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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Authors: David Etoori, Bernhard Kerschberger, Nelly Staderini, Mpumelelo Ndlangamandla, Bonisile Nhlabatsi, Kiran Jobanputra, Simangele Mthethwa-Hleza, Lucy Anne Parker, Sifiso Sibanda, Edwin Mabhena, Munyaradzi Pasipamire, Serge Mathurin Kabore, Barbara Rusch, Christine Jamet, Iza Ciglenecki, Roger Teck

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.

Methods

Lifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.

Results

Of 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.

Conclusions

PMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.
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Metadata
Title
Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland
Authors
David Etoori
Bernhard Kerschberger
Nelly Staderini
Mpumelelo Ndlangamandla
Bonisile Nhlabatsi
Kiran Jobanputra
Simangele Mthethwa-Hleza
Lucy Anne Parker
Sifiso Sibanda
Edwin Mabhena
Munyaradzi Pasipamire
Serge Mathurin Kabore
Barbara Rusch
Christine Jamet
Iza Ciglenecki
Roger Teck
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5258-3

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