PMTCT Update: Latest must-read Literature
- Missed Opportunities to Prevent Mother-to-Child Transmission in Sub-Saharan Africa: Systematic Review and Meta-Analysis
Wettstein, C., Mugglin, C., Egger, M., et al. AIDS (September 2012), e-publication ahead of print.
Programs to prevent mother-to-child transmission (PMTCT) of HIV decrease the risk of vertical transmission and identify HIV-infected infants for treatment. To assess how well PMTCT programs reach women and infants and retain them in services, the authors conducted a meta-analysis of a decade of research (2002 to 2012) on PMTCT in 15 African countries involving more than 75,000 women. They looked at 44 studies to examine four outcomes: percentage of pregnant women 1) tested for HIV, 2) initiating antiretroviral prophylaxis, 3) being tested for CD4 cell count, and 4) beginning combined antiretroviral therapy (ART). Two outcomes were examined for children: early infant diagnosis (EID) for HIV and combined ART initiation. The authors found that uptake of provider-initiated (opt-out) HIV testing is greater, with 94 percent of women getting tested, compared to 58 percent for patient-initiated (opt-in) testing. They also found that 40 percent of women who were ART-eligible did not receive any form of ART. For infants, only about two-thirds returned after the birth for EID, and even fewer for HIV testing between 12 and 18 months of age. Interventions that provide convenient access for mothers and their children, involve male partners, or integrate ART provision into standard antenatal care show promise for improving uptake, according to the authors. They recommend further research to understand the barriers to care experienced by many pregnant women in the region.
- The Role of HIV-Related Stigma in Utilization of Skilled Childbirth Services in Rural Kenya: A Prospective Mixed-Methods Study
Turan, J.M, Hatcher, A.H., Medema-Wijnveen, J., et al. PLoS Medicine (September 2012), Vol. 9 No. 8, p. e1001295.
The authors report on the results of the Maternity in Migori and AIDS Stigma Study (MAMAS), a prospective, mixed-methods study of how pregnant women’s perceptions of HIV-related stigma affect their use of maternity services. In 2007, MAMAS surveyed 1,777 pregnant women of unknown HIV status at their first antenatal care visit in a high-prevalence region of rural Kenya. These baseline data revealed that more than two-thirds of the respondents anticipated experiencing stigma if they were to test HIV-positive. Follow-up was conducted postpartum with a sub-sample of 411 women—HIV-positive, HIV-negative, and untested—as were interviews with 48 community health workers, childbearing women, and family members. Qualitative data from the interviews showed that most women in the study believe that delivering in a health facility is preferable for pregnant women with HIV or other health complications. Quantitative data revealed that women with stronger negative attitudes about persons living with HIV are less likely to deliver in a health facility. The authors postulate that women who deliver at a health facility are more likely to be labeled as HIV-positive by their communities. Because health outcomes are far better for clinic-based deliveries, they recommend community-based interventions to counter HIV-related stigma in order to reduce women’s concerns about using health facilities for childbirth.