1
|
Ayele AD, Kassa BG, Mihretie GN, Belay HG, Sewyew DA, Semahegn AM, Yehuala ED, Tiruneh GA, Tenaw LA, Sendekie AD, Teffera AG, Aychew EW, Belachew YY, Liyeh TM, Worke MD. Level of adherence to option B+ program and associated factors among HIV-positive women in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0298119. [PMID: 38662634 PMCID: PMC11045077 DOI: 10.1371/journal.pone.0298119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite policy initiatives and strategic measures highly focused on preventing mother-to-child transmission through the implementation of the Option B+ program, adherence to the treatment is still challenging. The level of adherence and determinants of Option B+ program utilization reported by different studies were highly inconsistent in Ethiopia. Hence, this systematic review and meta-analysis aimed to estimate the pooled prevalence of adherence to the Option B+ program and its predictors among HIV-positive women in Ethiopia. METHODS PubMed, Google Scholar, EMBASE, HINAR, Scopus, and Web of Sciences were searched for published articles from March 2010 to March 2022. The pooled prevalence of adherence was estimated using a weighted DerSimonian-Laird random effect model. The I2 statistics was used to identify the degree of heterogeneity. Publication bias was also assessed using the funnel plot and Egger's regression test. RESULTS A total of 15 studies were included. The pooled estimate of the option B+ program among HIV-positive women in Ethiopia was 81.58% (95% CI: 77.33-85.84). Getting social and financial support (AOR = 3.73, 95% CI: 2.12, 6.58), disclosure of HIV status to partners (AOR = 2.05, 95% CI: 1.75, 2.41), time to reach a health facility (AOR = 0.33, 95% CI: 0.16, 0.67), receiving counseling on drug side effects (AOR = 4.09, 95% CI: 2.74, 6.11), experience of drug side effects (AOR = 0.17, 95% CI: 0.08, 0.36), and knowledge (AOR = 4.73, 95% CI: 2.62, 8.51) were significantly associated with adherence to the Option B+ program. CONCLUSION This meta-analysis showed that the level of adherence to the Option B+ program in Ethiopia is lower than the 95% level of adherence planned to be achieved in 2020. Social and financial support, disclosure of HIV status, time to reach the health facility, counseling, drug side effects, and knowledge of PMTCT were significantly associated with option B+ adherence. The findings of this meta-analysis highlight that governmental, non-governmental, and other stakeholders need to design an effective strategy to scale up the level of disclosing one's own HIV status, access health facilities, improve knowledge of PMTCT, and counsel the potential side effects of Option B+ drugs, and advocate the program to reduce the multidimensional burden of HIV/AIDS. TRIAL REGISTRATION Prospero registration: CRD42022320947. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320947.
Collapse
Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu Sewyew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abenezer Melkie Semahegn
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew Yehuala
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Lebeza Alemu Tenaw
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | | | - Adanech Getie Teffera
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Eden Workneh Aychew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche Liyeh
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
2
|
Pellowski JA, Jensen D, Tsawe N, Colvin C, Cu-Uvin S, Operario D, Lurie M, Harrison A, Myer L, Knight L. Womandla Health: development and rationale of a behavioral intervention to support HIV treatment adherence among postpartum women in South Africa. BMC Womens Health 2023; 23:649. [PMID: 38057777 PMCID: PMC10701937 DOI: 10.1186/s12905-023-02817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND While Option B + has made great strides in eliminating vertical transmission of HIV and improving access to lifelong antiretroviral therapy (ART) for women, the postpartum period remains a risk period for disengagement from HIV care and non-adherence. METHODS Longitudinal qualitative data was collected from 30 women living with HIV in Cape Town, South Africa from pregnancy through 1 year postpartum to examine key barriers and facilitators to HIV treatment adherence across this transition. Participants were also asked about their preferences for behavioral intervention content, format, and scope. The intervention development process was guided by Fernandez et al.'s Intervention Mapping process and was informed by the qualitative data, the wider literature on ART adherence, and Transition Theory. RESULTS The Womandla Health Intervention is a multicomponent intervention consisting of four individual sessions with a lay health worker and four peer group sessions, which span late pregnancy and early postpartum. These sessions are guided by Transition Theory and utilize motivational interviewing techniques to empower women to ascertain their own individual barriers to HIV care and identify solutions and strategies to overcome these barriers. CONCLUSIONS This intervention will be tested in a small scale RCT. If successful, findings will provide an innovative approach to HIV treatment by capitalizing on the transition into motherhood to bolster self-care behaviors, focusing on ART adherence and also women's overall postpartum health and psychosocial needs.
Collapse
Affiliation(s)
- Jennifer A Pellowski
- School of Public Health, Brown University, Providence, USA.
- School of Public Health, University of Cape Town, Cape Town, South Africa.
| | - Destry Jensen
- School of Public Health, Brown University, Providence, USA
| | - Nokwazi Tsawe
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Christopher Colvin
- School of Public Health, University of Cape Town, Cape Town, South Africa
- School of Medicine, University of Virginia, Charlottesville, USA
| | - Susan Cu-Uvin
- The Warren Alpert Medical School of Brown University, Providence,, USA
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mark Lurie
- School of Public Health, Brown University, Providence, USA
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Landon Myer
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Lucia Knight
- School of Public Health, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
3
|
Larson BA, Tsikhutsu I, Bii M, Halim N, Agaba P, Sugut W, Muli J, Sawe F. The effects of revised peer-counselor support on the PMTCT cascade of care: results from a cluster-randomized trial in Kenya (the EMMA study). BMC Infect Dis 2023; 23:257. [PMID: 37098468 PMCID: PMC10127503 DOI: 10.1186/s12879-023-08246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND This study evaluated the effect of revisions to existing peer-counselor services, called Mentor Mothers (MM), at maternal and child health clinics on medication adherence for women living with HIV (WLWH) in Kenya and on early infant HIV testing. METHODS The Enhanced Mentor Mother Program study was a 12-site, two-arm cluster-randomized trial enrolling pregnant WLWH from March 2017 to June 2018 (with data collection through September 2020). Six clinics were randomized to continued MM-supported standard care (SC). Six clinics were randomized to the intervention arm (INT = SC plus revised MM services to include more one-on-one interactions). Primary outcomes for mothers were defined as: (PO1) the proportion of days covered (PDC) with antiretroviral therapy (ART) ≥ 0.90 during the last 24-weeks of pregnancy; and (PO2) ≥ 0.90 PDC during the first 24-weeks postpartum. Secondary outcomes were infant HIV testing according to national guidelines (at 6, 24, and 48 weeks). Crude and adjusted risk differences between study arms are reported. RESULTS We enrolled 363 pregnant WLHV. After excluding known transfers and subjects with incomplete data extraction, data were analyzed for 309 WLWH (151 SC, 158 INT). A small share achieved high PDC during the prenatal and postnatal periods (0.33 SC/0.24 INT achieved PO1; 0.30 SC/0.31 INT achieved PO2; crude or adjusted risk differences were not statistically significant). In addition, ~ 75% in both study arms completed viral load testing during year two after enrollment, with > 90% suppressed in both arms. For infants, ≥ 90% in both arms had at least one HIV test through study follow up (76 weeks) but testing on schedule according to PMTCT guidelines was uncommon. CONCLUSIONS While national guidelines in Kenya recommended that all HIV-infected pregnant women take a daily antiretroviral regimen for life following a HIV diagnosis, results presented here indicate that a minor share achieved high medication coverage during the prenatal and postnatal periods analyzed. In addition, adjustments to Mentor-Mother services showed no improvement in study outcomes. The lack of effect for this behavioral intervention is relatively consistent with the existing literature to improve mother-infant outcomes along the PMTCT care cascade. CLINICAL TRIAL NUMBER NCT02848235. Date of first trial registration 28/07/2016.
