Top

Published in:

Open Access 01-12-2021 | Human Immunodeficiency Virus | Research article

Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique

Authors: Laura Fuente-Soro, Sheila Fernández-Luis, Elisa López-Varela, Orvalho Augusto, Tacilta Nhampossa, Ariel Nhacolo, Edson Bernardo, Blanca Burgueño, Bernadette Ngeno, Aleny Couto, Helga Guambe, Kwalila Tibana, Marilena Urso, Denise Naniche

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally..

Methods

A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model.

Results

Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death.

Conclusions

In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.

Available only for authorised users

World Health Organization (WHO). Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of hiv and syphilis second edition 2017. 2017. Available: https://apps.who.int/iris/bitstream/handle/10665/259517/9789241513272-eng.pdf;jsessionid=262F3D3D96297A650F0A5E3733ED7DA5?sequence=1

World Health Organization (WHO). PROGRAMMATIC UPDATE _ Use of antirretroviral drugs for treating pregnant women and preventing HIV infections in infants. Exec Summ. 2012; Available: https://www.who.int/hiv/PMTCT_update.pdf. Cited 28 Nov 2019.

Joint United Nations Programme on HIV/AIDS. AIDSinfo | UNAIDS 2018. Available: http://aidsinfo.unaids.org/. Cited 20 Mar 2019

Carlucci JG, Liu Y, Friedman H, Pelayo BE, Robelin K, Sheldon EK, Clouse K, Vermund SH. Attrition of HIV-exposed infants from early infant diagnosis services in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc. 2018;21(11):e25209. https://doi.org/10.1002/jia2.25209.CrossRefPubMedPubMedCentral

Goggin K, Hurley EA, Staggs VS, Wexler C, Nazir N, Gautney B, Khamadi SA, Maloba M, Lwembe R, Finocchario-Kessler S. Rates and predictors of HIV-exposed infants lost to follow-up during early infant diagnosis Services in Kenya. AIDS Patient Care STDs. 2019;33(8):346–53. https://doi.org/10.1089/apc.2019.0050.CrossRefPubMedPubMedCentral

Joint United Nations Programme on HIV/AIDS (UNAIDS). Ending AIDS: Progress towards the 90–90–90 targets: UNAIDS/JC2900E; 2017.

Brennan AT, Bonawitz R, Gill CJ, Thea DM, Kleinman M, Useem J, Garrison L, Ceccarelli R, Udokwu C, Long L, Fox MP. A meta-analysis assessing all-cause mortality in HIV-exposed uninfected compared with HIV-unexposed uninfected infants and children. AIDS. 2016;30(15):2351–60. https://doi.org/10.1097/QAD.0000000000001211.CrossRefPubMed

Newell M-L, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F, et al. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364(9441):1236–43. https://doi.org/10.1016/S0140-6736(04)17140-7.CrossRefPubMed

UNAIDS. Miles to go closing gaps breaking barriers righting injustices. 2018. Available: http://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf

10.

Ministério da Saúde (MISAU), Instituto Nacional de Estatística (INE). Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA) 2015 _ Final Report. 2018. Available: https://dhsprogram.com/pubs/pdf/AIS12/AIS12.pdf

11.

AIDSinfo | UNAIDS. Available: http://aidsinfo.unaids.org/. Cited 24 Jan 2020

12.

World Health Organization. A short guide on methods : measuring the impact of national PMTCT programmes : towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive: World Health Organization; 2012.

13.

Goga A, Singh Y, Jackson D, Mukungunugwa S, Wafula R, Eliya M, Ng’ambi WF, Nabitaka L, Chirinda W, Bhardwaj S, Essajee S, Hayashi C, Pillay Y. How are countries in sub-Saharan African monitoring the impact of programmes to prevent vertical transmission of HIV? BMJ. 2019;364:l660. https://doi.org/10.1136/bmj.l660.CrossRefPubMedPubMedCentral

14.

Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, Mandomando I, Sacarlal J, Lauchande N, Sigaúque B, Alonso P, Macete E, Munguambe K, Guinovart C, Aide P, Menendez C, Acácio S, Quelhas D, Sevene E, Nhampossa T. Profile: Manhica Health Research Centre (Manhica HDSS). Int J Epidemiol. 2013;42(5):1309–18. https://doi.org/10.1093/ije/dyt148.CrossRefPubMed

15.

González R, Munguambe K, Aponte J, Bavo C, Nhalungo D, Macete E. et al, High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. HIV Med. 2012. https://doi.org/10.1111/j.1468-1293.2012.01018.x.

16.

Ahoua L, Tiendrebeogo T, Arikawa S, Lahuerta M, Aly D, Journot V, et al. PMTCT care cascade and factors associated with attrition in the first four years after Option B+ implementation in Mozambique. Tropical Med Int Health. 2019:tmi.13324. https://doi.org/10.1111/tmi.13324.

17.

