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Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?

BACKGROUND: Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendation...

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Autores principales: Komtenza, Brian, Satyanarayana, Srinath, Takarinda, Kudakwashe C., Mukungunugwa, Solomon H., Mugurungi, Owen, Chonzi, Prosper, Sithole, Ngwarai, Bvochora, Talent, Mushavi, Angela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415877/
https://www.ncbi.nlm.nih.gov/pubmed/30865646
http://dx.doi.org/10.1371/journal.pone.0212848
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author Komtenza, Brian
Satyanarayana, Srinath
Takarinda, Kudakwashe C.
Mukungunugwa, Solomon H.
Mugurungi, Owen
Chonzi, Prosper
Sithole, Ngwarai
Bvochora, Talent
Mushavi, Angela
author_facet Komtenza, Brian
Satyanarayana, Srinath
Takarinda, Kudakwashe C.
Mukungunugwa, Solomon H.
Mugurungi, Owen
Chonzi, Prosper
Sithole, Ngwarai
Bvochora, Talent
Mushavi, Angela
author_sort Komtenza, Brian
collection PubMed
description BACKGROUND: Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into “High” or”Low” MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status. OBJECTIVE: The study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment. METHODS: Cross-sectional study using review of records of routinely collected program data. RESULTS: Of the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as “high risk” for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants’ ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine). CONCLUSION: There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily.
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spelling pubmed-64158772019-04-02 Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing? Komtenza, Brian Satyanarayana, Srinath Takarinda, Kudakwashe C. Mukungunugwa, Solomon H. Mugurungi, Owen Chonzi, Prosper Sithole, Ngwarai Bvochora, Talent Mushavi, Angela PLoS One Research Article BACKGROUND: Despite high antiretroviral (ARV) treatment coverage among pregnant women for prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in Zimbabwe, the MTCT rate is still high. Therefore in 2016, the country adopted World Health Organization recommendations of stratifying pregnant women into “High” or”Low” MTCT risk for subsequent provision of HIV exposed infant (HEI) with appropriate follow-up care according to risk status. OBJECTIVE: The study sought to ascertain, among pregnant women who delivered in clinics of Harare in August 2017: the extent to which high risk MTCT pregnancies were identified at time of delivery; and whether their newborns were initiated on appropriate ARV prophylaxis, cotrimoxazole prophylaxis, subjected to early HIV diagnostic testing and initiated on ARV treatment. METHODS: Cross-sectional study using review of records of routinely collected program data. RESULTS: Of the 1,786 pregnant women who delivered in the selected clinics, HIV status at the time of delivery was known for 1,756 (98%) of whom 197 (11%) were HIV seropositive. Only 19 (10%) could be classified as “high risk” for MTCT and the remaining 90% lacked adequate information to classify them into high or low risk for MTCT due to missing data. Of the 197 live births, only two (1%) infants had a nucleic-acid test (NAT) at birth and 32 (16%) infants had NAT at 6 weeks. Of all 197 infants, 183 (93%) were initiated on single ARV prophylaxis (Nevirapine), 15 (7%) infants’ ARV prophylaxis status was not documented and one infant got dual ARV prophylaxis (Nevirapine+Zidovudine). CONCLUSION: There was paucity of data requisite for MTCT risk stratification due to poor recording of data; "high risk" women were missed in the few circumstances where sufficient data were available. Thus "high risk" HEI are deprived of dual ARV prophylaxis and priority HIV NAT at birth and onwards which they require for PMTCT. Health workers need urgent training, mentorship and supportive supervision to master data management and perform MTCT risk stratification satisfactorily. Public Library of Science 2019-03-13 /pmc/articles/PMC6415877/ /pubmed/30865646 http://dx.doi.org/10.1371/journal.pone.0212848 Text en © 2019 Komtenza 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 (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Komtenza, Brian
Satyanarayana, Srinath
Takarinda, Kudakwashe C.
Mukungunugwa, Solomon H.
Mugurungi, Owen
Chonzi, Prosper
Sithole, Ngwarai
Bvochora, Talent
Mushavi, Angela
Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title_full Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title_fullStr Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title_full_unstemmed Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title_short Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing?
title_sort identifying high or low risk of mother to child transmission of hiv: how harare city, zimbabwe is doing?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415877/
https://www.ncbi.nlm.nih.gov/pubmed/30865646
http://dx.doi.org/10.1371/journal.pone.0212848
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