Structural level differences in the mother-to-child HIV transmission rate in South Africa : a multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmission

dc.contributor.authorWoldesenbet, Selamawit A.
dc.contributor.authorJackson, Debra J.
dc.contributor.authorLombard, C.J.
dc.contributor.authorDinh, Thu-Ha
dc.contributor.authorRamokolo, Vundli
dc.contributor.authorDoherty, Tanya
dc.contributor.authorSherman, Gayle G.
dc.contributor.authorPillay, Yogan
dc.contributor.authorGoga, Ameena Ebrahim
dc.date.accessioned2017-05-11T10:00:51Z
dc.date.available2017-05-11T10:00:51Z
dc.date.issued2017-04
dc.description.abstractOBJECTIVES : In 2010, South Africa reported an early mother-to child transmission (MTCT) rate of 3.5% at 4–8 weeks postpartum. Provincial early MTCT rates ranged from 1.4% [95% confidence interval (CI): 0.1 to 3.4] to 5.9% (95% CI: 3.8 to 8.0). We sought to determine reasons for these geographic differences in MTCT rates. METHODS : This study used multilevel modeling using 2010 South African prevention of mother-to-child transmission (PMTCT) evaluation (SAPMTCTE) data from 530 facilities. Interview data and blood samples of infants were collected from 3085 mother–infant pairs at 4–8 weeks postpartum. Facility-level data on human resources, referral systems, linkages to care, and record keeping were collected through facility staff interviews. Provincial level data were gathered from publicly available data (eg, health professionals per 10,000 population) or aggregated at province-level from the SAPMTCTE (PMTCT maternal-infant antiretroviral (ARV) coverage). Variance partition coefficients and odds ratios (for provincial facility- and individual-level factors influencing MTCT) from multilevel modeling are reported. Results: The provincial- (5.0%) and facility-level (1.4%) variance partition coefficients showed no substantive geographic variation in early MTCT. In multivariable analysis accounting for the multilevel nature of the data, the following were associated with early MTCT : individual-level—low maternal–infant ARV uptake [adjusted odds ratio (AOR) = 2.5, 95% CI: 1.7 to 3.5], mixed breastfeeding (AOR = 1.9, 95% CI: 1.3 to 2.9) and maternal age ,20 years (AOR 1.8, 95% CI : 1.1 to 3.0); facility-level–insufficient (#2) health care-personnel for HIV-testing services (AOR = 1.8, 95% CI: 1.1 to 3.0); provincial-level PMTCT ARV (maternal–infant) coverage lower than 80% (AOR = 1.4, 95% CI: 1.1 to 1.9), and number of health professionals per 10,000 population (AOR = 0.99, 95% CI: 0.98 to 0.99). CONCLUSIONS: There was no substantial province-/facility-level MTCT difference. This could be due to good overall performance in reducing early MTCT. Disparities in human resource allocation (including allocation of insufficient health care personnel for testing and care at facility level) and PMTCT coverage influenced overall PMTCT programme performance. These are long-standing systemic problems that impact quality of care.en_ZA
dc.description.departmentPaediatrics and Child Healthen_ZA
dc.description.librarianhb2017en_ZA
dc.description.urihttp://journals.lww.com/jaidsen_ZA
dc.identifier.citationWoldesenbet, SA, Jackson, DJ, Lombard, CJ, Dinh, TH, Ramokolo, V, Doherty, T, Sherman, GG, Pillay, Y & Goga, AE 2017, 'Structural level differences in the mother-to-child HIV transmission rate in South Africa : a multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmission', Journal of Acquired Immune Deficiency Syndromes, vol. 74, no. 5, pp. 523-530.en_ZA
dc.identifier.issn1525-4135 (print)
dc.identifier.issn1944-7884 (online)
dc.identifier.other10.1097/QAI.0000000000001289
dc.identifier.urihttp://hdl.handle.net/2263/60327
dc.language.isoenen_ZA
dc.publisherLippincott, Williams & Wilkinsen_ZA
dc.rights© 2017 The Author(s). Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND).en_ZA
dc.subjectPopulation-level variationsen_ZA
dc.subjectUniversal accessen_ZA
dc.subjectMother-to child transmission (MTCT)en_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.subjectPrevention of mother-to-child transmission (PMTCT)en_ZA
dc.subjectInfant HIV transmissionen_ZA
dc.titleStructural level differences in the mother-to-child HIV transmission rate in South Africa : a multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmissionen_ZA
dc.typeArticleen_ZA

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