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Ambade PN, Hajjar J, Adjei NK, Yaya S. Using the Family Planning Estimation Tool (FPET) to assess national-level family planning trends and future projections for contraceptive prevalence and associated demand for HIV-infected women in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002637. [PMID: 39106280 DOI: 10.1371/journal.pgph.0002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/18/2024] [Indexed: 08/09/2024]
Abstract
The combination of low uptake of modern contraceptives, high rates of unintended pregnancies, and the pervasive HIV epidemic in Sub-Saharan Africa (SSA) poses a threat to maternal, newborn, and child health in the region. This study examined the prevalence, need, and demand satisfied by modern contraceptive methods for women who tested positive for HIV (both unmarried and married) in 10 countries in SSA. We used the Family Planning Estimation Tool (FPET) to generate national-level trends and projections from 1983 through 2030. Individual-level data from 30 DHS surveys conducted between 2004 and 2018 in 10 sub-Saharan Africa (SSA) countries were used to produce projections for 1) all women and 2) unmarried and married women who tested positive for HIV. Throughout the period, Ethiopian and Guinean women who tested positive for HIV had a higher %mCPR (utilization of modern family planning methods) vis-à-vis all women. Among women who tested positive for HIV, the highest percentage of family planning demand satisfied by modern methods was observed in Zimbabwe (85.27, CI: 76.32-91.69), Lesotho (82.75, CI: 71.80-89.86), Rwanda (80.17, CI: 70.01-87.62), Malawi (73.11, CI: 61.50-82.63), and Zambia (72.63, CI: 64.49-80.09). The highest unmet need for modern contraceptives was found in Senegal (25.38, CI:18.36-33.72), followed by Cameroon (23.59, CI:19.30-28.59) and Sierra Leone (23.16, CI:16.64-32.05). Zimbabwe had the lowest unmet need (10.61, CI:6.36-16.13) and achieved the highest change in %mCPR (49.28, SE:6.80). Among married women who tested positive for HIV, their unmet need for modern contraception will remain higher in 2030. Continuing existing policies until 2030 would result in significant coverage gain among married vis-à-vis unmarried women who tested positive for HIV. Our projections emphasize the importance of country-specific strengthening initiatives, programs, and services targeting unmarried women.
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Affiliation(s)
- Preshit Nemdas Ambade
- Department of Health Management, Economics and Policy, School of Public Health, Augusta University, Augusta, Georgia, United States of America
| | - Julia Hajjar
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Sanni Yaya
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Fletcher R, Forbes F, Dadi AF, Kassa GM, Regan C, Galle A, Beyene A, Liackman R, Temmerman M. Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review. Health Sci Rep 2024; 7:e2269. [PMID: 39086507 PMCID: PMC11286546 DOI: 10.1002/hsr2.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
Background and Aims East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being. Methods Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. Results A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being. Conclusions The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.
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Affiliation(s)
- Richard Fletcher
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Faye Forbes
- College of Health SciencesDebre Markos UniversityDebre MarkosEthiopia
- Global and Women's Health Unit, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Abel Fekadu Dadi
- Menzies School of Health ResearchCharles Darwin University, NT, Australia & Addis Continental Institute of Public HealthAddis AbabaEthiopia
| | | | - Casey Regan
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Anna Galle
- Department Public Health and Primary CareInternational Centre for Reproductive Health, Ghent UniversityGhentBelgium
| | - Addisu Beyene
- School of Public Health, College of Health and Medical SciencesHaramaya UniversityHararEthiopia
- Centre for Women's Health Research, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
| | - Rebecca Liackman
- College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Marleen Temmerman
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Centre of Excellence in Women and Child HealthAga Khan UniversityNairobiKenya
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Habteyes AT, Mekuria MD, Negeri HA, Kassa RT, Deribe LK, Sendo EG. Prevalence and associated factors of caesarean section among mothers who gave birth across Eastern Africa countries: Systematic review and meta-analysis study. Heliyon 2024; 10:e32511. [PMID: 38952380 PMCID: PMC11215273 DOI: 10.1016/j.heliyon.2024.e32511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
Background Caesarean section (CS) rate increased dramatically worldwide, exceeding the World Health Organization's benchmark (10-15 %) in many countries. This rate varies in different regions of the continent. Using various study designs, researchers from across East African countries investigated the prevalence of caesarean section and the factor associated with it but no study shows a pooled prevalence of caesarean section in the Eastern African region. Therefore, this review aimed to systematically summarize and estimate the pooled prevalence of caesarean section and its associated factors in Eastern Africa, 2023. Methods PubMed, Web of Science, EMBASE, Scopus and CINAHL were rigorously searched to find relevant studies. All identified observational studies reporting the prevalence of CS and its associated factors in East Africa published till August 2023 were considered. Heterogeneity across the studies was evaluated using the I2 test. Publication bias was assessed by funnel plot and Egger's regression test. Finally, a random effect meta-analysis model was computed to estimate the pooled prevalence of CS and qualitative analysis was employed for associated factors. The study protocol was registered in PROSPERO. Results This review was assessed using twenty-six eligible studies from a total of 2223 articles with a total of 600,431 participants. In this meta-analysis, the pooled prevalence of caesarean section in Eastern Africa was 24.0 % (95%CI: 22-27 %). The highest pooled prevalence of caesarean section was in Ethiopia, 28.30 % (95%CI; 21.3-35.2 %), and the lowest was seen in Uganda, 11.9 % (95%CI; 7.9-15.9 %). Urban residency, having high level of wealth asset, education level college and above, advanced maternal age, big birth weight, history of previous caesarean section, private institution delivery, multiple pregnancies, pregnancy-induced hypertension, antepartum haemorrhage and fetal malpresentation were linked with a greater likelihood of having CS. Conclusions and recommendation: The overall pooled prevalence of CS in Eastern Africa was high compared to the WHO proposed recommended range. Therefore, the finding implies that each East African countries Ministry of Health and health care professionals shall be given particular emphasis made on strengthening antenatal care services and ensure more women have access to skilled healthcare professionals during childbirth. This can help in providing appropriate interventions, support to women and reducing the need for emergency and unnecessary CSs. The result of this research are a baseline data for future researchers to conduct further studies to better understand the reasons behind the high rates and identify potential interventions and solutions specific to the African context.PROSPERO protocol number: CRD42023440131.