Ministerio da Saude. Republica de Moçambique. Prevenção da transmissão vertical do HIV. Man Bols. 2014;47(4):284. https://doi.org/10.1590/s0104-42302001000400018.CrossRef

18.

Carl Hartung, Yaw Anokwa, Waylon Brunette, Adam Lerer, Clint Tseng GB. Open Data Kit: Tools to Build Information Services for Developing Regions. 2010. Available: http://www.gg.rhul.ac.uk/ict4d/ictd2010/papers/ICTD2010Hartungetal.pdf. Cited 1 Mar 2017CrossRef

19.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMedPubMedCentral

20.

Rubin DB. Multiple imputation for nonresponse in surveys: Wiley; 1987. https://doi.org/10.1002/9780470316696.CrossRef

21.

Coviello V, Boggess M. Cumulative incidence estimation in the presence of competing risks. Stata J. 2004; Available: https://www.stata-journal.com/sjpdf.html?articlenum=st0059. Cited 11 Dec 2019.

22.

StataCorp. Stata statistical software: release 15. College Station: StataCorp LLC; 2017.

23.

Fernández-Luis S, Fuente-Soro L, Nhampossa T, Lopez-Varela E, Augusto O, Nhacolo A, et al. Survey on community breastfeeding practices and their implications for mother-to-child transmission in a high HIV prevalence context in southern Mozambique. In: Abstract Book - Virtual - 23rd International AIDS conference; 2020. Available: https://www.aids2020.org/wp-content/uploads/2020/09/AIDS2020_Abstracts.pdf.

24.

Goga AE, Dinh T-H, Essajee S, Chirinda W, Larsen A, Mogashoa M, Jackson D, Cheyip M, Ngandu N, Modi S, Bhardwaj S, Chirwa E, Pillay Y, Mahy M. What will it take for the global plan priority countries in sub-Saharan Africa to eliminate mother-to-child transmission of HIV? BMC Infect Dis. 2019;19(S1):783. https://doi.org/10.1186/s12879-019-4393-5.CrossRefPubMedPubMedCentral

25.

Goga A, Singh Y, Jackson D, Pillay Y, Bhardwaj S, Chirinda W, Hayashi C, Essajee S, Idele P. Is elimination of vertical transmission of HIV in high prevalence settings achievable? BMJ. 2019;364:l687. https://doi.org/10.1136/bmj.l687.CrossRefPubMedPubMedCentral

26.

Pons-Duran C, Lucas A, Narayan A, Dabalen A, Menéndez C. Inequalities in sub-Saharan African women’s and girls’ health opportunities and outcomes: evidence from the demographic and health surveys. J Glob Health. 2019;9(1). https://doi.org/10.7189/jogh.09.010410.

27.

Mekonnen T, Dune T, Perz J. Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review. BMC Pregnancy Childbirth. 2019;19(1):366. https://doi.org/10.1186/s12884-019-2501-6.CrossRefPubMedPubMedCentral

28.

Sacoor C, Payne B, Augusto O, Vilanculo F, Nhacolo A, Vidler M, Makanga PT, Munguambe K, Lee T, Macete E, von Dadelszen P, Sevene E, the CLIP Working Group. Health and socio-demographic profile of women of reproductive age in rural communities of southern Mozambique. PLoS One. 2018;13(2):e0184249. https://doi.org/10.1371/journal.pone.0184249.CrossRefPubMedPubMedCentral

29.

Kripke K, Opuni M, Odoyo-June E, Onyango M, Young P, Serrem K, Ojiambo V, Schnure M, Stegman P, Njeuhmeli E. Data triangulation to estimate age-specific coverage of voluntary medical male circumcision for HIV prevention in four Kenyan counties. PLoS One. 2018;13(12):e0209385. https://doi.org/10.1371/journal.pone.0209385.CrossRefPubMedPubMedCentral

30.

Odeny TA, Bukusi EA, Geng EH, Hughes JP, Holmes KK, McClelland RS. Participation in a clinical trial of a text messaging intervention is associated with increased infant HIV testing: A parallel-cohort randomized controlled trial. PLoS One. 2018;13:e0209854. https://doi.org/10.1371/journal.pone.0209854 Yotebieng M, editor.CrossRefPubMedPubMedCentral

31.

Finocchario-Kessler S, Gautney B, Cheng A, Wexler C, Maloba M, Nazir N, et al. Evaluation of the HIV Infant Tracking System (HITSystem) to optimise quality and efficiency of early infant diagnosis: a cluster-randomised trial in Kenya. Lancet HIV. 2018;5:e696–705. https://doi.org/10.1016/S2352-3018(18)30245-5.CrossRefPubMedPubMedCentral

32.

Wagner AD, Mugo C, Njuguna IN, Maleche-Obimbo E, Sherr K, Inwani IW, Hughes JP, Wamalwa DC, John-Stewart GC, Slyker JA. Implementation and operational research: active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. JAIDS J Acquir Immune Defic Syndr. 2016;73(5):e83–9. https://doi.org/10.1097/QAI.0000000000001184.CrossRefPubMed

33.

