Providing a conceptual framework for HIV prevention cascades and assessing feasibility of empirical measurement with data from east Zimbabwe: a case study.

Ahmadou Alioum, Mario Cortina-borja, François Dabis, Laurence Dequae-merchadou, Geert Haverkamp, James Hughes, John Karon, Valeriane Valériane Leroy, Marie-louise Newell, Barbra A Richardson, Liesbeth Van Weert, Gerrit-jan Weverling, U Inserm, Institut Epidémiologie, Santé Publique, Université Victor, Segalen Bordeaux, Patricia Opondo Awiti, Alessandra Grotta, Mia Van Der KopJohn Dusabe, Anna Thorson, Jonathan Mwangi, Rino Belloco, Richard Lester, Laura Ternent, Edwin Were, Anna Mia Ekström, Media Brief, Echezona E Ezeanolue, Byron J Powell, Dina Patel, Ayodotun Olutola, Michael Obiefune, Patrick Dakum, Prosper Okonkwo, Bola Gobir, Timothy Akinmurele, Mary Glenn Fowler, Geoffrey P Garnett, Timothy B Hallett, Albert Takaruza, James R Hargreaves, Rebecca Rhead, Mitchel Warren, Constance Nyamukapa, Simon Gregson, Peter Godfrey-Faussett, Michael E Herce, Tiwonge Mtande, Frank Chimbwandira, Innocent Mofolo, Christine K Chingondole, Nora E Rosenberg, Kathy E Lancaster, Esmie Kamanga, Jacqueline Chinkonde, Wiza Kumwenda, Gerald Tegha, Mina C Hosseinipour, Irving F Hoffman, Francis E Martinson, Eva Stein, Charles M van der Horst, Daniel R Hogan, Rob Baltussen, Chika Hayashi, Jeremy A Lauer, Joshua A Salomon, Scott E Kellerman, Saeed Ahmed, Theresa Feeley-summerl, Jonathan Jay, Maria Kim, B Ryan Phelps, Nandita Sugandhi, Pregnant Women, Shari Krishnaratne, Bernadette Hensen, Jillian Cordes, Joanne Enstone, James R Hargreaves, Colin D Mathers, Dejan Loncar, S N Mothi, M M Lala, A R Tappuni, Hermine L Nguena Nguefack, Henri Gwet, Sophie Desmonde, Odile Ouwe Missi Oukem-boyer, Céline Nkenfou, Mathurin Téjiokem, Patrice Tchendjou, Irénée Domkam, Valeriane Valériane Leroy, Thomas M Painter, Kassamba L Diaby, Danielle M Matia, Lillian S Lin, Toussaint S Sibailly, Moise K Kouassi, Ehounou R Ekpini, Thierry H Roels, Stefan Z Wiktor, F O R Parliamentarians, O N Hiv, Global Plan, Towards The, Elimination Of, N E W Hiv, Keeping Their, Mothers Alive, Bernhard Schwartländer, John Stover, Timothy B Hallett, Rifat Atun, Carlos Avila, Eleanor Gouws, Michael Bartos, Peter D Ghys, Marjorie Opuni, David Barr, Ramzi Alsallaq, Lori Bollinger, Marcelo De Freitas, Geoffrey P Garnett, Charles Holmes, Ken Legins, Yogan Pillay, Anderson Eduardo Stanciole, Melinda Gates Foundation, Jennifer a Smith, Sarah-Jane Anderson, Kate L Harris, Jessica B McGillen, Edward Lee, Geoffrey P Garnett, Timothy B Hallett, Kasioni Spiridoula, Pappas Stefanos, Vlachadis Nikolaos, Valsamidi Irene, Stournaras Stamatis, United States, John Stover, Lori Bollinger, Jose Antonio Izazola, Luiz Loures, Paul Delay, Executive Summary, Michael A Tolle, Daniel Dewey, World Vision, Integrated Approach, Strategic Approach, Tsitsi Bandason, Grace Mchugh, Ethel Dauya, Stanley Mungofa, Shungu M Munyati, Helen A Weiss, Hilda Mujuru, Katharina Kranzer, Rashida A Ferrand