Collapse
Affiliation(s)
- Bruce A Larson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Isaac Tsikhutsu
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Margaret Bii
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Patricia Agaba
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - William Sugut
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Jane Muli
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| | - Fredrick Sawe
- Kenya Medical Research Institute, Kericho, Kenya/U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- HJF Medical Research International, Kericho, Kenya
| |
Collapse
|
4
|
Schrubbe LA, Stöckl H, Hatcher AM, Marston M, Kuchukhidze S, Calvert C. Prevalence and risk factors of unsuppressed viral load among pregnant and breastfeeding women in sub-Saharan Africa: analysis from population-based surveys. AIDS 2023; 37:659-669. [PMID: 36511117 DOI: 10.1097/qad.0000000000003459] [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] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the prevalence of viral suppression and risk factors for unsuppressed viral load among pregnant and breastfeeding women living with HIV (WLH). DESIGN Pooled analysis among pregnant and breastfeeding WLH from Population-Based HIV Impact Assessment (PHIA) cross-sectional surveys from 10 sub-Saharan African countries. METHODS Questionnaires included sociodemographic, relationship-related, and HIV-related items, while blood tests examined HIV serostatus and viral load (data collected 2015-2018). The weighted prevalence of viral suppression was calculated. Logistic regression was used to examine risk factors for unsuppressed viral load (≥1000 copies/ml). RESULTS Of 1685 pregnant or breastfeeding WLH with viral load results, 63.8% (95% confidence interval (CI): 60.8-66.7%) were virally suppressed at the study visit. Among all included women, adolescence (adjusted odds ratio (aOR): 4.85, 95% CI: 2.58-9.14, P < 0.001) and nondisclosure of HIV status to partner (aOR: 1.48, 95% CI: 1.02-2.14, P = 0.04) were associated with unsuppressed viral load. Among only partnered women, adolescence (aOR: 7.95, 95% CI: 3.32-19.06, P < 0.001), and lack of paid employment (aOR: 0.67, 95% CI: 0.47-0.94, P = 0.02) were associated with unsuppressed viral load. Examining only women on ART, nondisclosure of HIV status to partner (aOR: 1.85, 95% CI: 1.19-2.88, P = 0.006) was associated with unsuppressed viral load. CONCLUSION Viral suppression among pregnant and breastfeeding WLH in sub-Saharan Africa remains suboptimal. Relationship dynamics around nondisclosure of HIV-positive status to partners was an important risk factor for unsuppressed viral load. Improving HIV care via sensitive discussions around partner dynamics in pregnant and breastfeeding women could improve maternal HIV outcomes and prevention of mother-to-child transmission of HIV (PMTCT).
Collapse
Affiliation(s)
- Leah A Schrubbe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Abigail M Hatcher
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milly Marston
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Salome Kuchukhidze
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Zhou J, Yun J, Ye X, Liu W, Xiao W, Song P, Wang H. Interventions to improve antiretroviral adherence in HIV-infected pregnant women: A systematic review and meta-analysis. Front Public Health 2022; 10:1056915. [PMID: 36568785 PMCID: PMC9773995 DOI: 10.3389/fpubh.2022.1056915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background Medication adherence in HIV-infected pregnant women remains suboptimal. This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions on improving antiretroviral adherence targeting among HIV-infected pregnant women. Methods Five databases were screened to identify quasi-experimental studies and randomized controlled trials. The risk ratios (RR) and confidential intervals (CI) were extracted to estimate the improvement in antiretroviral adherence after interventions compared with control conditions. This study was registered with PROSPERO, number CRD42021256317. Results Nine studies were included in the review, totaling 2,900 participants. Three interventions had significance: enhanced standard of care (eSOC, RR 1.14, 95%CI 1.07-1.22, Z = 3.79, P < 0.01), eSOC with supporter (RR 1.12, 95%CI 1.04-1.20, Z = 2.97, P < 0.01) and device reminder (RR 1.33, 95%CI 1.04-1.72, Z = 2.23, P = 0.03). Discussion The study supported the eSOC and the device reminder as effective intervention strategies for improving HIV medication adherence. Based on the current findings, the study called for more efforts to improve antiretroviral care for pregnant women through involving multicenter, large-sample, and high-quality research and combining the device reminder with other intervention methods. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256317, identifier CRD42021256317.
Collapse
Affiliation(s)
- Jie Zhou
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingyi Yun
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinxin Ye
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Liu
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhan Xiao
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- Department of Social Medicine of School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China,Peige Song
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Hongmei Wang
| |
Collapse
|
6
|
Mokua S, Maloba M, Wexler C, Goggin K, Staggs V, Mabachi N, Maosa N, Babu S, Hurley E, Finocchario-Kessler S. Evaluating the efficacy of the HITSystem 2.1 to improve PMTCT retention and maternal viral suppression in Kenya: Study protocol of a cluster-randomized trial. PLoS One 2022; 17:e0263988. [PMID: 35881649 PMCID: PMC9321364 DOI: 10.1371/journal.pone.0263988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background Gaps in the provision of guideline-adherent prevention of mother-to-child transmission of HIV (PMTCT) services and maternal retention in care contribute to nearly 8000 Kenyan infants becoming infected with HIV annually. Interventions that routinize evidence-based PMTCT service delivery and foster consistent patient engagement are essential to eliminating mother-to-child transmission of HIV. The HITSystem 2.1 is an eHealth intervention that aims to improve retention in PMTCT services and viral load monitoring, using electronic alerts to providers and SMS to patients. This study will evaluate the impact, implementation, and cost-effectiveness of HITSystem 2.1. Method This cluster randomized trial will be conducted at 12 study hospital (6 intervention, 6 control). Pregnant women living with HIV who have initiated PMTCT care ≤36 weeks gestation are eligible. Women enrolled at control hospitals will receive standard-of-care PMTCT services. Women enrolled at intervention hospitals will receive standard-of-care PMTCT services plus enhanced HITSystem 2.1 tracking. Mixed logistic regression models will compare the arms on two primary outcomes: (1) completed guideline-adherence PMTCT services and (2) viral suppression at both delivery and 6 months postpartum. We will assess associations between provider and patient characteristics (disclosure status, partner status, depression, partner support), PMTCT knowledge, and motivation with retention outcomes. Using the RE-AIM model, we will also assess implementation factors to guide sustainable scale-up. Finally, a cost-effectiveness analysis will be conducted. Discussion This study will provide insights regarding the development and adaptation of eHealth strategies to meet the global goal of eliminating new HIV infections in children and optimizing maternal health through PMTCT services. If efficacious, implementation and cost-effectiveness data gathered in this study will guide scale-up across Kenyan health facilities. Trial registration This study was registered at clinicaltrials.gov (NCT04571684) on October 1, 2020.
