Prevention of parent to child transmission services and interventions - coverage and utilization: A cohort analysis in Gujarat, India

BACKGROUND AND OBJECTIVES: Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective prevention of mother to child transmission (PMTCT) interventions. NACP-III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, dropouts, intervention efficacy with other determinants. MATERIALS AND METHODS: At ICTCs, registered ANCs are counseled and tested for HIV. HIV +ve ANCs are additionally linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV +ve ANCs since 2005 subsequently delivered till June 2008 and their exposed children in Gujarat’s category A, B districts constituted study cohort. RESULTS: 259622 pregnant women registered, 72.1% were counseled pre-test, 83.4% of them tested, 74.4% received post-test counseling. 541 ANCs were detected HIV+ve. 45.5% delivered institutionally, 12.8% were unregistered. 12.1% were cesarian section and 66% delivered vaginally. 96.8% were live births, 92.13% mother-baby pair received sdNVP. 35% children could be traced till 18 months, 89% were alive. 90% were tested, 3 were found HIV +ve. Of them, none received MB Pair. Two were delivered vaginally, two received mixed feeding, two children’s mothers were not linked with ART. CONCLUSIONS: PMTCT services – counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.