Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia

PLOS ONE, Nov 2019

About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.

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Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia

June Implementation and outcomes of guideline revisions for the prevention of mother-to- child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia Alemnesh H. Mirkuzie 0 1 0 Ethiopian Public Health Institute, National Data Management Center , Addis Ababa , Ethiopia 1 Editor: Wenhui Hu, Lewis Katz School of Medicine at Temple University , UNITED STATES - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The university of Bergen in Norway has funded the project. Competing interests: The author has declared that no competing interests exist. About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed. Introduction Ethiopia has reported a steady decline in HIV incidence and AIDS related mortality since 2005. The country has also achieved the first target of the Millennium development goal 6, which is halting and reversing the spread of HIV/AIDS [ 1, 2 ]. Concerted efforts by the government, local and international partners including local communities has contributed to this progress. Despite the overall significant decline in the HIV incidence, the MTCT remains a significant challenge in controlling the epidemic. Of the 21,000 estimated new HIV infections which occurred in 2013, 40% were among children <15 years old [2]. In 2009, the UNAIDS set a Global plan for the elimination of new HIV infections among children and keeping their mothers alive. The plan prioritized 22 high HIV burden low resource countries in Africa and Ethiopia is one of them [ 3 ]. In line with this initiative, at the national level Ethiopia has renewed its commitment and galvanized efforts to eliminate new HIV infections among children by 2015 and to keep HIV positive mothers alive. For this the 2011 revised national PMTCT guidelines introduced a more efficacious ART prophylactic option also called Option A. In option A, HIV positive women having CD4 cell count 350 cells/mm3 are eligible for lifelong ART for PMTCT and for their own health, while triple prophylaxis is prescribed for those who are not eligible for ART [ 3 ]. Following its implementation, the country recorded commendable progress. In the 2014 UNAIDS report, the proportion of women accessing prophylaxis antiretroviral therapy (ART) during pregnancy and breastfeeding increased from 9% in 2005 to 55% in 2013 [2]. However, this improvement far from achieving the 90% planned reduction in new HIV infection among children. Later, in 2013 Ethiopia launched Option-B plus to further accelerate progress in PMTCT as well as to improve access to ART for all HIV positive pregnant women for their own health. In Option-B plus, all HIV positive pregnant women receive lifelong ART [ 3 ]. Since the introduction of the first national PMTCT guidelines in 2001, Ethiopia has made series of guidelines revisions in 2007, 2011 and 2013 to incorporate new knowledge, global recommendations and scientific advances [4±6]. To facilitate impleme (...truncated)


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Alemnesh H. Mirkuzie. Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia, PLOS ONE, 2018, Volume 13, Issue 6, DOI: 10.1371/journal.pone.0198438