Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania

Abstract

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.     

Introduction of routine HIV testing in prenatal care--Botswana, 2004

In 2003, approximately 37% of pregnant women in Botswana (2001 population: 1.7 million; approximately 40,000 births per year) were infected with human immunodeficiency virus (HIV). Since 2001, all prenatal clinics in Botswana have offered HIV screening and interventions for prevention of mother-to-child transmission of HIV (PMTCT), which can decrease vertical transmission of HIV from 35%-40% to 5%-10%. Historically, HIV testing in Botswana has been performed after individual pretest counseling, with patients actively choosing whether to be tested (i.e., an "opt-in" approach). In 2003, 52% of pregnant women receiving prenatal care nationwide learned their HIV status. In 2004, to increase use of free national PMTCT and antiretroviral treatment (ARV) programs, Botswana began routine, noncompulsory (i.e., "opt-out") HIV screening in prenatal and other health-care settings. Concerns have been raised that routine testing in Africa might deter women from seeking prenatal care and might result in fewer women returning for their test results and HIV care after testing. To assess the early impact of routine testing on HIV-test acceptance and rates of return for care, the CDC Global AIDS Program and the PMTCT program in Botswana evaluated routine prenatal HIV testing at four clinics in Francistown, the second largest city in Botswana, where HIV prevalence has been > or =40% since 1995. This report describes the results of that assessment, which indicated that, during February-April 2004, the first 3 months of routine testing, 314 (90.5%) of 347 pregnant women were tested for HIV, compared with 381 (75.3%) of 506 women during October 2003-January 2004, the last 4 months of the opt-in testing period (p<0.001). However, many women who were tested never learned their HIV status because of logistical problems or not returning to the clinic. Substantial increases in HIV testing of pregnant women were also observed at the Francistown referral hospital and at prenatal clinics nationwide. These findings highlight the potential public health impact of routine HIV testing with rapid, same-day results for programs seeking to increase the number of persons with access to HIV-prevention and treatment services.     

Number and timing of antenatal HIV testing: Evidence from a community-based study in Northern Vietnam

Background  

HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities.     

Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis

Objectives We investigated whether a woman’s role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d’Ivoire, South Africa, and Zambia. Our exposure of interest was the women’s role (active vs. not active) in decision-making about her healthcare, large household purchases, children’s schooling, and children’s healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00–2.89 all p?<?.05). However, associations between decision-making and antiretroviral use—for both mother and infant—were generally not significant. An exception was active decision-making in a woman’s own healthcare and reported maternal antiretroviral use (AOR 1.69, p?<?0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services.

     

Operational effectiveness of single-dose nevirapine in preventing mother-to-child transmission of HIV

OBJECTIVE: To determine the operational effectiveness of the South African programme for preventing mother-to-child transmission (PMTCT) of HIV in reducing rates of early transmission of infection. METHODS: Participants were mother-infant pairs who participated in the South African PMTCT programme between October 2002 and November 2004. This was a prospective cohort study. Three sites in different provinces were selected to represent differences in socioeconomic status and HIV prevalence. Data on antenatal care and labour ward care were obtained from maternal interviews and from reviews of medical records. A total of 665 mother-infant pairs in which the mother was HIV-positive were recruited and 588 (88.4%) were followed up at 3 or 4 weeks postpartum to determine the HIV status and vital status of the infant. FINDINGS: Rural participants were significantly poorer and their health care was significantly worse. Women of higher socioeconomic status and those who received better counselling were more likely to be treated with nevirapine. Rates of early HIV transmission ranged from 8.6% to 13.7%. Maternal viral load was the only statistically significant risk factor for transmission. After adjusting for maternal viral load and prevalence of low birth weight, the odds of transmission were 1.8 times higher at the rural site. Controlling for having had > or = 4 antenatal visits and any delivery complication reduced the odds of transmission to 1.5 higher at the rural site. CONCLUSION: Rates of early transmission of HIV in an operational setting using single-dose nevirapine administered both to mother and child are similar to those obtained in clinical trials. Scaling up access to antiretroviral regimens for women will further reduce transmission to infants.     

