Implementation and Operational Research: Reconstructing the PMTCT Cascade Using Cross-sectional Household Survey Data. (1st September 2015)

• Record Type: Journal Article
• Authors: Chi, Benjamin H.; Tih, Pius M.; Zanolini, Arianna; Stinson, Kathryn; Ekouevi, Didier K.; Coetzee, David; Welty, Thomas K.; Bweupe, Maximillian; Shaffer, Nathan; Dabis, Francois; Stringer, Elizabeth M.; Stringer, Jeffrey S. A.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 70:Number 1(2015)
• Publication Date: 2015-09-01
• Subjects: prevention of mother-to-child transmission -- HIV -- cascade -- PEARL study -- Africa; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000000718
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Given the ambitious targets to reduce pediatric AIDS worldwide, ongoing assessment of programs to prevent mother-to-child HIV transmission (PMTCT) is critical. The concept of a "PMTCT cascade" has been used widely to identify bottlenecks in program implementation; however, most efforts to reconstruct the cascade have relied on facility-based approaches that may limit external validity. Methods: We analyzed data from the PEARL household survey, which measured PMTCT effectiveness in 26 communities across Zambia, South Africa, Cote d'Ivoire, and Cameroon. We recruited women who reported a delivery in the past 2 years. Among mothers confirmed to be HIV infected at the time of survey, we reconstructed the PMTCT cascade with self-reported participant information. We also analyzed data about the child's vital status; for those still alive, HIV testing was performed by DNA polymerase chain reaction testing. Results: Of the 976 eligible women, only 355 (36%) completed every step of the PMTCT cascade. Among the 621 mother–child pairs who did not, 22 (4%) reported never seeking antenatal care, 103 (17%) were not tested for HIV during pregnancy, 395 (64%) reported testing but never received their HIV-positive result, 48 (8%) did not receive maternal antiretroviral prophylaxis, and 53 (9%) did not receive infant antiretroviral prophylaxis. The lowest prevalence of infant HIV infection or death was observed in those completing the cascade (10%, 95% confidence interval: 7% to 12%). Conclusions: Future efforts to measure population PMTCT impact should incorporate dimensions explored in the PEARL study—including HIV testing of HIV-exposed children in household surveys—to better understand program effectiveness.