Collapse
Affiliation(s)
- Sharon Mokua
- Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail: ,
| | - May Maloba
- Global Health Innovations–Kenya, Nairobi, Kenya
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Missouri, United States of America
| | - Kathy Goggin
- Children’s Mercy Kansas City, Health Services and Outcomes Research, Kansas City, Missouri, United States of America
- University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, United States of America
| | - Vincent Staggs
- Children’s Mercy Kansas City, Health Services and Outcomes Research, Kansas City, Missouri, United States of America
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Missouri, United States of America
| | | | | | - Emily Hurley
- Children’s Mercy Kansas City, Health Services and Outcomes Research, Kansas City, Missouri, United States of America
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Missouri, United States of America
| |
Collapse
|
7
|
Li J, Li A, Ye J, Shao Y, Zhang H, Liu A, Li Z, Zhang G, Sun L. Loss to follow-up among human immunodeficiency virus-positive postpartum women and its predictive factors: A retrospective study. HIV Med 2022; 23 Suppl 1:42-53. [PMID: 35293108 DOI: 10.1111/hiv.13248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Antiretroviral treatment (ART) is essential in preventing mother-to-child transmission of human immunodeficiency virus (HIV), and postpartum discontinuation of ART is associated with adverse outcomes. This study identified factors associated with postpartum follow-up of HIV-positive women. METHODS This was a retrospective cohort study of 170 HIV-infected pregnant women who received regular obstetric examination and delivered successfully in Beijing between 2003 and 2020.The women's sociodemographic, clinical, treatment, obstetric, and gestational characteristics were analyzed. Cox proportional hazards models were used to estimate adjusted hazard ratios (AHRs) of loss to follow-up between levels of confounders. RESULTS In the multivariable Cox proportional hazard models, women with a longer time from HIV diagnosis to delivery per year had a 1.4-timeshigher risk (AHR = 1.433, 95% CI: 0.897-2.229) and a higher rate of loss to follow-up than the other women. Perinatal health care (AHR = 0.003,95% CI: 0.000-0.105) and gestational age above 37 weeks at delivery (AHR = 0.294, 95% CI: 0.005-15.818) were associated with a longer follow-up of postpartum HIV-positive women, when compared to women who did not receive perinatal healthcare and who delivered before 37 weeks of gestation, respectively. CONCLUSIONS The longer time from HIV diagnosis to delivery, access to perinatal care, and full-term gestation at delivery improved postpartum ART adherence and follow-up among HIV-positive women. Early initiation of ART, integration of adult ART into prevention of mother-to-child transmission, combination ART with maternal healthcare, and enhanced pregnancy care will improve ART adherence among HIV-positive women after delivery.
Collapse
Affiliation(s)
- Jianwei Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Aixin Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiangzhu Ye
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ying Shao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hongwei Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - An Liu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zaicun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guang Zhang
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Lijun Sun
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Abebe W, Gebremariam M, Molla M, Teferra S, Wissow L, Ruff A. Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia. PLoS One 2022; 17:e0262638. [PMID: 35051244 PMCID: PMC8775187 DOI: 10.1371/journal.pone.0262638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Vertical transmission of HIV remains one of the most common transmission modes. Antiretroviral therapy (ART) decreases the risk of transmission to less than 2%, but maintaining adherence to treatment remains a challenge. Some of the commonly reported barriers to adherence to ART include stress (physical and emotional), depression, and alcohol and drug abuse. Integrating screening and treatment for psychological problem such as depression was reported to improve adherence. In this study, we sought to determine the prevalence of depression and its association with adherence to ART among HIV-positive pregnant women attending antenatal care (ANC) clinics in Addis Ababa, Ethiopia.
Methods
We conducted a cross-sectional survey from March through November 2018. Participants were conveniently sampled from 12 health institutions offering ANC services. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for depression and the Center for Adherence Support Evaluation (CASE) Adherence index to evaluate adherence to ART. Descriptive statistics was used to estimate the prevalence of depression during third-trimester pregnancy and nonadherence to ART. A bivariate logistic regression analysis was used to get significant predictors for each of the two outcome measures. The final multivariable logistic regression analysis included variables with a P<0.25 in the bivariate logistic regression model; statistical significance was evaluated at P<0.05.
Results
We approached 397 eligible individuals, of whom 368 (92.7%) participated and were included in the analysis. Of the total participants, 175(47.6%) had depression. The participants’ overall level of adherence to ART was 82%. Pregnant women with low income were twice more likely to have depression (AOR = 2.10, 95%CI = 1.31–3.36). Women with WHO clinical Stage 1 disease were less likely to have depression than women with more advanced disease (AOR = 0.16, 95%CI = 0.05–0.48). There was a statistically significant association between depression and nonadherence to ART (P = 0.020); nonadherence was nearly two times higher among participants with depression (AOR = 1.88, 95%CI = 1.08–3.27).
Conclusion
We found a high prevalence of depression among HIV-positive pregnant women in the selected health facilities in Addis Ababa, and what was more concerning was its association with higher rates of nonadherence to ART adversely affecting the outcome of their HIV care. We recommend integrating screening for depression in routine ANC services.
Collapse
Affiliation(s)
- Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mahlet Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Larry Wissow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Andrea Ruff
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
9
|
Abdisa S, Tenaw Z. Level of adherence to option B plus PMTCT and associated factors among HIV positive pregnant and lactating women in public health facilities of Hawassa city, Southern Ethiopia. PLoS One 2021; 16:e0255808. [PMID: 34352020 PMCID: PMC8341661 DOI: 10.1371/journal.pone.0255808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy is very essential to achieve a great outcome of drugs via suppressing viral load, preventing multidrug resistance, and reducing mother to a child transmission rate of the Human Immune Virus. OBJECTIVE This study aimed to assess the level of adherence to option B plus PMTCT and associated factors among HIV Positive pregnant and lactating women in public health facilities of Hawassa city, Southern Ethiopia, 2020 G.C. METHODS Institution-based cross-sectional study was done on 254 HIV-positive pregnant and lactating women attending the prevention of mother-to-child transmission (PMTCT) follow-up. Participants were selected by simple random sampling. Data collected through a structured interviewer-administered questionnaire were cleaned and entered into Epi-data 3.1 and exported to SPSS 20 for statistical analysis. Descriptive analysis was done. Bivariable and multivariable logistic regressions were done to measure the strength of association between independent and dependent variables using the odds ratio and 95% of confidence interval. A p-value <0.05 was taken as statistically significant. RESULT The overall adherence level to option B+ was 224 (88.2%). Respondents in age group of ≤ 25 [AOR = 0.12, 95% CI (0.03, 0.42)], with no formal education [AOR = 0.12, 95% CI (0.03, 0.51)], experienced drug side effects [AOR = 0.11, 95% CI (0.04, 0.32)], have good knowledge of PMTCT [AOR = 3.6, 95% CI (1.16, 11.3)], and get support from partner/family [AOR = 4.5, 95% CI (1.62, 12.4)] were identified associated factors with adherence level. CONCLUSION The level of adherence to option B plus PMTCT was 88.2% which is suboptimal. Ages, educational level, knowledge on PMTCT, getting support from partner/family, and drug side effect were significantly associated with adherence. Therefore, educating and counseling on the service of PMTCT to improve their knowledge and encouraging partner/family involvement in care are mandatory to achieve the standard adherence level.