Effectiveness of the first district-wide programme for the prevention of mother-to-child transmission of HIV in South Africa

OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha. METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study. Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction. Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour. Infant formula milk was-offered to mothers who chose not to breastfeed. The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery. RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol. The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9). A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07). CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting.     

Prevention of mother-to-child transmission of HIV infection: Ukraine experience to date

BACKGROUND: Despite the availability of effective interventions for the prevention of mother-to-child transmission (PMTCT), questions remain regarding implementation of programmes in settings with limited resources. This article sets out to describe the first 2 years of the implementation of the national PMTCT programme in Ukraine. METHODS: National data sources and data from a cohort of pregnant HIV-infected women delivering in 13 centres in Ukraine since 2000 were analysed. RESULTS: Interventions for prevention of MTCT have been implemented as a national programme within Ukraine's well developed infrastructure for maternal and child health. Implementation of an 'opt-out' model of counselling and HIV testing in antenatal clinics resulted in a 97% uptake of women who agreed to be HIV tested. In 2002, approximately 91% of HIV-positive pregnant women received ARV prophylaxis (mainly single-dose nevirapine or short-course zidovudine) for PMTCT. The MTCT rate has decreased from 30% in 2000 to 10% in 2002. The need to scale-up prevention interventions in pregnant women with risky behaviour and late access to medical services was identified in a review of the national programme in 2003. CONCLUSIONS: Further implementation of a comprehensive approach for the prevention of HIV infection in infants, including more extensive ART regimen, as recommended by WHO, would help Ukraine to achieve the strategic goal of virtual elimination of HIV infection in infants by 2010.     

Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics

How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix of observations, focus group discussions, and interviews. In Indonesia the study was conducted in a community-based PMTCT program run by an NGO, while in Vietnam the study explored the care dynamics in routine PMTCT services, implemented by district and provincial public health facilities. In both of these PMTCT arrangements (the routine provider initiated approach in Vietnam and a more client-oriented system in Indonesia), pregnant women value the provision of HIV tests in antenatal care (ANC). Concerns are raised, however, by the unhappy few who test positive. These women are unsatisfied with the quality of counselling, and the failure to provide antiretroviral treatments. Acceptability of HIV testing in ANC is high, but the key policy issue from the perspective of pregnant women is whether the PMTCT services can provide good quality counselling and the necessary follow-up care.We find local level providers of PMTCT are pleased with the PMTCT program. In Vietnam, the PMTCT program offers health workers protection against HIV, since they can refer women away from the district health service for delivery. In Indonesia, community cadres are pleased with the financial incentives gained by mobilizing clients for the program.We conclude that achieving the global aims of reducing HIV infections in children by 50% requires a tailoring of globally designed public health programs to context-specific gendered transmission pathways of HIV, as well as local opportunities for follow-up care and social support.     

Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

OBJECTIVE: In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. METHODS: UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. RESULTS: Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. CONCLUSION: Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.     

Prevention of mother-to-child transmission of HIV at the second immunization visit: a cross-sectional study,Burkina Faso

ObjectiveTo evaluate the performance of the cascade of activities for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) at the second immunization visit in Burkina Faso.MethodsIn a cross-sectional study, we recruited mothers attending the second immunization visit for their infant in 20 health centres of Bobo-Dioulasso city, Burkina Faso over 12 months (2019–2020). We administered a short questionnaire to 14 176 mothers and performed HIV serological tests on mothers who had not been tested in the last 3 months. All mothers were asked about their attendance for antenatal care and HIV rapid testing. HIV-infected mothers were also asked about the timing of their HIV diagnosis, antiretroviral therapy, pre-exposure prophylaxis initiation at birth and infant diagnosis of HIV.FindingsOf 14 136 respondents, 13 738 (97.2%) had at least one HIV serological test in their lifetime. Of 13 078 mothers who were never tested or were HIV-negative, 12 454 (95.2%) were tested during or after their last pregnancy. Among HIV-infected mothers already aware of their status, 110/111 (99.1%) women were on antiretroviral therapy. Among HIV-exposed infants, 84/101 (83.2%) babies received 6 weeks of antiretroviral prophylaxis at birth and 58/110 (52.7%) had a blood sample collected for early infant diagnosis. Only two mothers received their child’s test results at the time of the second immunization visit. Four mothers were newly diagnosed as HIV-positive during the study.ConclusionCollecting data at the second immunization visit, a visit rarely missed by mothers, could be useful for identifying gaps in the PMTCT cascade in settings where mothers are difficult to reach, such as in low-income countries with intermediate or low HIV prevalence.     