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Affiliation(s)
- Abrham Tesfaye Habteyes
- Department of Midwifery, College of Medicine & Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mihret Debebe Mekuria
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haweni Adugna Negeri
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Roza Teshome Kassa
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leul Kitaw Deribe
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endalew Gemechu Sendo
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Facha W, Tadesse T, Wolka E, Astatkie A. Magnitude and risk factors of mother-to-child transmission of HIV among HIV-exposed infants after Option B+ implementation in Ethiopia: a systematic review and meta-analysis. AIDS Res Ther 2024; 21:39. [PMID: 38849895 PMCID: PMC11157738 DOI: 10.1186/s12981-024-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a major public health challenge in Ethiopia. The objective of this review was to assess the pooled magnitude of MTCT of HIV and its risk factors among mother-infant pairs who initiated antiretroviral therapy (ART) after Option B+ in Ethiopia. METHODS A systematic search of literature from PubMed, Hinari, African Journals Online (AJOL), Science Direct, and Google Scholar databases was conducted from June 11, 2013 to August 1, 2023. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to guide the article selection process and reporting. Observational studies that reported the magnitude and/or risk factors on MTCT of HIV among mother-infant pairs who initiated ART after the implementation of Option B+ in Ethiopia were included. We applied a random-effect model meta-analysis to estimate the overall pooled magnitude and risk factors of MTCT of HIV. A funnel plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I2 statistics. The protocol was registered in the PROSPERO database with registration ID number CRD42022325938. RESULT Eighteen published articles on the magnitude of MTCT and 16 published articles on its risk factors were included in this review. The pooled magnitude of MTCT of HIV after the Option B+ program in Ethiopia was 4.05% (95% CI 3.09, 5.01). Mothers who delivered their infants at home [OR: 9.74; (95% CI: 6.89-13.77)], had not been on ART intervention [OR: 19.39; (95% CI: 3.91-96.18)], had poor adherence to ART [OR: 7.47; (95% CI: 3.40-16.45)], initiated ART during pregnancy [OR: 5.09; (95% CI: 1.73-14.97)], had WHO clinical stage 2 and above [OR: 4.95; (95% CI: 1.65-14.88]], had a CD4 count below 350 at enrolment [OR: 5.78; (95% CI: 1.97-16.98], had no or low male partner involvement [OR: 5.92; (95% CI: 3.61-9.71]] and whose partner was not on ART [OR: 8.08; (95% CI: 3.27-19.93]] had higher odds of transmitting HIV to their infants than their counterparts. CONCLUSION This review showed that the pooled magnitude of MTCT of HIV among mother-infant pairs who initiated ART after the Option B + program in Ethiopia is at the desired target of the WHO, which is less than 5% in breastfeeding women. Home delivery, lack of male partner involvement, advanced HIV-related disease, lack of PMTCT intervention, and poor ARV adherence were significant risk factors for MTCT of HIV in Ethiopia.
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Affiliation(s)
- Wolde Facha
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, P.O.BOX 136, Wolaita Sodo, Ethiopia.
| | - Takele Tadesse
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, P.O.BOX 136, Wolaita Sodo, Ethiopia
| | - Eskinder Wolka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, P.O.BOX 136, Wolaita Sodo, Ethiopia
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, P.O.BOX: 1560, Hawassa, Ethiopia
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Facha W, Tadesse T, Wolka E, Astatkie A. Effect of Dolutegravir-Based First-Line Antiretroviral Therapy on Mother-to-Child Transmission of HIV Among HIV-Exposed Infants in Ethiopia: a Before-and-After Study. HIV AIDS (Auckl) 2024; 16:203-215. [PMID: 38765704 PMCID: PMC11100515 DOI: 10.2147/hiv.s456261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Background Currently, Dolutegravir (DTG)-based regimens are administered to women on Option B plus to prevent mother-to-child transmission (MTCT) of the virus. However, its effect on reducing MTCT of human immunodeficiency virus (HIV) among HIV-exposed infants over the previously used Efavirenz (EFV)-based regimen is unknown. Objective This study aimed to compare the effects of DTG-based and EFV-based regimens on the MTCT of HIV among HIV-exposed infants in Ethiopia. Methods An uncontrolled before-and-after study design was conducted among 958 mother-infant pairs (479 on EFV-based and 479 on DTG-based regimens) enrolled in the prevention of mother-to-child transmission (PMTCT) care from September 2015 to February 2023. The outcome variable was the HIV infection status among the exposed infants. A log-binomial model was employed, and the proportion was computed to compare the incidence of MTCT of HIV in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess the predictor variables. Results Mothers on DTG-based regimens were approximately 44% (adjusted risk ratio (aRR): 0.56; 95% CI: 0.44, 0.70) less likely to transmit HIV to their infants than those on EFV-based regimens. In addition, poor or fair adherence to antiretroviral therapy (ART) (aRR: 5.82; 95% CI: 3.41, 9.93), home delivery (aRR: 3.61; 95% CI: 2.32, 5.62), mixed feeding practice (aRR: 1.83; 95% CI: 1.45, 2.3) and not receiving antiretroviral prophylaxis (aRR: 3.26; 95% CI: 1.6, 6.64) were found to increase the risk of MTCT of HIV infection, whereas older maternal age (aRR: 0.93; 95% CI: 0.9, 0.96) was a protective factor. Conclusion Mother-to-child transmission of HIV was less frequently observed in mother-infant pairs exposed to the DTG-based regimens as compared to those exposed to the EFV-based regimens. Thus, DTG-based first-line ART regimens supplementation should be sustained to achieve global and national targets for zero new infections in HIV-exposed infants.
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Affiliation(s)
- Wolde Facha
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Takele Tadesse
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Wolka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Musiime V, Rujumba J, Kakooza L, Namisanvu H, Atuhaire L, Naguti E, Beinomugisha J, Kiggwe A, Nkinzi S, Segawa I, Matsiko N, Babirekere-Iriso E, Musoke P. HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study. PLoS One 2024; 19:e0301887. [PMID: 38626109 PMCID: PMC11020493 DOI: 10.1371/journal.pone.0301887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/25/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive. METHODOLOGY We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data. RESULTS Of 797 children tested, 463(58.1%) were male and 630(79.1%) were ≤18months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother-infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66/188). Child age >18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11-3.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic. CONCLUSION In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.