Collapse
Affiliation(s)
- Samuel Abdisa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
10
|
Finocchario-Kessler S, Brown M, Maloba M, Nazir N, Wexler C, Goggin K, Dariotis JK, Mabachi N, Lagat S, Koech S, Gautney B. A Pilot Study to Evaluate the Impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) Outcomes. AIDS Behav 2021; 25:2419-2429. [PMID: 33709212 PMCID: PMC8224224 DOI: 10.1007/s10461-021-03204-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
We assessed the preliminary impact of the adapted HIV Infant Tracking System (HITSystem v2.0) intervention on prevention of mother-to-child transmission (PMTCT) outcomes using a matched cluster randomized design in two Kenyan government hospitals. Between November 2017 and June 2019, n = 157 pregnant women with HIV were enrolled and followed from their first PMTCT appointment until 12-weeks postpartum. Data from 135 women were analyzed (HITSystem 2.0: n = 53, standard of care (SOC): n = 82), excluding eight deaths, eight pregnancy losses, and six transfers/moves. The primary outcome, complete PMTCT retention, is an aggregate measure of attendance at all scheduled antenatal appointments, hospital-based delivery, and infant HIV-testing before 7-weeks postnatal. HITSystem 2.0 participants were more likely to receive complete PMTCT services compared to SOC (56.6% vs. 17.1% p < 0.001). In multivariate modeling, HITSystem 2.0 was the strongest predictor of complete PMTCT retention (aOR 5.7, [1.2-90.8], p = 0.032). SOC participants had 1.91 increased hazard rate of PMTCT disengagement; (aHR 6.8, [2.2-21.1]; p < 0.001).
Collapse
Affiliation(s)
- Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Niaman Nazir
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, USA
- Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacinda K Dariotis
- Department of Human Development and Family Studies & Family Resiliency Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Sharon Koech
- Global Health Innovations, Nairobi, Kenya
- Ministry of Health, Nandi County, Kenya
| | | |
Collapse
|
11
|
Aferu T, Doang G, Zewudie A, Nigussie T. Adherence to Antiretroviral Therapy Among HIV-Positive Pregnant Women on followup at Mizan Tepi University Teaching and Tepi General Hospitals, Southwest Ethiopia. J Prim Care Community Health 2021; 11:2150132720902561. [PMID: 32321354 PMCID: PMC7180300 DOI: 10.1177/2150132720902561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The introduction of highly active antiretroviral therapy
has not only improved longevity in human immunodeficiency virus (HIV)–infected
individuals but in addition has had a significant impact on the rate of
mother-to-child transmission of the infection. Objective: To assess
antiretroviral therapy adherence among HIV-positive pregnant women on follow-up
at antiretroviral therapy clinic of Mizan Tepi University Teaching and Tepi
General Hospitals. Methods: A descriptive cross-sectional study was
undertaken in antiretroviral therapy clinics of Mizan Tepi University Teaching
and Tepi General Hospitals from April to May 2018. Data were collected through
face to face interview using structured and pretested questionnaires and
analyzed using Statistical Package for Social Sciences version 20.
Results: Majority of the patients had good adherence to their
antiretroviral therapy, 68 (66.00%). Medication side effects, 12 (34.00%) and
forgetfulness and distance of the hospital from home, each accounting 11
(31.00%) were the main reasons for nonadherence among nonadherent patients.
Frequency of counseling (P = .000), CD4 count (χ2 =
37.529, P = .000), World Health Organization’s clinical stage
(χ2 = 17.515, P = .000), stigma (χ2 =
70.426, P = .000), and family support (χ2 = 46.383,
P = .000) were found to be associated with patients’
medication adherence. Conclusion: The overall patient adherence to
antiretroviral therapy in the study facilities was good. Collaborative work
among patients, health care organizations, and the public are necessary to
tackle the adherence obstacles and enhance patient adherence to the prescribed
medication.
Collapse
Affiliation(s)
| | - Gatluak Doang
- Nyinenyang Hospital, Gambela Region, Gambela, Ethiopia
| | | | | |
Collapse
|
12
|
Biomndo BC, Bergmann A, Lahmann N, Atwoli L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS One 2021; 16:e0249813. [PMID: 33882084 PMCID: PMC8059826 DOI: 10.1371/journal.pone.0249813] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV's association with poor ART adherence. We investigate this association among a broad group of women. METHODS We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using the Visual Analogue Scale (VAS); responses were dichotomised at a ≥95% cut-off. Multiple logistic regression models assessed the association between the independent variables and ART adherence. RESULTS The participants' mean age was 38.6 (range: 18-69 years). The majority had ever attended school (94%, n = 382), were in monogamous marriages (70%, n = 282), and had disclosed status to partners (94%, n = 380). Overall, 60% (n = 242) reported optimal ART adherence (≥ 95%) in the previous 30 days. The prevalence of IPV by the current partner was 76% (CI95 = 72-80%). Experiencing physical IPV (AOR 0.57, CI95: 0.34-0.94, p = .028), sexual IPV (AOR 0.50, CI95: 0.31-0.82, p = .005), or controlling behaviour (AOR 0.56, CI95: 0.34-0.94, p = .027) reduced the odds of achieving optimal adherence, while a higher education level and having an HIV-positive partner increased the odds. CONCLUSION IPV is common and is associated with suboptimal ART adherence rates among a broad group of HIV-positive women. ART programs could consider incorporating basic IPV interventions into regular clinic services to identify, monitor and support exposed women, as they might be at risk of poor ART adherence. Still, there is need for more research on how IPV affects ART adherence.