妊娠前后获知HIV感染对预防母婴传播干预措施利用的影响

目的 探讨妇女妊娠前后获知HIV感染对预防母婴传播(PMTCT)干预措施利用的影响.方法 前瞻性调查了2005-2009年河南、广西、云南、新疆四省(自治区)确认HIV感染的孕产妇5552例,5894人次妊娠,了解其社会人口学特征(将调查对象分为15～、25～、35～49岁3个年龄段),以及确认感染的时期、妊娠结局、艾滋病抗病毒药物应用等PMTCT干预措施的实施.采用单因素和非条件logistic多因素回归模型对HIV感染孕产妇实施PMTCT干预措施的影响因素进行分析.结果 HIV感染孕产妇84.5%(4979/5894)年龄在35岁以下,56.0%(3108/5552)为汉族,85.1%(4727/5552)为农民或无业,86.8%(4815/5552)为初中或以下文化程度,31.2%(1836/5894)的感染孕产妇在妊娠前已知HIV感染.31.7%(1869/5894)的HIV感染孕产妇选择人工终止妊娠,妊娠前已知感染者终止妊娠的比例高达43.8%(805/1836).80.0%(3046/3808)分娩的HIV感染孕产妇应用抗病毒药物,92.3%(883/957)的妊娠前已知感染者应用抗病毒药物,远高于当次妊娠才明确感染者[75.9%(2163/2851);x2=120.39,P＜0.05].多变量分析结果显示,妊娠前已知感染较妊娠前未知感染(OR=3.91,95%CI:3.03～5.05)、15～岁年龄段较35～49岁年龄段(OR=0.75,95%CI:0.57～0.98)的HIV感染孕产妇抗病毒药物应用比例较高.结论 妊娠前已知HIV感染有利于感染孕产妇尽早接受抗病毒药物应用等预防母婴传播的干预措施.     

From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple

The first step in preventing mother-to-child HIV transmission (PMTCT) programmes is offering HIV counselling and testing to pregnant women. In developing countries where HIV testing remains rare, it represents a unique opportunity for many women to learn their HIV status. This prenatal HIV testing is not only the entry point to prevention of mother-to-child HIV transmission, but also an occasion for women to sensitize their male partner to sexual risks. Here we explore if these women, HIV-tested as mothers, apply the prevention recommendations they also receive as women.In the Ditrame Plus PMTCT program in Abidjan, Côte d'Ivoire, two cohorts of women (475 HIV-infected women and 400 HIV-negative women) were followed up two years after the pregnancy when they were offered prenatal HIV testing. In each cohort, we compared the proportion of women who communicated with their regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed socio-demographic factors related to this communication. We measured two potential conjugal outcomes of women HIV testing: the level of condom use at sex resumption after delivery and the risk of union break-up.Prenatal HIV testing increased conjugal communication regarding sexual risks, whatever the woman's serostatus. This communication was less frequent for women in a polygamous union or not residing with their partner. Around 30% of women systematically used condoms at sex resumption. Among HIV infected ones, conjugal talk on sexual risks was related to improved condom use. After HIV testing, more HIV-infected women separated from their partners than HIV-uninfected women, despite very few negative reactions from the notified partners.In conclusion, offering prenatal HIV counselling and testing is an efficient tool for sensitizing women and their partners to HIV prevention. But sexual prevention in a conjugal context remains difficult and need to be specifically addressed.     