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Affiliation(s)
- Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lawrence Kakooza
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henriator Namisanvu
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Loice Atuhaire
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Erusa Naguti
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Judith Beinomugisha
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kiggwe
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharafat Nkinzi
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ivan Segawa
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicholas Matsiko
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Esther Babirekere-Iriso
- Mwanamugimu Nutrition Unit, Directorate of Paediatrics and Child Care, Mulago National Referral Hospital, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Menbere F, Teshome B, G Hana E, Godie Y. Outcome of HIV exposed infants towards prevention of mother to child transmission (PMTCT) program and its associated factors in selected health facilities of Addis Ababa, Ethiopia, 2020. Retrospective cross sectional study. Pediatr Neonatol 2024:S1875-9572(24)00006-8. [PMID: 38413270 DOI: 10.1016/j.pedneo.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/29/2023] [Accepted: 07/18/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Globally, an estimated 36.9 million (31.1-43.9 million) people were living with HIV in 2017, of whom 17.8 million were women and 1.8 million (1.3-2.4 million) children under 15 years of age. Ethiopia has developed an HIV/AIDS prevention, care, and treatment strategic plan in an investment case approach that has been implemented from 2015 to 2020. The study aim was to assess the outcome and risk factors for HIV-exposed infants receiving Prevention of Mother to Child Transmission (PMTCT) follow-up. METHOD A cross-sectional retrospective study was done. All HIV-exposed infants who were on follow-up in the ART and (PMTCT) clinics of St Paul's Hospital Millennium Medical College, Yekatit 12 Hospital Medical College, and Selam Health Center beginning from September 2016 to January 2019 were included. Data collection was done using a well-designed questionnaire and a review of mothers' and infants' medical record charts and HMIS log book. Descriptive and logistic regression analysis was performed to assess the association between dependent and independent variables. Differences are considered statistically significant at p < 0.05, and their strength is presented using an odds ratio and 95% confidence interval. RESULT Among the 302 enrolled HIV-exposed infants, 27 (8.9%) were diagnosed as HIV positive. Maternal ART initiation during labor and delivery (AOR = 3.468, 95% CI: 1.22, 13.34, p = 0.04), frequent hospital admission of the infant (AOR = 17.49, 95% CI: 5.41, 56.2, p = 0.001), and mixed feeding option (AOR = 8.25, 95% CI: 2.212, 30.77, p = 0.02) were the major factors associated with positive HIV serostatus among HIV-exposed infants. CONCLUSION and Recommendation: The level of HIV infection among infants born to HIV-positive mothers is high as compared to the national and WHO goals. Exclusive breastfeeding should be advocated for all HIV-exposed infants, especially in resource-limited settings like Ethiopia due to the increased prevalence of diarrheal illness.
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Affiliation(s)
- Fasil Menbere
- Department of Pediatric and Child Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Blen Teshome
- Department of Pediatric and Child Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ewenat G Hana
- Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yohannes Godie
- Department of Pediatric and Child Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
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Suwedi-Kapesa LC, Nyondo-Mipando AL, Choko A, Obasi A, MacPherson P, Desmond N. Process Evaluation of Services for HIV-Infected Post-Partum Women and HIV-Exposed Infants in Primary Health Care Blantyre Malawi. Health Serv Insights 2024; 17:11786329231224623. [PMID: 38322594 PMCID: PMC10846036 DOI: 10.1177/11786329231224623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
HIV testing among HIV-exposed infants (HEI) in Malawi is below global targets and, affected by low utilisation of health services after birth. We conducted a mixed methods evaluation of the implementation of services for early infant diagnosis (EID) of HIV against national guidelines in Blantyre, Malawi, to inform the development of strategies to improve EID services uptake. We estimated coverage of HEI enrolment in HIV care and HIV testing at 6 weeks through a retrospective data review. We qualitatively explored implementation gaps in EID services through process mapping of 8 mother-infant pairs (MIP); and investigated healthcare workers' (HCW) perspectives on the implementation gaps through group interviews with 16 HCWs. We analysed the quantitative data descriptively and conducted a thematic content analysis of qualitative data. Of 163 HEIs born at the study sites, 39 (24%) were enrolled in an HIV care clinic before post-natal discharge, and 85 (52%) received HIV testing by 6 weeks. The median time for MIP to receive EID services was 4 (1-8) hours. The implementation gaps observed during process mapping included: failure to identify and enrol HEI in HIV care clinic; lack of immunisation, counselling for HEI testing, HIV testing, drug refilling, and family planning; and different appointment dates for mother and infant. HCWs reported delays and gaps influencing optimal service provision including: lack of screening to identify MIP, limited supervision for student HCWs when providing services, inadequate capacity of point of care machines, challenges with integrating services, and role confusion. Use of unique identifiers for MIP and establishing a booking system to schedule appointments to suit point of care machine capacity were primary service improvement recommendations. This study identified suboptimal EID services in Malawi due to process, capacity, and system factors. Context-appropriate interventions accommodating systems thinking are needed to enhance service provision.