Collapse
Affiliation(s)
- Bornice C. Biomndo
- Institute of Health and Nursing Science, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nils Lahmann
- Clinic for Geriatrics and Geriatric Medicine, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
- Medical College East Africa, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
13
|
Ankrah AK, Dako-Gyeke P. Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study. PLoS One 2021; 16:e0246876. [PMID: 33596241 PMCID: PMC7888588 DOI: 10.1371/journal.pone.0246876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early Infant Diagnosis (EID) of HIV and timely initiation of Antiretroviral Therapy (ART) can significantly reduce morbidity and mortality of HIV infected infants. Despite the benefits of early infant testing, the coverage of EID of HIV services is still low in Sub-Saharan Africa, including Ghana. OBJECTIVES To ascertain the factors that facilitate or hinder the delivery and uptake of EID of HIV services. METHODS The study is a cross-sectional exploratory qualitative research conducted in two health facilities in the Greater Accra Region of Ghana. Respondents (n = 50) comprising health workers (n = 20) and HIV positive mothers (n = 30) were purposively sampled and engaged in in-depth interviews. The Nvivo 11 software and the Braun and Clarke's stages of thematic analysis were used in coding data and data analysis respectively. RESULTS The study found that health system factors such as inadequate Staff with sample collection skills, unavailability of vehicles to convey samples to the reference laboratory for analysis, the long turnaround time for receipt of Polymerase Chain Reaction (PCR) results, inadequate and frequent breakdown of PCR machine hindered EID service delivery. On the other hand, adequate knowledge of health workers on EID, availability of Dried Blood Spot (DBS) cards and the adoption of task shifting strategies facilitated EID service delivery. Factors such as the denial of HIV status, non-completion of the EID process due to frustrations encountered whiles accessing service and delay in receipt of PCR results served as barriers to mother's utilisation of EID services for their exposed infants. The study also identified that adequate knowledge of EID, perceived importance of EID, financial stability as well as financial support from others and the positive attitudes of health workers facilitated HIV positive mother's uptake of EID services for their exposed infants. CONCLUSION The factors attributing to the low coverage of EID of HIV services must be promptly addressed to improve service delivery and uptake.
Collapse
Affiliation(s)
- Antoinette Kailey Ankrah
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail:
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
14
|
Gebretsadik GG, Gebretnsae H, Ftwi M, Tesfahunegn A. Alarm Clock-Based Reminder for Improving Low Adherence on Option B Plus Antiretroviral Therapy Among HIV Positive Pregnant and Lactating Mothers in Northern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:687-695. [PMID: 33177885 PMCID: PMC7652568 DOI: 10.2147/hiv.s261420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022]
Abstract
Background Option B plus antiretroviral therapy (ART) is an approach used to eliminate new Human Immune Deficiency Virus (HIV) infections among infants. Considering the high adherence on Option B plus ART in HIV positive mothers is a crucial part in preventing mother-to-child transmission HIV. Therefore, this study was performed to assess the status of adherence and factors related to Option B plus ART. Methods A cross-sectional study design was conducted in Eastern zone of Tigrai Region from January to February 2017. Data were collected by using pre-tested structured interviewer-administered questionnaire from 350 participants selected using simple random sampling. Descriptive and binary logistic regression was done during analysis. Results The overall good adherence status of Option B plus ART among pregnant and lactating mothers was 67.3% [62.3–72.3%]. Attending formal education (AOR=2.78, 95% CI 1.52–5.07), traveling for <1 hour to reach health facility (AOR=2.03, 95% CI 1.19–3.44), (CD4) count <350 cells/mm3 (AOR=2.3, 95% CI 1.33–3.95), starting their Option B plus during pregnancy (AOR= 2.08, 95% CI 1.08–3.97), taking one pill per day (AOR=2.12, 95% CI 1.25–3.58), using a clock as a reminder (AOR=2.51, 95% CI 1.3–4.86), and having good male involvement (AOR=2.91, 95% CI 1.64–5.16) were associated with good level of adherence for Option B plus ART treatment. Conclusion Our study revealed that the level of good adherence is low compared with the national target. Therefore, addressing the low adherence of Option B plus ART requires a policy response, such as efforts to enhance male partner involvement and better service accessibility in Prevention of Mother-to-Child Transmission (PMTCT) program. Moreover, health care providers and policymakers need to maximaze their efforts on HIV positive pregnant and lactating mothers using a clock as a reminder.
Collapse
Affiliation(s)
| | | | - Mulu Ftwi
- Department of Midwifery, College of Health Science, Adigrat University, Adigrat, Tigray, Ethiopia
| | - Afewerki Tesfahunegn
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| |
Collapse
|
15
|
Hatcher AM, Darbes L, Kwena Z, Musoke PL, Rogers AJ, Owino G, Helova A, Anderson JL, Oyaro P, Bukusi EA, Turan JM. Pathways for HIV Prevention Behaviors Following a Home-Based Couples Intervention for Pregnant Women and Male Partners in Kenya. AIDS Behav 2020; 24:2091-2100. [PMID: 31894444 DOI: 10.1007/s10461-019-02774-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pregnancy is a time of heightened HIV risk, but also a phase when a couple can prioritize family health. We conducted secondary analysis of a home-based intervention in rural Kenya to explore couple-level adherence to HIV prevention behaviors. The intervention included health education, relationship-building skills, and Couples HIV Testing and Counseling. Pregnant women were randomized to the intervention (n = 64) or standard care (n = 63) along with male partners. Of 96 couples, 82 (85.0%) were followed to 3 months postpartum, when 31.0% of couples reported perfect adherence to HIV prevention. In logistic regression, intervention condition couples had three-fold higher odds of perfect adherence (AOR = 3.07, 95% CI = 1.01-9.32). A structural equation model found the intervention had moderate effects on couple communication, large effects on couple efficacy to take action around HIV, which in turn improved HIV prevention behaviors (CFI = 0.969; TLI = 0.955; RMSEA = 0.049). Strengthening couple communication and efficacy may help prevent the spread of HIV to infants or partners around the time of pregnancy.
Collapse
|
16
|
Mathivha E, Olorunju S, Jackson D, Dinh TH, du Plessis N, Goga A. Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. BMC Infect Dis 2019; 19:790. [PMID: 31526376 PMCID: PMC6745775 DOI: 10.1186/s12879-019-4342-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%. CONCLUSIONS Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014.