Opt-out HIV testing during antenatal care: experiences of pregnant women in rural Uganda

Two years after the introduction of provider-initiated, opt-out HIV counselling and testing during antenatal care (ANC) in Uganda, HIV testing uptake is still low. This study was carried out to explore pregnant women's experiences of, and views on, the policies for opt-out, and couple HIV testing, and to understand how the policy implementation could be improved in order to increase access to prevention of mother-to-child-transmission (PMTCT) services. The study was conducted at three ANC health facilities at different levels of care in rural eastern Uganda. Data were collected through sit-in observations during ANC and 18 semi-structured interviews with pregnant women receiving ANC, and thereafter analysed using latent content analysis. Pregnant women who received ANC from facilities that provided HIV testing on-site perceived HIV testing as compulsory without actually fully realizing the benefits of HIV testing and PMTCT. No referral for HIV testing or information about testing was given at ANC facilities that lacked HIV testing on-site. A major challenge of couple HIV testing was that pregnant women were made responsible for recruiting their spouses for testing, a precarious dilemma for many women who tried to fulfil health workers' requests without having the power to do so. In order to increase uptake of PMTCT services, the pre-test counselling in groups that precedes the provider-initiated HIV testing should be adjusted to inform women about the benefits of PMTCT. Further, if testing is perceived as compulsory it could potentially deter some women from seeking ANC services. In order to increase HIV testing of male partners new strategies are needed, for example peer-sensitization and male clinics. Moreover, to achieve the desired outcomes of the PMTCT programme, monitoring and evaluation should be built into the programme.     

Participation of traditional birth attendants in prevention of mother-to-child transmission of HIV services in two rural districts in Zimbabwe: a feasibility study

Background  

Prevention of Mother-to-Child Transmission of HIV (PMTCT) is among the key HIV prevention strategies in Zimbabwe. A decrease in use of antenatal care (ANC) services with an increase in home deliveries is affecting the coverage of PMTCT interventions in a context of accelerated economic crisis. The main objective was to evaluate acceptability and feasibility of reinforcing the role of traditional birth attendants (TBAs) in family and child health services through their participation in PMTCT programmes in Zimbabwe.     

Antenatal HIV testing in rural eastern Uganda in 2003: incomplete rollout of the prevention of mother-to-child transmission of HIV programme?

Background  

Uganda began to implement the prevention of mother-to-child transmission (PMTCT) of HIV programme in 2000, and by the end of 2003 it had expanded to cover 38 of the 56 districts including Mbale District. However, reports from Mbale Hospital showed that less than 10% of pregnant women accepted antenatal HIV testing. We therefore conducted a study to determine the proportion of pregnant women who tested for HIV and the gaps and barriers in PMTCT implementation.     

HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe

BACKGROUND: Vitamin A status during pregnancy is important to maternal and infant health. OBJECTIVE: Our goal was to identify predictors of serum beta-carotene and retinol. DESIGN: This was a cross-sectional study of 1669 women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum beta-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses. RESULTS: HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum beta-carotene concentrations (geometric x: 0.19 micromol/L) were lower in HIV-infected women than in uninfected women (10beta = 0.78; 95% CI: 0.72, 0.84) and increased with age (10beta = 1.05; 1.02, 1.07) in gravida 1 but not in gravida > or =2 (P for interaction = 0.00002). Serum retinol (x: 0.92 micromol/L) increased with age (beta = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-micromol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum beta-carotene. Serum retinol was lower in women carrying male (beta = -0.04; -0.08, -0.00005) and multiple (beta = -0.21; -0.35, -0.08) fetuses. Serum ACT concentrations of 0.3-0.4, 0.4-0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum beta-carotene and 0.04-, 0.15-, and 0.41-micromol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (beta = 0.10; 0.03, 0.16) and in gravida 1 than in gravida > or =2 (beta = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (beta = 0.001; -0.008, 0.011). CONCLUSIONS: HIV infection, malaria, gravidity, and gestational age were predictors of serum beta-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.     