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Affiliation(s)
- Leticia Chimwemwe Suwedi-Kapesa
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
- Department of Health Systems and Policy, School of Global and Public Health Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool, England, UK
| | - Augustine Choko
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Malawi-Liverpool-Welcome Trust Clinical Research Programme (MLWT), Blantyre, Malawi
| | - Angela Obasi
- Liverpool School of Tropical Medicine, Liverpool, England, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Desmond
- Liverpool School of Tropical Medicine, Liverpool, England, UK
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Stalter RM, Amorim G, Mocello AR, Jakait B, Shepherd BE, Musick B, Bernard C, Bukusi EA, Wools-Kaloustian K, Cohen CR, Yiannoutsos CT, Patel RC. Contraceptive implant use duration is not associated with breakthrough pregnancy among women living with HIV and using efavirenz: a retrospective, longitudinal analysis. J Int AIDS Soc 2022; 25:e26001. [PMID: 36073977 PMCID: PMC9454412 DOI: 10.1002/jia2.26001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Contraceptive implants containing etonogestrel and levonorgestrel have emerged as popular contraceptive options among women in areas of high HIV burden in sub‐Saharan Africa. However, recent pharmacokinetic data have shown drug–drug interactions between implants and efavirenz‐containing antiretroviral therapy (ART), reducing the effectiveness of the implants. Here, we evaluated pregnancy incidence in 6‐month intervals following implant initiation among women using efavirenz and contraceptive implants to assess whether the risk of breakthrough pregnancy is higher after specific periods of implant use. Methods We used data from a retrospective longitudinal analysis of women living with HIV ages 18–45 years in western Kenya who attended HIV‐care facilities between 2011 and 2015. We used Cox proportional hazard models to compute hazard ratios (HRs) for breakthrough pregnancy by implant type and ART regimen. Depending on the model, we adjusted for socio‐demographic and clinical factors, programme, site and interaction between calendar time and ART regimen. We utilized inverse probability weights (IPWs) to account for three sampling phases (electronic medical record [EMR], chart review and phone interview) and calculated overall parameter estimates. Results Women contributed 14,768 woman‐years from the largest sampling phase (EMR). The median age was 31 years. Women used etonogestrel implants for 26–69% of the time and levonorgestrel implants for 7–31% of the time, depending on the sampling phase. Women used efavirenz, nevirapine or no ART for 27–33%, 40–46% and 15–26% of follow‐ups, respectively. When combining sampling phases, there was little evidence to suggest that the relative hazard of pregnancy among efavirenz‐containing ART users relative to nevirapine‐containing ART changed with length of time on implants: IPW‐adjusted HR of 3.1 (CI: [1.5; 6.4]) at 12 months, 3.4 (CI: [1.8; 6.3]) at 24 months, 3.8 (CI: [1.9; 7.7]) at 36 months and 4.2 (CI: [1.6; 11.1]) at 48 months (interaction p‐value = 0.88). Similarly, no significant change in HRs over time was found when comparing women not using ART to nevirapine‐containing ART users (interaction p‐value = 0.49). Conclusions We did not find evidence to suggest implants being more fallible from drug–drug interactions with efavirenz at later time intervals of implant use. Thus, we would not recommend shortening the duration of implant use or replacing implants sooner when concomitantly used with efavirenz.
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Affiliation(s)
- Randy M Stalter
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - A Rain Mocello
- Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Beatrice Jakait
- Moi Teaching & Referral Hospital/Moi University & Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Caitlin Bernard
- Division of Family Planning, Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Craig R Cohen
- Bixby Center for Global Reproductive Health and Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Constantin T Yiannoutsos
- Department of Biostatistics and Health Data Science, R.M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Rena C Patel
- Division of Allergy and Infectious Diseases, Department of Medicine and Department of Global Health, University of Washington, Seattle, Washington, USA
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- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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A Retrospective Study of Incidence and Predictors on Mother-to-Child Transmission of HIV among HIV-Exposed Infants in West Guji Zone, Southern Ethiopia. AIDS Res Treat 2022; 2022:2906490. [PMID: 35251712 PMCID: PMC8890858 DOI: 10.1155/2022/2906490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/10/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022] Open
Abstract
Background The transmission of HIV from mother to child among HIV-positive infants is estimated to be higher than 20%, despite the fact that antiretroviral treatment is available for antenatal mothers with HIV. In Ethiopia, the prevalence of HIV transmission from mother to child among infants aged one and a half years is estimated to be approximately 15.7 percent. Methods A retrospective cohort analysis using a simple random sampling technique was incorporated among 422 HIV-exposed babies and their mothers who were randomly chosen and screened using OPD (outpatient card) from March 2019 to March 2021 in the general hospitals of West Guji zone, Oromia, Ethiopia. The data were coded and entered into EpiData version 4.6.1 and exported to SPSS version 23 for cleaning and analysis. Result The study revealed that at the end of follow-up, 3.8% of the HIV-exposed infants were found to be HIV positive. Poor adherence of infant for CPT (AOR: 5.6; 95% CI: 1.010–27.24), father not enrolled to ART (AOR: 4.4; 95% CI: 1.187–15.724), age of infants at enrollment >6 weeks (AOR: 4.5; 95% CI: 1.102–16.1), mother's enrollment to PMTCT during labor and delivery or after (AOR: 6.84; 95% CI: 1.316–42.743), and mothers on the WHO clinical stage mild or advanced (AOR: 3.6; 95% CI: 1.146–16.842) was found to be the most important significant predictors of mother-to-child transmission of HIV. Conclusion Several factors included in the study were the main predictors of mother-to-child transmission of HIV. The study concluded that there are some lacunae in the prevention of MTCT of HIV but that the incidence of MTCT of HIV was significantly lower in this part of the world.
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Melis T, Fikadu Y. Magnitude and determinants of male partner involvement in PMTCT service utilization of pregnant women attending public health facilities of Ethiopia, 2021: a systematic review and meta-analysis. AIDS Res Ther 2022; 19:8. [PMID: 35172839 PMCID: PMC8848825 DOI: 10.1186/s12981-022-00436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant antiretroviral prophylaxis has an important role in reduction of Human immune virus transmission from mother to child during the postpartum period. Male partner involvement was considered as a priority aforementioned area needs to be enhanced in Prevention of Mother-To Child Transmission (PMTCT). PMTCT service utilization can minimize the risk of the transmission of HIV from mother to child and related mortalities. Adequate utilization and adherence to this service has been challenging for some of the women if their partners are not aware or do partners do not support the women. The aim of this study is to assess the magnitude and determinants of male involvement in PMTCT service in Ethiopia. METHODS AND MATERIALS We had conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). We had used PubMed, Google Scholar, and cross reference for searching articles. We had used the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. Met-analysis and meta-regression were computed to present the pooled prevalence and determinants of male partner involvement with a 95% confidence interval using Revman. RESULTS Among a total of 338 studies, 11 studies were included in this analysis. The estimated pooled magnitude of male partner involvement was 40% (95% CI: 29.11-50.69). Knowledge of husband on PMTCT (2.30, 95% CI 1.75, 3.02), perceived responsibility for the women (4.22, 95% CI 2.31, 7.71), being government employee (2.89, 95% CI 2.02, 4.12), cultural barriers (3.44, 95% CI 2.54, 4.65) and educational status of husband (2.4, 95% CI 1.79, 3.50) were the determinants of pooled estimates of male partner involvement in PMTCT activities. CONCLUSION The pooled prevalence of male partner involvement was lower than the study conducted in sub Saharan Africa. Knowledge of husband on PMTCT, perceived responsibility for women, occupational status, cultural barriers and educational status of husband were determinants of male partner involvement. Therefore, the existing strategies to improve male involvement should be strengthened.
