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Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Article scientifique 2018 Anglais

Résumé

BACKGROUND: Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland. METHODS: Lifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01-06/2013, mid: 07-12/2013 and late: 01-06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses. RESULTS: Of 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+. CONCLUSIONS: PMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

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Etoori, D., Kerschberger, B., Staderini, N., Ndlangamandla, M., Nhlabatsi, B., Jobanputra, K., Mthethwa‐Hleza, S., Parker, L., Sibanda, S., Mabhena, E., Pasipamire, M., Kabore, S., Rusch, B., Jamet, C., Ciglenečki, I., Teck, R. (2018). Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland. https://doi.org/10.1186/s12889-018-5258-3

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Auteur(s)

David Etoori Bernhard Kerschberger Nelly Staderini Mpumelelo Ndlangamandla Bonisile Nhlabatsi Kiran Jobanputra Simangele Mthethwa‐Hleza Lucy Anne Parker Sifiso Sibanda Edwin Mabhena Munyaradzi Pasipamire Serge Mathurin Kabore Barbara Rusch Christine Jamet Iza Ciglenečki Roger Teck

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