Supporting Option B+ scale up and strengthening the prevention of mother-to-child transmission cascade in central Malawi: results from a serial cross-sectional study

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  • Herce, Michael E
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Mtande, Tiwonge
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Chimbwandira, Frank
    • Other Affiliation: HIV Unit, Ministry of Health, Government of the Republic of Malawi, Lilongwe 3, Malawi
  • Mofolo, Innocent
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Chingondole, Christine K
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Rosenberg, Nora E
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Lancaster, Kathryn
  • Kamanga, Esmie
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Chinkonde, Jacqueline
    • Other Affiliation: UNICEF Malawi, Lilongwe 3, Malawi
  • Kumwenda, Wiza
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Tegha, Gerald
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Hosseinipour, Mina
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Hoffman, Irving
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Martinson, Francis E
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
  • Stein, Eva
  • van der Horst, Charles
    • Other Affiliation: Tidziwe Centre, UNC Project—Malawi, Lilongwe, Malawi
Abstract
  • Abstract Background We established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID). To these ends, we implemented the following interventions in 5 districts: 1) health worker training and mentorship; 2) couples’ HTC and male partner involvement; 3) women’s psychosocial support groups; and 4) health and laboratory system strengthening for EID. Methods We conducted a serial cross-sectional study using facility-level quarterly (Q) program data and individual-level infant HIV-1 DNA PCR data to evaluate STF performance on PMTCT indicators for project years (Y) 1 (April—December 2011) through 3 (January—December 2013), and compared these results to national averages. Results Facility-level uptake of HTC, ART, infant nevirapine prophylaxis, and infant DNA PCR testing increased significantly from quarterly baselines of 66 % (n/N = 32,433/48,804), 23 % (n/N = 442/1,958), 1 % (n/N = 10/1,958), and 52 % (n/N = 1,385/2,644) to 87 % (n/N = 39,458/45,324), 96 % (n/N = 2,046/2,121), 100 % (n/N = 2,121/2,121), and 62 % (n/N = 1,462/2,340), respectively, by project end (all p < 0.001). Quarterly HTC, ART, and infant nevirapine prophylaxis uptake outperformed national averages over years 2–3. While transitioning EID laboratory services to MoH, STF provided first-time HIV-1 DNA PCR testing for 2,226 of 11,261 HIV-exposed infants (20 %) tested in the MoH EID program in STF districts from program inception (Y2) through Y3. Of these, 78 (3.5 %) tested HIV-positive. Among infants with complete documentation (n = 608), median age at first testing decreased from 112 days (interquartile range, IQR: 57–198) in Y2 to 76 days (IQR: 46–152) in Y3 (p < 0.001). During Y3 (only year with national data for comparison), non-significantly fewer exposed infants tested HIV-positive (3.6 %) at first testing in STF districts than nationally (4.1 %) (p = 0.4). Conclusions STF interventions, integrated within the MoH Option B+ program, achieved favorable HTC, maternal ART, infant prophylaxis, and EID services uptake, and a low proportion of infants found HIV-infected at first DNA PCR testing. Continued investments are needed to strengthen the PMTCT cascade, particularly around EID.
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  • Article
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  • In Copyright
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  • Herce et al.
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  • English
Bibliographic citation
  • BMC Infectious Diseases. 2015 Aug 12;15(1):328
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  • BioMed Central

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