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12
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Hussen R, Zenebe WA, Mamo TT, Shaka MF. Determinants of HIV infection among children born from mothers on prevention of mother to child transmission programme of HIV in southern Ethiopia: a case-control study. BMJ Open 2022; 12:e048491. [PMID: 35131814 PMCID: PMC8823216 DOI: 10.1136/bmjopen-2020-048491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was aimed to identify determinants of HIV infection among children born from mothers on the prevention of mother to child transmission (PMTCT) programme in Southern Ethiopia. It was designed to explore the main contributors to the considerable transmission rate of HIV from mother to child. SETTING AND DESIGN A multicentre facility-based unmatched case-control study was conducted using 27 health facilities providing PMTCT service in Southern Ethiopia. PARTICIPANTS Out of 307 (62 cases and 245 controls) expected to participate in this study, a total of 290 mother-child pairs of 58 cases and 232 controls have completed the interview. Cases were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV positive test result at ≤24 months of age. Controls were children born to mothers on PMTCT programme and with DNA PCR or antibody HIV negative test result at ≤24 months of age. RESULT Data were collected from the mother and record and analysed using SPSS V.20. Logistic regression analysis was done for statistical association and the significance of association was declared at a p value of <0.05. Rural residence (adjusted OR (AOR): 4.15, 95% CI: (1.57 to 10.97)), knowing serostatus during current pregnancy (AOR: 5.11, 95% CI: (1.33 to 19.69)), home delivery (AOR: 6.00, 95% CI: (2.310 to 15.593)), poor partner involvement (AOR: 5.95, 95% CI: 1.91 to 18.53)), poor adherence, late enrolment of the child for ARV prophylaxis (AOR: 4.89, 95% CI: 1.34 to 17.88)), mixed breastfeeding practice (AOR: 10.36, 95% CI: (3.10 to 34.60)) and failure to be on cotrimoxazole therapy (AOR: 7.56, 95% CI: 2.07 to 27.61)) were factors significantly associated with MTCT. CONCLUSION The finding implies that more needs to be done on rural residents, strengthening screening for HIV before pregnancy, encouraging male involvement, early enrolment of child for ARV prophylaxis, avoiding mixed breast feeding and putting newborn on cotrimoxazole therapy.
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Affiliation(s)
- Rehima Hussen
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Wagaye Alemu Zenebe
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- School of Public Health, Dilla University College of Health Sciences, Dilla, Ethiopia
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Alemu A, Molla W, Yinges K, Shumye M. Determinants of HIV infection among children born to HIV positive mothers on prevention of mother to child transmission program at referral hospitals in west Amhara, Ethiopia; case control study. Ital J Pediatr 2022; 48:17. [PMID: 35115031 PMCID: PMC8812050 DOI: 10.1186/s13052-022-01220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Immune Deficiency Virus infection among children has continued to be a global concern with an estimated 160,000 new infections in 2018. Over 90% acquire HIV from their mother. Currently, 92% of pregnant women are on antiretroviral therapy (ART). Despite, greater achievements in coverage of PMTCT and ARV drug in Ethiopia as well as in west Amhara, child HIV infections are yet an important public health problem with a high transmission rate. There are limited studies done in Ethiopia on identifying determinants of child HIV infection. OBJECTIVE This study was aimed at identifying determinants of HIV infection among children born to HIV positive mothers on the PMTCT program at referral hospitals in the west Amhara, Ethiopia, 2021. METHODS An unmatched case-control study was conducted at referral hospitals in the west Amhara region, Ethiopia. Data were collected through document review, which has been registered from July 1, 2016 to July 1, 2020. A two-stage sampling technique was applied. Consecutive sampling technique for cases and simple random sampling technique for controls was done to include a total of 320 samples (66 cases and 254 controls). Epi data 4.6 for data entry and SPSS 23 for analysis were used. Variables with p- value ≤0.2 in bivariate regression were run in the multivariable logistic regression and AOR with 95% CI and a p-value ≤0.05 was used to declare determinants. RESULT Home delivery (AOR = 4.3; 95%CI: 2.0, 11.6), mixed feeding (AOR = 10; 95%CI: 3.2, 17.9), poor maternal ARV drug adherence (AOR = 4.3; 95% CI: 1.4, 13.4), advanced WHO clinical stage (AOR = 11.4; 95% CI: 4.1,19.1), poor nevirapine adherence (AOR = 10; 95% CI: 3.2, 22.4) and late enrollment of the infant (AOR = 15; 95% CI: 3.0, 3.0,20.5) were determinants. CONCLUSION Minister of Health and NGOs should work on mobilization of the community and awareness creation on the important of exclusive breast feeding, drugs adherence, on benefit of health institutional delivery as well as the risk of homedelivery.
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Affiliation(s)
- Asrat Alemu
- Department of Midwifery, Dilla University, Dilla, Ethiopia
| | | | - Kindu Yinges
- School of midwifery, college of medicine and health science, University of Gondar, Gonder, Ethiopia
| | - Muhabaw Shumye
- School of midwifery, college of medicine and health science, University of Gondar, Gonder, Ethiopia
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Tadewos K, Adimasu M, Tachbele E. Mother-to-Child Transmission of HIV and Associated Factors Among Exposed Infants in Pastoralist Health Facilities, South Omo Zone, Ethiopia, 2020 - A Retrospective Cross-Sectional Study. HIV AIDS (Auckl) 2021; 13:1015-1023. [PMID: 34916853 PMCID: PMC8668224 DOI: 10.2147/hiv.s332904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although HIV/AIDS is affecting all age groups, it is a primary cause of illness and deaths among children globally. A significant bulk of HIV infections in children under the age of 15 were as a result of vertical transmission, where it accounts for 95% of childhood HIV infections in Ethiopia. OBJECTIVE To assess the proportion of mother-to-child transmission (MTCT) of HIV and associated factors among exposed infants on follow-up in pastoralist health facilities, South Omo, Ethiopia. METHODOLOGY A retrospective, cross-sectional study was employed among 228 HIV-exposed infants. Medical records of HIV-exposed infant-mother pairs in the study institutions were extracted. The confirmatory HIV serostatus of every infant was taken at the end of 24 months. Data were entered in Epi Data 4.2 version and exported to SPSS version 25 for final analysis. Multivariable logistic regression analysis was used to identify significant predictor variables at P-value < 0.05. RESULTS A total of 228 records were included in the analysis. The rate of HIV transmission was 5.3% (95% CI: 2.6-8.3%). Not receiving antiretroviral prophylaxis at birth (AOR = 5.8, 95% CI: 1.02-33.53), absence of maternal antiretroviral prior to current pregnancy (AOR = 5.6, 95% CI: 1.14-28.1), and mother's advanced World Health Organization clinical stage of HIV (AOR: 10.5, 95% CI: 1.4-81) were associated with MTCT of HIV. CONCLUSION This study identified a high proportion of MTCT among exposed infants in the study area. Not receiving antiretrovirals prior to pregnancy and advanced WHO clinical stage of HIV, and not getting antiretroviral prophylaxis at birth resulted in higher risk of MTCT of HIV. Hence, health workers and policy-makers should offer antiretroviral prophylaxis, put mothers on antiretroviral therapy and limit the stage of HIV at lower WHO clinical stages.
