Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa : uptake, determinants, and attributable risk (the SAPMTCTE)

dc.contributor.authorWoldesenbet, Selamawit A.
dc.contributor.authorJackson, Debra J.
dc.contributor.authorLombard, Carl
dc.contributor.authorDinh, Thu-ha
dc.contributor.authorPuren, Adrian
dc.contributor.authorSherman, Gayle
dc.contributor.authorRamokolo, Vundli
dc.contributor.authorDoherty, Tanya
dc.contributor.authorMogashoa, Mary M.
dc.contributor.authorBhardwaj, S.
dc.contributor.authorChopra, Mickey
dc.contributor.authorShaffer, Nathan
dc.contributor.authorPillay, Yogan
dc.contributor.authorGoga, Ameena Ebrahim
dc.contributor.editorAnglewicz, Philip
dc.date.accessioned2015-08-28T07:31:20Z
dc.date.available2015-08-28T07:31:20Z
dc.date.issued2015-07-06
dc.description.abstractObjectives We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. Methods A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. Results Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4%received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged 20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. Conclusion A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities.en_ZA
dc.description.librarianam2015en_ZA
dc.description.sponsorshipThe President’s Emergency Plan for AIDS Relief under the Cooperative Agreement between CDC and MRC (1U2GPS001137-02 and 1U2GPS001137-03)- A, The United Nations Children's Fund (UNICEF) - A, National Department of Health, South Africa—A, South Africa National Research Foundation—D, South African Centre for Epidemiological Modelling and Analysis (SACEMA) - S, African Doctoral Dissertation Research Fellowship—S.en_ZA
dc.description.urihttp://www.plosone.orgen_ZA
dc.identifier.citationWoldesenbet S, Jackson D, Lombard C, Dinh T-H, Puren A, Sherman G, et al. (2015) Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE). PLoS ONE 10(7): e0132425. DOI: 10.1371/journal.pone.0132425.en_ZA
dc.identifier.issn1932-6203
dc.identifier.other10.1371/journal.pone.0132425
dc.identifier.urihttp://hdl.handle.net/2263/49633
dc.language.isoenen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights© 2015 Woldesenbet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.en_ZA
dc.subjectPMTCT servicesen_ZA
dc.subjectHealth facilityen_ZA
dc.subjectCommunitiesen_ZA
dc.subjectRisk factorsen_ZA
dc.subjectPrevention of mother-to-child transmission (PMTCT)en_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.titleMissed opportunities along the prevention of mother-to-child transmission services cascade in South Africa : uptake, determinants, and attributable risk (the SAPMTCTE)en_ZA
dc.typeArticleen_ZA

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