Suze Holband’s scientific contributions

Objectives To evaluate the cascade of care for the elimination of mother-to-child-transmission of human immunodeficiency virus (HIV) in Suriname and identify sociodemographic and clinical factors preventing transmission to exposed infants. Methods A mixed-methods study design was used. Antenatal care data from the 2018 cross-sectional multi-indicator cluster survey on 1 026 women aged 15–49 years who had had a live birth in the previous 2 years were used. Furthermore, national data on a cohort of 279 mothers with HIV and their 317 infants born from 2016 to 2018 were evaluated. Additionally, 13 cases of mother-to-child-transmission of HIV were reviewed. Results In 89.3% of cases, no mother-to-child HIV transmission occurred. Early cascade steps show that 28.4% of women had unmet family planning needs, 15% had no antenatal visits, 8% delivered outside a health facility, and 71.5% received an HIV test during antenatal care. Of the pregnant women with HIV, 84.2% received antiretroviral therapy, while 95.5% of their infants received HIV prophylactic treatment. Receiving antiretroviral therapy for the mother (odds ratio (OR) 45.4, 95% confidence interval (CI) 9.6–215.3) and the child (OR 145.7, 95% CI 14.4–1477.4) significantly increased the odds of a negative HIV test result in infants. Conversely, living in the interior decreased the odds (OR 0.2, 95% CI 0.4–0.7) compared with urban living. Conclusions HIV medication for mothers with HIV and their infants remains key in the prevention of mother-to-child-transmission of HIV. Early prenatal care with follow-up should be strengthened in Suriname.

Background The calculation of the cascade for the Elimination Mother-to-Child-Transmission of HIV (EMTCT) enables the systematic evaluation of different steps in the health care system towards not transmitting HIV to the exposed infant. This study aims to calculate the EMTCT cascade and identify influencing sociodemographic and clinical factors for Suriname. Methods Descriptive analytical study using data regarding prenatal care for women 15–49 year collected in the Multi Indicator Cluster Survey (MICS) 2018. Furthermore, national data from infants and their HIV infected mothers born 2016 to 2018 were used. Multiple regression looking into sociodemographic and clinical factors effecting the transmission of HIV from mother-to-child was executed. Results In 89% (95%CI 85–92%) of the cases there was no transmission of HIV from mother-to-child. Earlier cascade steps show 38% unmet family planning needs and evaluating pregnant women 15% with no prenatal visit, 8% deliveries outside a health facility and 72% HIV test coverage during prenatal care. Of the 0.9% (95%CI 0.8-1.0) of pregnant women with HIV, the ART coverage was 84% (95%CI 80–88%). Their infants received HIV prophylactic treatment in 96% (95%CI 93–98%) and a PCR test after birth in 94% (95%CI 90–96%) of the cases. Increased odd of having a negative PCR result was linked with HIV treatment for mother (aOR 26.8, 95% CI 4.1–173.7) and child (aOR 33.9, 95% CI 2.7–419.7). This while living in the interior compared to urban living decreased the odds (aOR 0.8, 95% CI 0.6-1.0). Conclusions HIV medication for both HIV infected mothers and their infants remain key in the prevention of HIV mother-to-child-transmission. Prenatal care for pregnant women in general shows gaps reaching those important steps. Interventions with a particular focus on mothers living in the interior, guaranteeing the continuity of care are needed.