Cargando…

Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

INTRODUCTION: Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV...

Descripción completa

Detalles Bibliográficos
Autores principales: Kelly-Hanku, Angela, Nightingale, Claire Elizabeth, Pham, Minh Duc, Mek, Agnes, Homiehombo, Primrose, Bagita, Mary, Nankinga, Justine, Vallely, Andrew, Vallely, Lisa, Sethy, Ghanashyan, Kaldor, John, Luchters, Stanley
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735082/
https://www.ncbi.nlm.nih.gov/pubmed/33310792
http://dx.doi.org/10.1136/bmjopen-2020-038311
_version_ 1783622593116372992
author Kelly-Hanku, Angela
Nightingale, Claire Elizabeth
Pham, Minh Duc
Mek, Agnes
Homiehombo, Primrose
Bagita, Mary
Nankinga, Justine
Vallely, Andrew
Vallely, Lisa
Sethy, Ghanashyan
Kaldor, John
Luchters, Stanley
author_facet Kelly-Hanku, Angela
Nightingale, Claire Elizabeth
Pham, Minh Duc
Mek, Agnes
Homiehombo, Primrose
Bagita, Mary
Nankinga, Justine
Vallely, Andrew
Vallely, Lisa
Sethy, Ghanashyan
Kaldor, John
Luchters, Stanley
author_sort Kelly-Hanku, Angela
collection PubMed
description INTRODUCTION: Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes. METHODS: We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme. RESULTS: 763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test. CONCLUSIONS: Our study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.
format Online
Article
Text
id pubmed-7735082
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-77350822020-12-21 Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit Kelly-Hanku, Angela Nightingale, Claire Elizabeth Pham, Minh Duc Mek, Agnes Homiehombo, Primrose Bagita, Mary Nankinga, Justine Vallely, Andrew Vallely, Lisa Sethy, Ghanashyan Kaldor, John Luchters, Stanley BMJ Open HIV/AIDS INTRODUCTION: Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes. METHODS: We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme. RESULTS: 763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test. CONCLUSIONS: Our study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care. BMJ Publishing Group 2020-12-12 /pmc/articles/PMC7735082/ /pubmed/33310792 http://dx.doi.org/10.1136/bmjopen-2020-038311 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle HIV/AIDS
Kelly-Hanku, Angela
Nightingale, Claire Elizabeth
Pham, Minh Duc
Mek, Agnes
Homiehombo, Primrose
Bagita, Mary
Nankinga, Justine
Vallely, Andrew
Vallely, Lisa
Sethy, Ghanashyan
Kaldor, John
Luchters, Stanley
Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title_full Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title_fullStr Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title_full_unstemmed Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title_short Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit
title_sort loss to follow up of pregnant women with hiv and infant hiv outcomes in the prevention of maternal to child transmission of hiv programme in two high-burden provinces in papua new guinea: a retrospective clinical audit
topic HIV/AIDS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735082/
https://www.ncbi.nlm.nih.gov/pubmed/33310792
http://dx.doi.org/10.1136/bmjopen-2020-038311
work_keys_str_mv AT kellyhankuangela losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT nightingaleclaireelizabeth losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT phamminhduc losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT mekagnes losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT homiehomboprimrose losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT bagitamary losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT nankingajustine losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT vallelyandrew losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT vallelylisa losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT sethyghanashyan losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT kaldorjohn losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit
AT luchtersstanley losstofollowupofpregnantwomenwithhivandinfanthivoutcomesinthepreventionofmaternaltochildtransmissionofhivprogrammeintwohighburdenprovincesinpapuanewguineaaretrospectiveclinicalaudit