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Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)

BACKGROUND: Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (...

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Autores principales: Kim, Evelyn, Jonnalagadda, Sasi, Cuervo-Rojas, Juliana, Jahn, Andreas, Payne, Danielle, West, Christine, Ogollah, Francis, Maida, Alice, Kayira, Dumbani, Nyirenda, Rose, Dobbs, Trudy, Patel, Hetal, Radin, Elizabeth, Voetsch, Andrew, Auld, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9436140/
https://www.ncbi.nlm.nih.gov/pubmed/36048781
http://dx.doi.org/10.1371/journal.pone.0273639
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author Kim, Evelyn
Jonnalagadda, Sasi
Cuervo-Rojas, Juliana
Jahn, Andreas
Payne, Danielle
West, Christine
Ogollah, Francis
Maida, Alice
Kayira, Dumbani
Nyirenda, Rose
Dobbs, Trudy
Patel, Hetal
Radin, Elizabeth
Voetsch, Andrew
Auld, Andrew
author_facet Kim, Evelyn
Jonnalagadda, Sasi
Cuervo-Rojas, Juliana
Jahn, Andreas
Payne, Danielle
West, Christine
Ogollah, Francis
Maida, Alice
Kayira, Dumbani
Nyirenda, Rose
Dobbs, Trudy
Patel, Hetal
Radin, Elizabeth
Voetsch, Andrew
Auld, Andrew
author_sort Kim, Evelyn
collection PubMed
description BACKGROUND: Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years. METHODS: MPHIA was a nationally representative household survey; consenting eligible women aged 15–64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection). RESULTS: Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%–11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%–88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%–98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%–95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%–81.7%) had VLS and 66.5% (95% CI: 59.8%–73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%–58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%–23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%–4.6%) had positive results. CONCLUSIONS: MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing.
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spelling pubmed-94361402022-09-02 Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016) Kim, Evelyn Jonnalagadda, Sasi Cuervo-Rojas, Juliana Jahn, Andreas Payne, Danielle West, Christine Ogollah, Francis Maida, Alice Kayira, Dumbani Nyirenda, Rose Dobbs, Trudy Patel, Hetal Radin, Elizabeth Voetsch, Andrew Auld, Andrew PLoS One Research Article BACKGROUND: Malawi spearheaded the development and implementation of Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), providing life-long ART for all HIV-positive pregnant and breastfeeding women. We used data from the 2015–2016 Malawi Population-based HIV Impact Assessment (MPHIA) to estimate progress toward 90-90-90 targets (90% of those with HIV know their HIV-positive status; of these, 90% are receiving ART; and of these, 90% have viral load suppression [VLS]) for HIV-positive women reporting a live birth in the previous 3 years. METHODS: MPHIA was a nationally representative household survey; consenting eligible women aged 15–64 years were interviewed on pregnancies and outcomes, including HIV status during their most recent pregnancy, PMTCT uptake, and early infant diagnosis (EID) testing. Descriptive analyses were weighted to account for the complex survey design. Viral load (VL) results were categorized by VLS (<1,000 copies/mL) and undetectable VL (target not detected/below the limit of detection). RESULTS: Of the 3,153 women included in our analysis, 371 (10.1%, 95% confidence interval [CI]: 8.8%–11.3%) tested HIV positive in the survey. Most HIV-positive women (84.2%, 95% CI: 79.9%–88.6%) reported knowing their HIV-positive status; of these, 94.9% (95% CI: 91.7%–98.2%) were receiving ART; and of these, 91.2% (95% CI: 87.4%–95.0%) had VLS. Among the 371 HIV-positive women, 76.0% (95% CI: 70.4%–81.7%) had VLS and 66.5% (95% CI: 59.8%–73.2%) had undetectable VL. Among 262 HIV-exposed children, 50.8% (95% CI: 42.8%–58.8%) received EID testing within 2 months of birth, whereas 17.9% (95% CI: 11.9%–23.8%) did not receive EID testing. Of 190 HIV-exposed children with a reported HIV test result, 2.1% (95% CI: 0.0%–4.6%) had positive results. CONCLUSIONS: MPHIA data demonstrate high PMTCT uptake at a population level. However, our results identify some gaps in VLS in postpartum women and EID testing. Public Library of Science 2022-09-01 /pmc/articles/PMC9436140/ /pubmed/36048781 http://dx.doi.org/10.1371/journal.pone.0273639 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Kim, Evelyn
Jonnalagadda, Sasi
Cuervo-Rojas, Juliana
Jahn, Andreas
Payne, Danielle
West, Christine
Ogollah, Francis
Maida, Alice
Kayira, Dumbani
Nyirenda, Rose
Dobbs, Trudy
Patel, Hetal
Radin, Elizabeth
Voetsch, Andrew
Auld, Andrew
Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title_full Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title_fullStr Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title_full_unstemmed Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title_short Toward elimination of mother-to-child transmission of HIV in Malawi: Findings from the Malawi Population-based HIV Impact Assessment (2015–2016)
title_sort toward elimination of mother-to-child transmission of hiv in malawi: findings from the malawi population-based hiv impact assessment (2015–2016)
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9436140/
https://www.ncbi.nlm.nih.gov/pubmed/36048781
http://dx.doi.org/10.1371/journal.pone.0273639
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