FACTORS THAT CONTRIBUTE TO WOMEN DECLINING ANTENATAL HIV TESTING

In this study we aimed to identify factors that contribute to women’s decisions to decline an HIV test during their pregnancy in an antenatal clinic setting in Metropolitan London. Voluntary HIV testing (“opt-in”) is recommended by the British Department of Health in areas of higher HIV prevalence. We developed a questionnaire that focused on attitudes toward testing, knowledge of transmission routes, a self-assessment of HIV risk, and reasons for declining the HIV test. All women attending the 16-week antenatal booking appointment were offered an HIV test. Of these 560 women, 124 (23%) had an HIV test and the 436 (77%) who declined the test were asked to complete a questionnaire that explored their reasons for declining. We based our findings on the 393 completed returned questionnaires. The major finding was that women declined testing because they did not think they had been at risk for HIV. However, they based this belief on patchy HIV knowledge. The women were making an important decision during their pregnancy on the basis of poor information. The antenatal setting may not be the most appropriate environment in which to give HIV information, however, this task must be performed also in other health environments.     

A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria

ABSTRACT: INTRODUCTION: Most HIV/AIDS infections in women occur at a younger age, during the first few years after sexual debut. This study was therefore designed to assess factors associated with the knowledge and utilization of the prevention of mother-to-child transmission (PMTCT) services by the teenage pregnant women when compared to mature pregnant women in Ogun state, Nigeria. METHODS: This study is an analytical cross-sectional study. A total sample of all pregnant women [52 teenagers and 148 adults] attending the primary health care centres in Sagamu local government area, Ogun State, Nigeria within a 2 months period were recruited into the study. RESULTS: A total of 225 respondents were recruited into the study. The overall point prevalence of HIV/AIDS infection among those that had been tested and disclosed their result was 4 [2.8%]. The prevalence of HIV among the teenagers was 2 [7.4%] compared with 2 [1.8%] among older women. Only 85 [37.8%] of all respondents were tested through the Voluntary counseling and testing (VCCT) programme and 53 (23.7%) were aware of antiretroviral therapy while 35 (15.6%) have ever used the PMTCT services before.There was no statistically significant difference in the knowledge of the teenage pregnant women when compared with the older women about mother to child transmission (MTCT) [OR = 1.47, C.I = 0.57-3.95] and its prevention [OR = 0.83, C.I = 0.38-1.84]. The teenagers were 3 times less likely to use the services when compared with the older women. [OR = 0.34, C.I = 0.10-1.00]. Those from the low socio-economic background were about 6 times more likely to utilize PMTCT facilities when compared to those from high socioeconomic background [OR = 6.01, C.I = 1.91-19.19]. CONCLUSION: The study concludes that the teenage pregnant women who were more vulnerable to HIV/AIDS infection did not utilize PMTCT services as much as the older pregnant women. Special consideration should be given to teenagers and those from high socioeconomic group in the design of scale up programmes to improve the uptake of PMTCT services in Nigeria and other low income countries.     

Factors that contribute to women declining antenatal HIV testing

In this study we aimed to identify factors that contribute to women's decisions to decline an HIV test during their pregnancy in an antenatal clinic setting in Metropolitan London. Voluntary HIV testing ("opt-in") is recommended by the British Department of Health in areas of higher HIV prevalence. We developed a questionnaire that focused on attitudes toward testing, knowledge of transmission routes, a self-assessment of HIV risk, and reasons for declining the HIV test. All women attending the 16-week antenatal booking appointment were offered an HIV test. Of these 560 women, 124 (23%) had an HIV test and the 436 (77%) who declined the test were asked to complete a questionnaire that explored their reasons for declining. We based our findings on the 393 completed returned questionnaires. The major finding was that women declined testing because they did not think they had been at risk for HIV. However, they based this belief on patchy HIV knowledge. The women were making an important decision during their pregnancy on the basis of poor information. The antenatal setting may not be the most appropriate environment in which to give HIV information, however, this task must be performed also in other health environments.     

Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

Objective

To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia.

Methods

Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women, irrespective of immunological status, at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death.

Findings

In the first survey (2008–2009), 335 of 1778 women (18.8%) tested positive for HIV. In the second (2011), 390 of 2386 (16.3%) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95% confidence interval, CI: 0.63–0.76) in the first survey and 0.89 (95% CI: 0.83–0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33, 95% CI: 0.15–0.73). Maternal knowledge of HIV status, use of HIV tests and use of combination regimens during pregnancy increased between the surveys.

Conclusion

The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased.