TY - JOUR
T1 - Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea
T2 - A retrospective clinical audit
AU - Kelly-Hanku, Angela
AU - Nightingale, Claire Elizabeth
AU - Pham, Minh Duc
AU - Mek, Agnes
AU - Homiehombo, Primrose
AU - Bagita, Mary
AU - Nankinga, Justine
AU - Vallely, Andrew
AU - Vallely, Lisa
AU - Sethy, Ghanashyan
AU - Kaldor, John
AU - Luchters, Stanley
N1 - Funding Information:
Funding The study was funded by UNICEF PNG.
Funding Information:
The implementation model for the prevention of mother to child transmission programme differed between the two sites. In Port Moresby, prevention of mother to child transmission services were integrated in antenatal, delivery and postnatal care services for the first 6 weeks. After the 6-week postnatal period, HIV-exposed infants were referred for enrolment in the paediatric HIV clinic for ongoing HIV prophylaxis, confirmatory HIV testing and treatment as required, while mothers were referred to the adult ART outpatient clinic. The adult and paediatric HIV clinics were not co-located and operated on different days, and clinical records were not linked manually or electronically. In Goroka, prevention of mother to child transmission services were integrated in antenatal, delivery and postnatal care, and the mother-infant pair is cared for by the same clinical team until the confirmatory HIV test for the infant was conducted at 18 months. Despite its co-location infants were still enrolled in the paediatric HIV clinic at 6 weeks. At 18 months after birth, the mother was transferred (back) to the adult ART clinic, while the HIV-infected infant/s remained in the clinic for ongoing clinical care and management. All healthcare was provided by staff who were employed as government healthcare workers or were supported and funded by the Clinton Health Access Initiative, funded by the Australian government.
Publisher Copyright:
©
PY - 2020/12/12
Y1 - 2020/12/12
N2 - Introduction Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes. Methods We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012-June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme. Results 763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test. Conclusions Our study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.
AB - Introduction Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes. Methods We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012-June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme. Results 763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test. Conclusions Our study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.
KW - HIV & AIDS
KW - clinical audit
KW - international health services
KW - paediatric infectious disease & immunisation
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85097897162&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-038311
DO - 10.1136/bmjopen-2020-038311
M3 - Article
C2 - 33310792
AN - SCOPUS:85097897162
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - 38311
ER -
