Monitoring and evaluation of programmes to prevent mother to child transmission of HIV in Africa

Vanderbilt University, Нашвилл, Michigan, United States
BMJ (online) (Impact Factor: 16.38). 07/2007; 334(7604):1143-6. DOI: 10.1136/bmj.39211.527488.94
Source: PubMed

ABSTRACT Many countries are expanding the coverage of programmes to prevent mother to child transmission of HIV. Although the need is unquestionable, Richard Reithinger and colleagues are concerned that without true measures of effectiveness we may not be making the best use of resources


Available from: Sten H Vermund, Jun 06, 2015
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    ABSTRACT: Services to diagnose early infant HIV infection should be offered at the six-week immunisation visit. Despite high six-week immunisation attendance, the coverage of early infant diagnosis (EID) is low in many sub-Saharan countries. We explored reasons for such missed opportunities at six-week immunisation visits. We used data from two cross-sectional surveys conducted in 2010 in South Africa. A national assessment was undertaken among randomly selected public facilities (n=625) to ascertain procedures for EID. A sub-sample of these facilities (n=565) were re-visited to assess the HIV-status of 4-8 week old infants receiving six-week immunisation. We examined potential missed opportunities for EID. We used logistic regression to assess factors influencing maternal intention to report for EID at six-week immunisation visits. EID services were available in >95% of facilities, and 72% of immunisation service points (ISPs). The majority (68%) of ISPs provide EID for infants with reported or documented (on infant's Road-to-Health Chart/booklet - iRtHC) HIV-exposure. Only 9% of ISPs offered provider-initiated counselling and testing (PICT) for infants of undocumented/unknown HIV-exposure. Interviews with self-reported HIV-positive mothers at ISPs revealed only 55% had their HIV-status documented on their iRtHC and 35% intended to request EID during six-week immunisation. Maternal non-reporting for EID was associated with fear of discrimination, poor adherence to antiretrovirals, and inadequate knowledge about mother-to-child HIV transmission (MTCT). Missed opportunities for EID were attributed to poor documentation of HIV-status on iRtHC, inadequate maternal knowledge about MTCT, fear of discrimination, and the lack of PICT service for undocumented, unknown, or undeclared HIV-exposed infants.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 12/2014; 68(3). DOI:10.1097/QAI.0000000000000460 · 4.39 Impact Factor
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    ABSTRACT: Introduction Residents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15–49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting. Methods We studied rates of 2-year mortality and loss to follow-up (LTFU) for children <15 years of age initiating cART between June 2006–July 2011 in 10 rural districts. National guidelines define LTFU as >60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk. Results Of 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3–8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001). Conclusions We found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.
    PLoS ONE 10/2014; 9(10):e110116. DOI:10.1371/journal.pone.0110116 · 3.53 Impact Factor
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    ABSTRACT: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC's), where the penetration rate approaches 100%. In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.
    02/2013; 15(1). DOI:10.4102/sajim.v15i1.528