transmission of HIV especially if started before pregnancy.