Collapse
Affiliation(s)
- Elelwani Mathivha
- Mamelodi Hospital, Pretoria, 0112 South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, 0001 South Africa
| | - Steve Olorunju
- Biostistics Unit, South African Medical Research Council, Pretoria, 0001 South Africa
| | - Debra Jackson
- Health Section, United Nations Children’s Fund (UNICEF), New York, NY 10017 USA
- School of Public Health, University of the Western Cape, Cape Town, 7535 South Africa
| | - Thu-Ha Dinh
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | | | - Ameena Goga
- Department of Paediatrics, University of Pretoria, Pretoria, 0001 South Africa
- Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
- 8 HIV Prevention Research Unit, South African Medical Research Counci, Durban, 3630 South Africa
| |
Collapse
|
17
|
Finocchario-Kessler S, Maloba M, Brown M, Gautney B, Goggin K, Wexler C, Mabachi N, Odeny B, Lagat S, Koech S, Dariotis JK, Odeny TA. Adapting the HIV Infant Tracking System to Support Prevention of Mother-to-Child Transmission of HIV in Kenya: Protocol for an Intervention Development Pilot Study in Two Hospitals. JMIR Res Protoc 2019; 8:e13268. [PMID: 31199305 PMCID: PMC6592400 DOI: 10.2196/13268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 01/10/2023] Open
Abstract
Background Despite progress to expand access to HIV testing and treatment during pregnancy in Kenya, gaps still remain in prevention of mother-to-child transmission of HIV (PMTCT) services. This study addresses the need for effective and scalable interventions to support women throughout the continuum of care for PMTCT services in low-resource settings. Our research team has successfully implemented the HIV Infant Tracking System (HITSystem), a Web-based, system-level intervention to improve early infant diagnosis (EID) outcomes. Objective This study will expand the scope of the HITSystem to address PMTCT services to bridge the gap between maternal and pediatric HIV services and improve outcomes. This paper describes the intervention development protocol to adapt and pilot an HITSystem version 2.0 to assess acceptability, feasibility, and preliminary PMTCT outcomes in Kenya. Methods This is a 3-year intervention development study to adapt the current HITSystem intervention to support a range of PMTCT outcomes including appointment attendance, antiretroviral therapy (ART) adherence, hospital deliveries, and integration of maternal and pediatric HIV services in low-resource settings. The study will be conducted in 3 phases. Phase 1 will elicit feedback from intervention users (patients and providers) to guide development and refinement of the new PMTCT components and inform optimal implementation. In Phase 2, we will design and develop the HITSystem 2.0 features to support key PMTCT outcomes guided by clinical content experts and findings from Phase 1. Phase 3 will assess complete PMTCT retention (before, during, and after delivery) using a matched randomized pilot study design in 2 hospitals over 18 months. A total of N=108 HIV-positive pregnant women (n=54 per site) will be enrolled and followed from their first PMTCT appointment until infant HIV DNA Polymerase Chain Reaction testing at the target age of 6 weeks (<7 weeks) postnatal. Results Funding for this study was received in August 2015, enrollment in Phase 1 began in March 2016, and completion of data collection is expected by May 2019. Conclusions This protocol will extend, adapt, and pilot an HITSystem 2.0 version to improve attendance of PMTCT appointments, increase ART adherence and hospital-based deliveries, and prompt EID by 6 weeks postnatal. The HITSystem 2.0 aims to improve the integration of maternal and pediatric HIV services. Trial Registration ClinicalTrials.gov NCT02726607; https://clinicaltrials.gov/ct2/show/NCT02726607 (Archived by WebCite at http://www.webcitation.org/78VraLrOb) International Registered Report Identifier (IRRID) DERR1-10.2196/13268
Collapse
Affiliation(s)
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brad Gautney
- Global Health Innovations, Dallas, TX, United States
| | - Kathy Goggin
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States.,Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, United States.,School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Beryne Odeny
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Silas Lagat
- Ministry of Health, Nandi County, Kapsabet, Kenya
| | - Sharon Koech
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jacinda K Dariotis
- College of Education, Criminal Justice & Human Services, University of Cincinnati, Cincinnati, OH, United States
| | - Thomas A Odeny
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States.,Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| |
Collapse
|
18
|
Larson BA, Bii M, Tsikhutsu I, Halim N, Wolfman V, Coakley P, Sugut W, Sawe F. The Enhanced Mentor Mother ProgrAm (EMMA) for the prevention of mother-to-child transmission of HIV in Kenya: study protocol for a cluster randomized controlled trial. Trials 2018; 19:594. [PMID: 30376872 PMCID: PMC6208066 DOI: 10.1186/s13063-018-2975-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background As of September 2014, Kenya implemented the WHO recommended Option B+ guidelines in which all newly diagnosed HIV-infected pregnant women are immediately eligible for triple antiretroviral therapy (ART) for life regardless of CD4 count. In addition, Kenya previously established the Kenya Mentor Mother Program (KMMP) in 2012 to improve peer education and psychosocial support services within the national prevention of mother-to-child transmission (PMTCT) program. The primary objectives of the study described in the current protocol are: (1) to evaluate implementation of these new guidelines (Option B+ with Mentor Mothers) as part of routine service delivery; and (2) to evaluate potential benefits of a package of services within the KMMP (called EMMA) to improve PMTCT service delivery. Methods We will conduct a cluster randomized controlled trial in western Kenya. We will allocate 12 clinics providing PMTCT services including ART to two study arms using pair matching: the standard of care (SOC) arm, which includes the KMMP as implemented by the clinics; and the intervention arm, which is the SOC (including KMMP) with the EMMA package of services (a targeted exit interview, visit reminders, and targeted follow-up). At the intervention clinics, the EMMA package of services is implemented as part of routine service delivery. A total of 360 (180 in each arm) pregnant women will be enrolled in the study at or near their first visit for antenatal care for prospective records review through 72 weeks post-partum. The primary and secondary outcomes are uninterrupted supplies of ART medications throughout the PMTCT cascade of care as well as infants completing HIV testing on schedule. Discussion The EMMA package of services provides specific structure to the use of Mentor Mothers within PMTCT programs. This strategy was developed in collaboration with local health facility and PMTCT program staff based on their experience providing PMTCT services within the integrated ART-MCH facilities. If successful, this approach has the potential to improve dramatically PMTCT service delivery with minor additional costs beyond the basic mother–mentor program and support global goals to eliminate mother-to-child transmission. Trial registration ClinicalTrials.gov, NCT02848235. Registered on 19 July 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2975-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bruce A Larson
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Margaret Bii
- Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.,HJF Medical Research International, Inc., Nairobi, Kenya
| | - Isaac Tsikhutsu
- Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.,HJF Medical Research International, Inc., Nairobi, Kenya
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Vanessa Wolfman
- US Military HIV Research Program (MHRP), Henry Jackson Foundation, Bethesda, MD, USA
| | - Peter Coakley
- US Military HIV Research Program (MHRP), Henry Jackson Foundation, Bethesda, MD, USA
| | - William Sugut
- Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.,HJF Medical Research International, Inc., Nairobi, Kenya
| | - Fredrick Sawe
- Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya.,HJF Medical Research International, Inc., Nairobi, Kenya
| |
Collapse
|
19
|
Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA, Hoelscher M, Kroidl A. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B. BMC Pregnancy Childbirth 2018; 18:418. [PMID: 30359239 PMCID: PMC6202832 DOI: 10.1186/s12884-018-2058-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/15/2018] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon's Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART. METHODS We prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined. RESULTS At 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8-30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4-10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4-5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0-3.6)]. CONCLUSIONS During the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure.
Collapse
Affiliation(s)
- Pascal N Atanga
- Cameroon Baptist Convention Health Service (CBCHS), P. O. Box 152, Tiko, Health Services Complex, Mutengene, South West Region, Cameroon. .,Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. .,Centre for International Health (CIH), University of Munich (LMU), Munich, Germany.
