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Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE)
OBJECTIVES: We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. METHODS: A cross-sectional survey was conducted among 4...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492960/ https://www.ncbi.nlm.nih.gov/pubmed/26147598 http://dx.doi.org/10.1371/journal.pone.0132425 |
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author | Woldesenbet, Selamawit Jackson, Debra Lombard, Carl Dinh, Thu-Ha Puren, Adrian Sherman, Gayle Ramokolo, Vundli Doherty, Tanya Mogashoa, Mary Bhardwaj, Sanjana Chopra, Mickey Shaffer, Nathan Pillay, Yogan Goga, Ameena |
author_facet | Woldesenbet, Selamawit Jackson, Debra Lombard, Carl Dinh, Thu-Ha Puren, Adrian Sherman, Gayle Ramokolo, Vundli Doherty, Tanya Mogashoa, Mary Bhardwaj, Sanjana Chopra, Mickey Shaffer, Nathan Pillay, Yogan Goga, Ameena |
author_sort | Woldesenbet, Selamawit |
collection | PubMed |
description | OBJECTIVES: We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. METHODS: A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. RESULTS: Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. CONCLUSION: A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. |
format | Online Article Text |
id | pubmed-4492960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44929602015-07-15 Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) Woldesenbet, Selamawit Jackson, Debra Lombard, Carl Dinh, Thu-Ha Puren, Adrian Sherman, Gayle Ramokolo, Vundli Doherty, Tanya Mogashoa, Mary Bhardwaj, Sanjana Chopra, Mickey Shaffer, Nathan Pillay, Yogan Goga, Ameena PLoS One Research Article OBJECTIVES: We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. METHODS: A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. RESULTS: Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. CONCLUSION: A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. Public Library of Science 2015-07-06 /pmc/articles/PMC4492960/ /pubmed/26147598 http://dx.doi.org/10.1371/journal.pone.0132425 Text en © 2015 Woldesenbet et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Woldesenbet, Selamawit Jackson, Debra Lombard, Carl Dinh, Thu-Ha Puren, Adrian Sherman, Gayle Ramokolo, Vundli Doherty, Tanya Mogashoa, Mary Bhardwaj, Sanjana Chopra, Mickey Shaffer, Nathan Pillay, Yogan Goga, Ameena Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title | Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title_full | Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title_fullStr | Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title_full_unstemmed | Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title_short | Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE) |
title_sort | missed opportunities along the prevention of mother-to-child transmission services cascade in south africa: uptake, determinants, and attributable risk (the sapmtcte) |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492960/ https://www.ncbi.nlm.nih.gov/pubmed/26147598 http://dx.doi.org/10.1371/journal.pone.0132425 |
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