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Affiliation(s)
- Kidist Tadewos
- Department of Nursing, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | - Mekonen Adimasu
- Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Erdaw Tachbele
- Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
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Knippler ET, Mwamba RN, Coleman JN, Knettel BA, Minja LM, Kisigo GA, Ngocho JS, Cichowitz C, Mmbaga BT, Watt MH. Attitudes Toward Pregnancy Among Women Enrolled in Prevention of Mother-to-Child Transmission of HIV (PMTCT) Services in Moshi, Tanzania. AIDS Behav 2021; 25:4008-4017. [PMID: 34125322 DOI: 10.1007/s10461-021-03339-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
For pregnant women living with HIV (WLWH), feelings about pregnancy may influence their emotional well-being and health seeking behaviors. This study examined attitudes toward pregnancy and associated factors among women enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Moshi, Tanzania. 200 pregnant WLWH were enrolled during their second or third trimester of pregnancy and completed a structured survey. Univariable and multivariable regression models examined factors associated with attitudes toward pregnancy, including demographics, interpersonal factors, and emotional well-being. Attitudes toward the current pregnancy were generally positive, with 87% of participants reporting feeling happy about being pregnant. In the final multivariable model, having higher levels of partner support, being newly diagnosed with HIV, and having fewer children were significantly associated with more positive attitudes toward their pregnancy. Findings point to a need for tailored psychosocial support services in PMTCT, as well as comprehensive reproductive health care for WLWH.
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Affiliation(s)
- Elizabeth T Knippler
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- UNC Gillings School of Global Public Health, 104 Rosenau Hall 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Cody Cichowitz
- Department of Medicine, Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Nwankwo B, Oluchukwu J, Usman N. Disclosure of human immune deficiency virus status to infected children at a tertiary hospital in North-western Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tsegaye R, Etafa W, Wakuma B, Mosisa G, Mulisa D, Tolossa T. The magnitude of adherence to option B plus program and associated factors among women in eastern African countries: a systematic review and meta-analysis. BMC Public Health 2020; 20:1812. [PMID: 33246437 PMCID: PMC7693523 DOI: 10.1186/s12889-020-09903-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge. Though few primary studies are available on the magnitude of adherence to option B plus and factors associated in Eastern African countries, they do not provide strong evidence in helping policymakers to address suboptimal adherence to option B plus. Therefore, this systematic review and meta-analysis was intended to estimate the pooled magnitude of adherence to option B plus program and associated factors among women in Eastern African countries. Methods PubMed, Medline, HINARI, Cochrane library, the Web of Science, and Google Scholar were searched for studies reported on the magnitude of adherence to option B plus among women in Eastern African countries. The search terms used were “option B plus”, “magnitude”, “prevalence”, “PMTCT”, “ART adherence”, “associated factors”, “all lists of Eastern African countries” and their combination by Boolean operators. The effect sizes of the meta-analysis were the magnitude of adherence to option B plus and the odds ratio of the associated factors. STATA/SE V14 was used for statistical analysis, and publication bias was assessed using funnel plots and Egger’s test. Results Fourteen studies having total participants of 4883 were included in the systematic review and meta-analysis. Using the random effect model, the pooled prevalence of adherence to option B plus was 71.88% (95% CI: 58.54–85.23%). The factors associated with good adherence to option B plus PMTCT program were partner support (Adjusted odds ratio (AOR) = 4.13; 95% CI: 2.78–6.15), received counseling services (AOR = 4.12, 95% CI: 2.81–6.02), disclosure of HIV status to partner (AOR = 4.38; 95% CI: 1.79–10.70), and clinical stage of HIV/AIDS I/II (AOR = 2.62; 95% CI: 1.53–4.46). Conclusion The level of adherence to option B plus program in Eastern African countries was generally sub-optimal. Thus, a coordinated effort is needed to raise the number of mothers to be tested, and early treatment initiation for HIV positive mothers before the disease advances. Furthermore, counseling services for couples on the importance of early treatment initiation and adherence to medications must be given due attention.
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Affiliation(s)
- Reta Tsegaye
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Werku Etafa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Are Male Partners the Missing Link to Eliminating Mother-To-Child Transmission of HIV in Sub-Saharan Africa? Evidence From a Retrospective Case-Control Study. J Assoc Nurses AIDS Care 2020; 31:439-447. [PMID: 31033630 DOI: 10.1097/jnc.0000000000000072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When male partners of pregnant women living with HIV do not participate in antenatal care, it decreases the uptake of prevention of mother-to-child transmission interventions, which increases the risk of HIV transmission to newborns. We evaluated the association of male partner involvement and vertical HIV transmission at 6 weeks along 4 constructs: antenatal clinic accompaniment, mother's awareness of partner HIV status, disclosure of mother's HIV status to partner, and couple testing. Thirty-three HIV-exposed infants with positive 6-week polymerase chain reaction (PCR) results were compared with 144 HIV-exposed infants with a negative PCR. Mothers of PCR-negative infants were 14 times more likely to have disclosed their HIV status to their partners (odds ratio [OR] = 14.1 [5.0-39.4]), to be aware of partner HIV status (OR = 0.2 [0.1-0.96]), and to have been accompanied by their male partners to the antenatal clinic (OR = 0.6 [0.5-0.9]). There is a need for male engagement in prevention of mother-to-child transmission programs.