Schwartz SR, Clouse K, Yende N, Van Rie A, Bassett J, Ratshefola M, et al. Acceptability and feasibility of a Mobile phone-based case management intervention to retain mothers and infants from an option B+ program in postpartum HIV care. Matern Child Health J. 2015;19(9):2029–37. https://doi.org/10.1007/s10995-015-1715-0.CrossRefPubMedPubMedCentral

34.

Lassi ZS, Kedzior SG, Bhutta ZA. Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries. Cochrane Database Syst Rev. 2019;2019. https://doi.org/10.1002/14651858.CD007647.pub2.

35.

Drake AL, Thomson KA, Quinn C, Newman Owiredu M, Nuwagira IB, Chitembo L, Essajee S, Baggaley R, Johnson CC. Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother-to-child HIV transmission (EMTCT) efforts. J Int AIDS Soc. 2019;22(4):e25271. https://doi.org/10.1002/jia2.25271.CrossRefPubMedPubMedCentral

36.

Fayorsey RN, Wang C, Chege D, Reidy W, Syengo M, Owino SO, Koech E, Sirengo M, Hawken MP, Abrams EJ. Effectiveness of a lay counselor–led combination intervention for retention of mothers and infants in HIV care. JAIDS J Acquir Immune Defic Syndr. 2019;80(1):56–63. https://doi.org/10.1097/QAI.0000000000001882.CrossRefPubMed

37.

Sarna A, Saraswati LR, Okal J, Matheka J, Owuor D, Singh RJ, Reynolds N, Kalibala S. Cell phone counseling improves retention of mothers with HIV infection in care and infant HIV testing in Kisumu, Kenya: a randomized controlled study. Glob Heal Sci Pract. 2019;7(2):171–88. https://doi.org/10.9745/GHSP-D-18-00241.CrossRef

38.

Camlin CS, El Ayadi AM, Kwena ZA, McFarland W, Johnson MO, Neilands TB, et al. High mobility and HIV prevalence among female market traders in East Africa in 2014. JAIDS J Acquir Immune Defic Syndr. 2017;74(5):e121–8. https://doi.org/10.1097/QAI.0000000000001252.CrossRefPubMed

39.

Edwards JK, Arimi P, Ssengooba F, Mulholland G, Markiewicz M, Bukusi EA, et al. The HIV care continuum among resident and non-resident populations found in venues in East Africa cross-border areas; 2019. https://doi.org/10.1002/jia2.25226/full. Cited 23 Apr 2019CrossRef

40.

Camlin CS, Charlebois ED. Mobility and its effects on HIV acquisition and treatment engagement: recent theoretical and empirical advances. Curr HIV/AIDS Rep. 2019;16(4):314–23. https://doi.org/10.1007/s11904-019-00457-2.CrossRefPubMedPubMedCentral

41.

Hogan DR, Salomon JA, Canning D, Hammitt JK, Zaslavsky AM, Bärnighausen T. National HIV prevalence estimates for sub-Saharan Africa: controlling selection bias with Heckman-type selection models. Sex Transm Infect. 2012;88(Suppl 2):i17–23. https://doi.org/10.1136/sextrans-2012-050636.CrossRefPubMedPubMedCentral

42.

Reniers G, Eaton J. Refusal bias in HIV prevalence estimates from nationally representative seroprevalence surveys. AIDS. 2009;23(5):621–9. https://doi.org/10.1097/QAD.0b013e3283269e13.CrossRefPubMedPubMedCentral

43.

Bärnighausen T, Tanser F, Gqwede Z, Mbizana C, Herbst K, Newell M-L. High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study. AIDS. 2008;22(1):139–44. https://doi.org/10.1097/QAD.0b013e3282f2ef43.CrossRefPubMed

Title: Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique
Authors: Laura Fuente-Soro
Sheila Fernández-Luis
Elisa López-Varela
Orvalho Augusto
Tacilta Nhampossa
Ariel Nhacolo
Edson Bernardo
Blanca Burgueño
Bernadette Ngeno
Aleny Couto
Helga Guambe
Kwalila Tibana
Marilena Urso
Denise Naniche
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Human Immunodeficiency Virus
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10568-4

2024 ASCO Annual Meeting

Springer Medicine

Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Temporal trends in the prevalence of metabolic syndrome among middle-aged and elderly adults from 2011 to 2015 in China: the China health and retirement longitudinal study (CHARLS)

HIV stigma in the teaching hospitals in Sana’a, Yemen: a conflict and low-resource setting

Comparison of physical and psychological health outcomes for motorcyclists and other road users after land transport crashes: an inception cohort study

Sleep problems among sexual minorities: a longitudinal study on the influence of the family of origin and chosen family

Current status of premature mortality from four non-communicable diseases and progress towards the Sustainable Development Goal target 3.4: a population-based study in northeast China, 2004–2017

Supporting parents by combatting social inequalities in health: a realist evaluation