Evaluation of the prevention of mother-to-child transmission of HIV programs at the second immunization visit in Burkina Faso and Zambia

Objective: Our study aimed to assess the PMTCT indicators in Burkina Faso and Zambia using a patient-orientated innovative strategy based on the second visit in the Expanded Program on Immunization (EPI-2) visit at 6–8 weeks. Design: This was a cross sectional study. Methods: We assessed women attending EPI-2 at primary healthcare facilities in Burkina Faso and Zambia with their children about their exposure to PMTCT interventions. For women living with HIV (WLHIV), viral load was measured and their children were tested for HIV DNA using point of care devices. Results: Overall, 25 093 were enrolled from Burkina Faso and 8961 women from Zambia. Almost, all women attended at least one antenatal care visit. Among those aware of their HIV-positive status, 95.8 and 99.2% were on antiretroviral therapy (ART) in Burkina Faso and Zambia, respectively. Among WLHIV on ART, 75 and 79.2% achieved a viral load suppression (viral load <1000 copies/ml) in Burkina Faso and Zambia, respectively. Infant postnatal prophylaxis was administered from birth until EPI-2 to 60.9 and 89.7% of HIV-exposed children in Burkina Faso and Zambia, respectively. In Burkina Faso, only 60 of 192 (31.3%) of HIV-exposed children were sampled at day 42 for early infant diagnosis (EID) and 3 (1.6%) received a result by EPI-2. In Zambia, these figures were 879 of 1465 (64.0%) and 9.9% (145/1465), respectively for HIV-exposed children sampled at birth. Conclusion: This evaluation strategy at EPI-2 visit could strengthen program monitoring and help identifying gaps to be addressed on the last mile towards elimination of MTCT of HIV.

[1]  L. Myer,et al.  Cost-effectiveness of point-of-care versus centralised, laboratory-based nucleic acid testing for diagnosis of HIV in infants: a systematic review of modelling studies , 2023, The lancet. HIV.

[2]  Jennifer M. Zech,et al.  Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV , 2023, Global Health: Science and Practice.

[3]  In Danger: UNAIDS Global AIDS Update 2022 , 2022 .

[4]  E. Conroy,et al.  Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis , 2022, BMC Infectious Diseases.

[5]  R. Zimba,et al.  Estimates of the prevalence of undiagnosed HIV among children living with HIV in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Zambia, and Zimbabwe from 2015 to 2017: an analysis of data from the cross-sectional Population-based HIV Impact Assessment surveys. , 2022, The lancet. HIV.

[6]  J. Molès,et al.  Design and challenges of a large HIV prevention clinical study on mother-to-child transmission: ANRS 12397 PROMISE-EPI study in Zambia and Burkina Faso. , 2021, Contemporary clinical trials.

[7]  J. Reece,et al.  Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi , 2020, BMC Public Health.

[8]  A. Ajayi,et al.  Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries , 2020, PloS one.

[9]  C. Giaquinto,et al.  Correlates of loss to follow-up and missed diagnosis among HIV-exposed infants throughout the breastfeeding period in southern Mozambique , 2020, PloS one.

[10]  George Githuka,et al.  Impact of Routine Point-of-Care Versus Laboratory Testing for Early Infant Diagnosis of HIV: Results From a Multicountry Stepped-Wedge Cluster-Randomized Controlled Trial , 2020, Journal of acquired immune deficiency syndromes.

[11]  O. Oladimeji,et al.  Prenatal care and uptake of HIV testing among pregnant women in Gambia: a cross-sectional study , 2020, BMC Public Health.

[12]  B. Chi,et al.  Incident HIV among pregnant and breastfeeding women in sub-Saharan Africa: a systematic review and meta-analysis. , 2020, AIDS (London).

[13]  A. Abimiku,et al.  Missed opportunities for early infant diagnosis of HIV in rural North-Central Nigeria: A cascade analysis from the INSPIRE MoMent study , 2019, PloS one.

[14]  J. Baeten,et al.  Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners , 2018, The Journal of infectious diseases.

[15]  B. Chi,et al.  Women's decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia , 2018, AIDS care.

[16]  J. Safrit,et al.  Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks? , 2017, PloS one.

[17]  S. Modi,et al.  Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go , 2017, Journal of the International AIDS Society.

[18]  M. Hoelscher,et al.  Uptake and performance of prevention of mother‐to‐child transmission and early infant diagnosis in pregnant HIV‐infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia , 2017, Tropical medicine & international health : TM & IH.

[19]  A. Puren,et al.  First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa , 2014, Journal of Epidemiology & Community Health.

[20]  W. Moss,et al.  Turnaround Time for Early Infant HIV Diagnosis in Rural Zambia: A Chart Review , 2014, PloS one.

[21]  P. Tugwell,et al.  The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review , 2013, PloS one.

[22]  Jay J H Park,et al.  Interventions to improve adherence to antiretroviral therapy: a systematic review and network meta-analysis. , 2017, The lancet. HIV.