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Belachew A, Tewabe T, Malede GA. Prevalence of vertical HIV infection and its risk factors among HIV exposed infants in East Africa: a systematic review and meta-analysis. Trop Med Health 2020; 48:85. [PMID: 33088209 PMCID: PMC7572247 DOI: 10.1186/s41182-020-00273-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) is one of the most important global health problems. More than one and half million of children are living with HIV in the world, and majority of them are found in sub-Saharan Africa. There are primary fragmented study findings, and no review was conducted with regard to vertical HIV infection in East Africa. Therefore, this review aimed to assess the prevalence of vertical HIV infection and its risk factors among HIV-exposed infants in East Africa. Main body Eligible studies were retrieved by relevant search terms in CINHAL, Pub-MED, Google Scholar, EMBASE, Web of Science, SCOPUS, Cochrane, African Journals Online databases, and Ethiopian University research repositories. Data were extracted with Microsoft Excel and analyzed with Stata version 11 software. The random effect model was used to estimate the pooled prevalence of vertical HIV infection in East Africa. The variation between studies was quantified with an I 2 statistic test. Furthermore, sub-group and meta-regression analyses were done to identify the sources of heterogeneity between the studies. The publication bias was assessed by Egger test. This systematic review and meta-analysis have included a total of 33 research articles. The overall pooled prevalence of vertical HIV infection in East Africa was 7.68% with a 95% confidence interval [CI]: (6.23, 9.12) with a heterogeneity of I 2 = 86.8 with a p value < 0.001. In subgroup analysis, the pooled prevalence of vertical HIV infection in cross-sectional studies was 6.58%, while in cohort studies were 9.37%. Mixed feeding, AOR = 6.22 (1.02, 11.41); home delivery, AOR = 2 (1.01, 3); mothers took ART less than 4 weeks, AOR = 1.92 (1.79, 2.06); and infants who have not received ARV prophylaxis, AOR = 2.02 (1.05, 2.98) were the associated factors for vertical HIV infection for exposed infants. Conclusions The pooled prevalence of the mother to child transmission of HIV is way more than the desired target of the World Health Organization, which is less than 5% in breastfeeding populations. Thus, strengthening the prevention of vertical HIV transmission, promotion of exclusive breastfeeding, timely initiation of ART prophylaxis for HIV exposed infants, encouragement of hospital delivery, and the start of ART at the time of diagnosis of every HIV-positive person may all reduce the transmission of vertical HIV infection.
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Affiliation(s)
- Amare Belachew
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Tewabe
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizat Abinet Malede
- Department of Laboratory Science, Bahir Dar Health Science College, Bahir Dar, Ethiopia
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Barriers and enablers of adherence to infant nevirapine prophylaxis against HIV 1 transmission among 6-week-old HIV exposed infants: A prospective cohort study in Northern Uganda. PLoS One 2020; 15:e0240529. [PMID: 33057393 PMCID: PMC7561159 DOI: 10.1371/journal.pone.0240529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sub-optimal adherence to infant prophylaxis has been associated with mother-to-child-transmission of HIV. However, the factors associated have not been well characterised in different settings. This study describes barriers and enablers of adherence to infant prophylaxis among 6-week-old HIV exposed infants in Lira district, Northern Uganda. Methods This prospective cohort study was conducted from 2018–2020 at the PMTCT clinic at Lira Regional Referral Hospital and included 472 mother-infant pairs. HIV-infected pregnant women were recruited, followed up at delivery and 6 weeks postpartum. We used a structured questionnaire to obtain data on socio-demographic, reproductive-related, HIV-related characteristics and adherence. Data were analysed using Stata to estimate adjusted risk ratios using Poisson regression models to ascertain barriers and enablers of adherence to infant nevirapine prophylaxis. Results Barriers to infant adherence are maternal characteristics including: younger age (≤20 years adjusted risk ratio (ARR) = 1.55; 95% CI: 1.1–2.2), missing a viral load test during pregnancy (ARR: 1.4; 95% CI: 1.1–1.7) and not receiving nevirapine syrup for the baby after childbirth (ARR = 6.2; 95% CI: 5.1–7.6). Enablers were: having attained ≥14 years of schooling (ARR = 0.7; 95% CI: 0.5–0.9), taking a nevirapine-based regimen (ARR = 0.6; 95% CI: 0.4–0.9), long-term ART (≥ 60 months ARR = 0.75; 95% CI: 0.6–0.9), accompanied by a husband to hospital during labour and childbirth (ARR = 0.5; 95% CI: 0.4–0.7) and labour starting at night (ARR = 0.7; 95% CI: 0.6–0.8). Conclusion and recommendations Despite mothers receiving nevirapine syrup from the health workers for the infant, non-adherence rates still prevail at 14.8%. The health system needs to consider giving HIV infected pregnant women the nevirapine syrup before birth to avoid delays and non-adherence. There is need to pay particular attention to younger women and those who recently started ART.