| | - Harrison T Ndetan
- Department of Epidemiology and Biostatistics, University Texas Health Northeast, School of Community and Rural Health, Tyler, USA.,Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Peter N Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Henry D Meriki
- Department of Microbiology and Parasitology, Faculty of Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.,Laboratory Department, Regional Hospital Buea, Buea, Cameroon
| | - Tih P Muffih
- Cameroon Baptist Convention Health Service (CBCHS), P. O. Box 152, Tiko, Health Services Complex, Mutengene, South West Region, Cameroon
| | - Eric A Achidi
- Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Michael Hoelscher
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| |
Collapse
|
20
|
Impact of Facility-Based Mother Support Groups on Retention in Care and PMTCT Outcomes in Rural Zimbabwe: The EPAZ Cluster-Randomized Controlled Trial. J Acquir Immune Defic Syndr 2017; 75 Suppl 2:S207-S215. [PMID: 28498191 DOI: 10.1097/qai.0000000000001360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prevention of mother-to-child transmission elimination goals are hampered by low rates of retention in care. The Eliminating Paediatric AIDS in Zimbabwe project assessed whether mother support groups (MSGs) improve rates of retention in care of HIV-exposed infants and their HIV-positive mothers, and maternal and infant outcomes. METHODS The study involved 27 rural clinics in eastern Zimbabwe. MSGs were established in 14 randomly selected clinics and met every 2 weeks coordinated by volunteer HIV-positive mothers. MSG coordinators provided health education and reminded mothers of MSG meetings by cell phone. Infant retention in care was defined as "12 months postpartum point attendance" at health care visits of HIV-exposed infants at 12 months of age. We also measured regularity of attendance and other program indicators of HIV-positive mothers and their HIV-exposed infants. RESULTS Among 507 HIV-positive pregnant women assessed as eligible, 348 were enrolled and analyzed (69%) with mothers who had disclosed their HIV status being overrepresented. In the intervention arm, 69% of infants were retained in care at 12 months versus 61% in the control arm, with no statistically significant difference. Retention and other program outcomes were systematically higher in the intervention versus control arm, suggesting trends toward positive health outcomes with exposure to MSGs. DISCUSSION We were unable to show that facility-based MSGs improved retention in care at 12 months among HIV-exposed infants. Selective enrollment of mothers more likely to be retained-in-care may have contributed to lack of effect. Methods to increase the impact of MSGs on retention including targeting of high-risk mothers are discussed.
Collapse
|
21
|
Musomba R, Mubiru F, Nakalema S, Mackline H, Kalule I, Kiragga AN, Ratanshi RP, Castelnuovo B. Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda. AIDS Res Treat 2017; 2017:3527563. [PMID: 28469942 PMCID: PMC5392405 DOI: 10.1155/2017/3527563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64-1.0, and P = 0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34-0.98, and P = 0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.
Collapse
Affiliation(s)
- Rachel Musomba
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Hope Mackline
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Ivan Kalule
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Agnes N. Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Rosalind Parkes Ratanshi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- Cambridge Institute of Public Health, Cambridge, UK
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| |
Collapse
|
22
|
Finocchario-Kessler S, Clark KF, Khamadi S, Gautney BJ, Okoth V, Goggin K. Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012. AIDS Behav 2016; 20:2602-2611. [PMID: 25903508 PMCID: PMC4618783 DOI: 10.1007/s10461-015-1071-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p’s < 0.001). Pediatric HIV infection was halved (8.6–4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
Collapse
Affiliation(s)
| | - Kristine F Clark
- Department of Global Studies, University of Kansas, Lawrence, KS, USA
| | - Samoel Khamadi
- Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya
| | | | - Vincent Okoth
- Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, USA
| |
Collapse
|
23
|
Goggin K, Wexler C, Nazir N, Staggs VS, Gautney B, Okoth V, Khamadi SA, Ruff A, Sweat M, Cheng AL, Finocchario-Kessler S. Predictors of Infant Age at Enrollment in Early Infant Diagnosis Services in Kenya. AIDS Behav 2016; 20:2141-50. [PMID: 27108002 PMCID: PMC4995224 DOI: 10.1007/s10461-016-1404-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite the importance of early detection to signal lifesaving treatment initiation for HIV+ infants, early infant diagnosis (EID) services have received considerably less attention than other aspects of prevention of mother to child transmission care. This study draws on baseline data from an on-going cluster randomized study of an intervention to improve EID services at six government hospitals across Kenya. Two logistic regressions examined potential predictors of “on time” (infant ≤6 weeks of age) vs. “late” (≥7 weeks) and “on time” versus “very late” (≥12 weeks) EID engagement among 756 mother-infant pairs. A quarter of the infants failed to get “on time” testing. Predictors of “on time” testing included being informed about EID by providers when pregnant, perceiving less HIV stigma, and mother’s level of education. Predictors of “very late” testing (≥12 weeks of age) included not being informed about EID by providers when pregnant and living farther from services. Findings highlight the importance of ensuring that health care providers actively and repeatedly inform HIV+ mothers of the availability of EID services, reduce stigma by frequently communicating judgment free support, and assisting mothers in early planning for accessing EID services. Extra care should be focused on engaging mothers with less formal education who are at increased risk for seeking “late” EID testing. This study offers clear targets for improving services so that all HIV-exposed infants can be properly engaged in EID services, thus increasing the potential for the best possible outcomes for this vulnerable population.
Collapse
Affiliation(s)
- Kathy Goggin
- Children's Mercy Hospitals and Clinics, Health Services and Outcomes Research, 2401 Gillham Road, Kansas City, MO, 64108, USA.
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA.
- University of Missouri-Kansas City, School of Pharmacy, Kansas City, MO, USA.
| | - Catherine Wexler
- University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, USA
| | - Niaman Nazir
- University of Kansas Medical Center, Department of Preventive Medicine, Kansas City, KS, USA
| | - Vincent S Staggs
- Children's Mercy Hospitals and Clinics, Health Services and Outcomes Research, 2401 Gillham Road, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA
| | | | | | | | - Andrea Ruff
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Michael Sweat
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA
| | - An-Lin Cheng
- University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | | |
Collapse
|
24
|
Altan AMD, Taafo F, Fopa F, Buonomo E, Marazzi MC, Nielsen-Saines K, Orlando S, Scarcella P, Ciccacci F, Mancinelli S, Lio MMS, Palombi L. An assessment of option B implementation for the prevention of mother to child transmission in Dschang, Cameroon: results from the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) cohort. Pan Afr Med J 2016; 23:72. [PMID: 27217896 PMCID: PMC4862786 DOI: 10.11604/pamj.2016.23.72.7958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/27/2016] [Indexed: 11/12/2022] Open
Abstract
Introduction Scaling up of antiretroviral therapy (ART) to HIV+ pregnant women is crucial for the elimination of HIV infection in children. The aim of this study was to evaluate the feasibility and effectiveness of triple ART for Prevention of Mother-to Child Transmission (PMTCT) in Cameroon. Methods HIV-positive pregnant women attending the DREAM Centre of Dschang, Cameroon for prenatal care were enrolled in a prospective cohort study, and received ART until the end of breastfeeding or indefinitely if their CD4 count was <350mm3. Infants were evaluated for HIV infection at 1, 6 and 12 months of age. Results A total of 298 women were enrolled. Among them, 152 were already on established ART. Women were followed until 6 months after delivery with a retention rate of 92.6%. Eight women died. Those with a CD4 count <350 cells/mm3 during pregnancy had the highest mortality risk (RR 2.53; 95% CL= 1.86-3.44). The HIV transmission rate was 1.2% at 12 months with an HIV free survival of 91%. In the proportional Cox regression analysis, the following factors were positively associated with infant mortality: maternal CD4< 350 cells/mm3, no breastfeeding in the first 6 months of life, weight-for-age z score<-2. Conclusion Results confirm the feasibility and effectiveness of the implementation of Option B, with very low rates of HIV MTC transmission, and potential benefits to the health of mothers and infants with earlier initiation of ART. Breastfeeding again demonstrates to be highly beneficial for the growth and survival of HIV exposed children.