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Abstract

BACKGROUND: We established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID). To these ends, we implemented the following interventions in 5 districts: 1) health worker training and mentorship; 2) couples' HTC and male partner involvement; 3) women's psychosocial support groups; and 4) health and laboratory system strengthening for EID. METHODS: We conducted a serial cross-sectional study using facility-level quarterly (Q) program data and individual-level infant HIV-1 DNA PCR data to evaluate STF performance on PMTCT indicators for project years (Y) 1 (April-December 2011) through 3 (January-December 2013), and compared these results to national averages. RESULTS: Facility-level uptake of HTC, ART, infant nevirapine prophylaxis, and infant DNA PCR testing increased significantly from quarterly baselines of 66 % (n/N = 32,433/48,804), 23 % (n/N = 442/1,958), 1 % (n/N = 10/1,958), and 52 % (n/N = 1,385/2,644) to 87 % (n/N = 39,458/45,324), 96 % (n/N = 2,046/2,121), 100 % (n/N = 2,121/2,121), and 62 % (n/N = 1,462/2,340), respectively, by project end (all p <0.001). Quarterly HTC, ART, and infant nevirapine prophylaxis uptake outperformed national averages over years 2-3. While transitioning EID laboratory services to MoH, STF provided first-time HIV-1 DNA PCR testing for 2,226 of 11,261 HIV-exposed infants (20 %) tested in the MoH EID program in STF districts from program inception (Y2) through Y3. Of these, 78 (3.5 %) tested HIV-positive. Among infants with complete documentation (n = 608), median age at first testing decreased from 112 days (interquartile range, IQR: 57-198) in Y2 to 76 days (IQR: 46-152) in Y3 (p <0.001). During Y3 (only year with national data for comparison), non-significantly fewer exposed infants tested HIV-positive (3.6 %) at first testing in STF districts than nationally (4.1 %) (p = 0.4). CONCLUSIONS: STF interventions, integrated within the MoH Option B+ program, achieved favorable HTC, maternal ART, infant prophylaxis, and EID services uptake, and a low proportion of infants found HIV-infected at first DNA PCR testing. Continued investments are needed to strengthen the PMTCT cascade, particularly around EID.
Original languageEnglish
Title of host publicationThe lancet. HIV
PublisherBMC Infectious Diseases
Pagese297-306
ISBN (Print)0000000000000
DOIs
Publication statusPublished - 2016

Publication series

NameThe lancet. HIV
Volume3

Keywords

  • 35
  • 72
  • AIDS
  • Adult
  • Africa
  • Antiretroviral Therapy
  • Antiretroviral therapy (ART)
  • Breast Feeding
  • Breastfeeding
  • Children
  • Cross-Sectional Studies
  • Early Diagnosis
  • Female
  • HIV
  • HIV Infections
  • HIV Infections: drug therapy
  • HIV Infections: transmission
  • HIV/PMTCT
  • Highly Active
  • Humans
  • Infant
  • Infectious
  • Infectious Disease Transmission
  • Infectious: drug therapy
  • Kenya
  • Malawi
  • Male
  • Mobile health (m-health)
  • Modelling
  • Mother-to-child transmission
  • Newborn
  • Post-Exposure Prophylaxis
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications
  • Prenatal Care
  • Program Evaluation
  • Retention
  • Vertical
  • Vertical: prevention & control
  • Young Adult
  • adolescents
  • africa
  • aids
  • antiretroviral therapy
  • art
  • awiti
  • barriers
  • breastfeeding
  • children
  • com
  • correspondence
  • decrease in new hiv
  • early diagnosis and public
  • effective
  • exercises were conducted
  • fi c syndr 2016
  • gaps
  • gmail
  • have contributed to a
  • health campaigns
  • hermine
  • hiv
  • hiv screening
  • implementa-
  • implementation strategies
  • india
  • infections
  • j acquir immune de
  • kenya
  • ki
  • lives since fi rst
  • m-health
  • methods
  • mobile health
  • modelling
  • more than 34 million
  • mother-to-child transmission
  • nguena
  • nigeria
  • option b þ
  • patricia
  • pediatric
  • perinatal hiv infection
  • pmtct
  • pregnancy
  • prophylactic treatment of hiv
  • recognized
  • retention
  • s161
  • s166
  • se
  • testing and counselling
  • tion research
  • transmission
  • treatment
  • two 1-hour structured group
  • women

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