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Sifunda S, Peltzer K, Rodriguez VJ, Mandell LN, Lee TK, Ramlagan S, Alcaide ML, Weiss SM, Jones DL. Impact of male partner involvement on mother-to-child transmission of HIV and HIV-free survival among HIV-exposed infants in rural South Africa: Results from a two phase randomised controlled trial. PLoS One 2019; 14:e0217467. [PMID: 31166984 PMCID: PMC6550447 DOI: 10.1371/journal.pone.0217467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Sub-Saharan Africa region still remains the epicentre of the global HIV/AIDS epidemic. With regards to new paediatric HIV infections, almost 90% of new HIV infections are among children (aged 0-14 years), largely through mother to child transmission. Male Partner Involvement in Prevention of Mother to Child Transmission programmes is now strongly advocated as being key in improving infant outcomes. This study describes the role of Male Partner Involvement on infant HIV infection and mortality survival in the first year among HIV-exposed infants born from HIV positive mothers. METHODS This study was a two-phase, two condition (intervention or control) longitudinal study as part of a clinic-randomized Prevention of Mother to Child Transmission controlled trial. For Phase 1, female participants were recruited without their male partners. In Phase 2, both female and male participants were enrolled in the study as couples in order to encourage active Male Partner Involvement during pregnancy. Participants had two assessments prenatally (8-24 weeks and 32 weeks) and three assessments postnatally (6 weeks, 6 months, and 12 months). RESULTS About 1424 women were eligible for recruitment into the study and 18 eligible women declined to participate. All women had a partner; 54% were unmarried, 26% were cohabiting, and 20% were married. Just over half (55%) of the women had been diagnosed with HIV during the current pregnancy. Phase 1 had significantly more HIV-infected infants than Phase 2 at 12-months postpartum (aOR = 4.55 [1.38, 15.07]). Increased depressive symptoms were associated with infant HIV infection at 12-months (aOR = 1.06 [1.01, 1.10]). Phase 1 also had a significantly greater proportion of dead and HIV-infected infants than Phase 2 at 12-months (aOR = 1.98 [1.33, 2.94]). CONCLUSION Male partner involvement in antenatal care is critical in ensuring infant survival and HIV infection among children born to HIV-positive mothers. This study highlights the high risk of ante-and-post natal depression and underscores the need of screening for depression during pregnancy. TRIAL REGISTRATION ClinicalTrials.Gov; Trial Number NCT02085356.
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Affiliation(s)
- Sibusiso Sifunda
- Social Aspects of Public Health (SAPH) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Karl Peltzer
- Social Aspects of Public Health (SAPH) Research Programme, Human Sciences Research Council, Pretoria, South Africa
- Department of Research & Innovation, University of Limpopo, Sovenga, South Africa
| | - Violeta J. Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Department of Psychology, University of Georgia, Athens, GA, United States of America
- Ford Foundation Fellow, National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States of America
| | - Lissa N. Mandell
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Shandir Ramlagan
- Social Aspects of Public Health (SAPH) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Maria L. Alcaide
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Stephen M. Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
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Long-term effects of unintended pregnancy on antiretroviral therapy outcomes among South African women living with HIV. AIDS 2019; 33:885-893. [PMID: 30649049 DOI: 10.1097/qad.0000000000002139] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Unintended pregnancies are common among women living with HIV, but there are no data on their long-term impact on treatment outcomes. In a cohort of women initiating antiretroviral therapy (ART) during pregnancy, we examined the association between the intendedness of the current pregnancy, measured antenatally, and elevated viral load up to 5 years postpartum. DESIGN Prospective study with enrolment at entry into antenatal care and follow-up at study visits separate from routine care. METHODS At enrolment women completed the London Measure of Unplanned Pregnancy. Mixed effects models examined the impact of the intendedness of the pregnancy (planned versus each of unplanned or ambivalent, respectively) on viral load 50 or more copies/ml across postpartum study visits. RESULTS Overall, 459 women were followed for a median of 43 months postpartum, contributing 2535 viral load measures (median per woman: 6). Ambivalent and unplanned pregnancy were commonly reported (20 and 60%, respectively), and the proportion of women with elevated viral load increased over time (16% at 6 weeks to 43% by 36-60 months postpartum). Compared with those reporting a planned pregnancy, elevated viral load was more common among women reporting an unplanned pregnancy (odds ratio: 2.87; 95% confidence interval: 1.46-5.64), with a trend towards a higher odds among those reporting ambivalence (odds ratio: 2.19; 95% confidence interval: 0.97-4.82); associations persisted after adjustment for a wide range of demographic, clinical and psychosocial factors. CONCLUSION These novel data suggest that unplanned pregnancy may be a prevalent and persistent predictor of poor ART outcomes among women initiating ART during pregnancy.
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Nyandwi J, Bazikamwe S, Nisubire D, Ndabashinze P, Shaker ME, Said E. Prevention of Mother-to-Child Transmission and Early Real-Time DNA Polymerase Chain Reaction Results Among HIV-Exposed Infants in Bujumbura, Burundi. East Afr Health Res J 2018; 2:112-117. [PMID: 34308181 PMCID: PMC8279233 DOI: 10.24248/eahrj-d-18-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Prevention of mother-to-child transmission (PMTCT) programmes aim to both eliminate vertical transmission of HIV and optimise the health and survival of infants born with HIV. Therefore, early infant diagnosis (EID) of HIV infection via DNA polymerase chain reaction (PCR) testing is a key component of PMTCT programming. We assessed the effectiveness of EID and PMTCT interventions at health-care facilities in Bujumbura, Burundi. Methods: This was a prospective analytical study of infants born to HIV-positive mothers on antiretroviral therapy (ART), who were followed from December 2016 to March 2017 at 3 centres providing PMTCT services in Bujumbura. Babies enrolled in this study received once-daily nevirapine from birth through to 6 weeks of life, after which HIV DNA PCR testing was conducted. Results: Of 122 HIV-exposed infants, 60 were boys and 62 were girls. The mother-to-child transmission rate at 6 weeks of life was 0.9%. Eighty-three (68%) of the women had commenced ART before pregnancy and 39 (32%) during pregnancy. The mean CD4 lymphocyte count was 653±308 cells/μl. Ninety-two (75.4%) of the pregnancies were planned, and 98 (80%) of the births were via spontaneous vaginal delivery. After birth, 111 (91.0%) infants were exclusively breastfed, and 11 (9.0%) infants received exclusive replacement feeding. Conclusion: There was a low rate of transmission of HIV from women taking ART to children who were given nevirapine for the first 6 weeks of life. Infants of HIV-positive women can live healthy lives free from HIV infection if their mothers participate in PMTCT programmes.
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Affiliation(s)
- Joseph Nyandwi
- Hemodialysis Unit, Department of Internal Medicine, University Hospital of Kamenge, Bujumbura, Burundi
| | - Sylvestre Bazikamwe
- Department of Gynecology and Obstetrics, University Hospital of Kamenge, Bujumbura, Burundi
| | - Désiré Nisubire
- Microbiology Unit, Laboratory Department, University Hospital of Kamenge, Bujumbura, Burundi
| | - Pontien Ndabashinze
- Department of Pediatrics, University Hospital of Kamenge, Bujumbura, Burundi
| | | | - Eman Said
- Department of Pharmacology and Toxicology, Mansoura University, Mansoura, Egypt
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