Collapse
Affiliation(s)
| | | | | | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, California
| | | | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| |
Collapse
|
25
|
Bengtson AM, Chibwesha CJ, Westreich D, Mubiana-Mbewe M, Chi BH, Miller WC, Mapani M, Pence BW, Musonda P, Stringer JS, Pettifor A. A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period. AIDS Care 2016; 28:1035-45. [PMID: 26887526 DOI: 10.1080/09540121.2016.1144869] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa (SSA). For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. Among 2029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy and number of antenatal care visits were associated with LTFU (p-value < .10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions.
Collapse
Affiliation(s)
- Angela M Bengtson
- a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA
| | - Carla J Chibwesha
- b Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA
| | - Daniel Westreich
- a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA
| | | | - Benjamin H Chi
- b Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA.,c Centre for Infectious Disease Research , Zambia , Africa
| | - William C Miller
- a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.,d Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Muntanga Mapani
- b Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA
| | - Brian W Pence
- a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA
| | - Patrick Musonda
- e Department of Public Health , University of Zambia School of Medicine , Lusaka , Zambia , Africa
| | - Jeffrey Sa Stringer
- b Department of Obstetrics and Gynecology , University of North Carolina , Chapel Hill , NC , USA
| | - Audrey Pettifor
- a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA
| |
Collapse
|
26
|
Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia. Int J Infect Dis 2014; 33:123-9. [PMID: 25529555 DOI: 10.1016/j.ijid.2014.12.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the level of adherence to Option B+ PMTCT drugs and factors associated with adherence among HIV-positive pregnant women in public hospitals of Tigray, northern Ethiopia. METHODS A cross-sectional study was conducted among 277 HIV-positive pregnant women in 2014. A two-stage cluster sampling technique was used to select the study participants. Individual consent was obtained from each participant. Multivariate logistic regression was used to estimate the net effect sizes of factors associated with adherence to Option B+ PMTCT drugs. RESULTS The level of adherence of respondents to Option B+ PMTCT drugs was 87.1% (95% confidence interval (CI) 82.6-90.7%). Controlling for the effect of other factors, the odds of adhering to Option B+ PMTCT were 4.7 times higher among women who received counselling on medication as compared to those who did not (adjusted odds ratio (aOR) 4.7, 95% CI 1.98-11.35). Similarly, disclosing HIV status was positively associated with good adherence (aOR 4.2, 95% CI 1.07-16.33). CONCLUSIONS The adherence level was found to be reasonably good. Counselling on medication and HIV status disclosure were positive predictors of adherence to Option B+ PMTCT drugs.
Collapse
|
27
|
Hodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, Amzel A, Fogg KP. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One 2014; 9:e111421. [PMID: 25372479 PMCID: PMC4221025 DOI: 10.1371/journal.pone.0111421] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/15/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. METHODS Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. RESULTS Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman's awareness and control (e.g., commitment to child's health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. CONCLUSIONS To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.
Collapse
Affiliation(s)
- Ian Hodgson
- Independent Consultant, Bingley, United Kingdom
| | | | - Sarah N. Konopka
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Christopher J. Colvin
- Centre for Infectious Disease Epidemiology and Research (CIDER), Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edna Jonas
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Jennifer Albertini
- United States Agency for International Development (USAID)/Africa Bureau, Washington, D.C., USA
| | - Anouk Amzel
- USAID/Bureau for Global Health (BGH)/Office of HIV/AIDS, Washington, D.C., USA
| | - Karen P. Fogg
- USAID/BGH/Office of Health, Infectious Diseases, and Nutrition, Washington, D.C., USA
| |
Collapse
|
28
|
Colvin CJ, Konopka S, Chalker JC, Jonas E, Albertini J, Amzel A, Fogg K. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One 2014; 9:e108150. [PMID: 25303241 PMCID: PMC4193745 DOI: 10.1371/journal.pone.0108150] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/25/2014] [Indexed: 11/29/2022] Open
Abstract
Background Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes—ART initiation, retention in care, and long-term ART adherence—remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. Methods Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. Results Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. Conclusions There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade.
Collapse
Affiliation(s)
- Christopher J. Colvin
- Centre for Infectious Disease Epidemiology and Research (CIDER), Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Medical School Campus, Cape Town, South Africa
- * E-mail:
| | - Sarah Konopka
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, United States of America
| | - John C. Chalker
- Center for Pharmaceutical Management, Management Sciences for Health, Arlington, Virginia, United States of America
| | - Edna Jonas
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, United States of America
| | - Jennifer Albertini
- United States Agency for International Development (USAID)/Africa Bureau, Washington, District of Columbia, United States of America
| | - Anouk Amzel
- USAID/Bureau for Global Health (BGH)/Office of HIV/AIDS, Washington, District of Columbia, United States of America
| | - Karen Fogg
- USAID/BGH/Office of Health, Infectious Diseases and Nutrition, Washington, District of Columbia, United States of America
| |
Collapse
|
29
|
Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study. J Int AIDS Soc 2014; 17:19242. [PMID: 25301494 PMCID: PMC4192834 DOI: 10.7448/ias.17.1.19242] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/25/2014] [Accepted: 09/02/2014] [Indexed: 12/05/2022] Open
Abstract
Introduction Recent international guidelines call for expanded access to triple-drug antiretroviral therapy (ART) in HIV-positive women during pregnancy and postpartum. However, high levels of non-adherence and/or disengagement from care may attenuate the benefits of ART for HIV transmission and maternal health. We examined the frequency and predictors of disengagement from care among women initiating ART during pregnancy in Cape Town, South Africa. Methods We used routine medical records to follow-up pregnant women initiating ART within prevention of mother-to-child transmission of HIV services in Cape Town, South Africa. Outcomes assessed through six months postpartum were (1) disengagement (no attendance within 56 days of a scheduled visit) and (2) missed visits (returning to care 14–56 days late for a scheduled visit). Results A total of 358 women (median age, 28 years; median gestational age, 26 weeks) initiated ART during pregnancy. By six months postpartum, 24% of women (n=86) had missed at least one visit and an additional 32% (n=115) had disengaged from care; together, 49% of women had either missed a visit or had disengaged by six months postpartum. Disengagement was more than twice as frequent postpartum compared to in the antenatal period (6.2 vs. 2.4 per 100 woman-months, respectively; p<0.0001). In a proportional hazards model, later gestational age at initiation (HR: 1.04; 95% CI: 1.00–1.07; p=0.030) and being newly diagnosed with HIV (HR: 1.57; 95% CI: 1.07–2.33; p=0.022) were significant predictors of disengagement after adjusting for patient age, starting CD4 cell count and site of ART initiation. Conclusions These results demonstrate that missed visits and disengagement from care occur frequently, particularly post-delivery, among HIV-positive women initiating ART during pregnancy. Women who are newly diagnosed with HIV may be particularly vulnerable and there is an urgent need for interventions both to promote retention overall, as well as targeting women newly diagnosed with HIV during pregnancy.
Collapse
|
30
|
Wools-Kaloustian K. Focusing attention on therapy adherence and retention among women diagnosed with HIV during pregnancy. Future Virol 2014. [DOI: 10.2217/fvl.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|