Author: Ms Mutinta Hamahuwa
Citation Style For This Article: Hamahuwa M. Progress towards eliminating mother-to-child transmission of HIV in Macha area in Zambia from 2010-2020; a cross-sectional study. The Health Press Zambia Bull. 2020; 4(4); pp 29
Scaling up prevention of mother-to-child transmission of HIV (PMTCT) services is important in achieving national targets as well as global targets for 90% coverage and less than 5% mother-to-child transmission of HIV. Generally, there has been improvement in coverage of antiretroviral therapy (ART) among HIV-infected pregnant women across regions, particularly in the African region of the WHO where the majority of HIV-infected women reside. At a national level, the improvement in PMTCT coverage among HIV-infected pregnant women, an increase in the proportion of infants receiving HIV prophylaxis and being tested, and the decrease in the number of infants infected with HIV has been well documented. However, fewer studies have been done at a local level. To address this gap, an assessment of the improvement in PMTCT coverage in the Macha area was done.
Cross-sectional studies were conducted from August 2010 to March 2013 (DBS study), April 2013 to October 2015 (EID study), and February 2016 to March 2020 (NSEBA study) of HIV-infected mothers bringing their infants for early infant diagnosis at Macha Hospital. All mothers bringing their infants to either the ART clinic or the primary health center associated with the hospital were eligible for enrollment. For the DBS study, a chart review was conducted and data were abstracted from the laboratory logbooks for all the dried blood samples that were collected. For the EID and NSEBA studies, a questionnaire was administered to the mother after enrollment to collect demographic information, and a chart review was done.
1,259 mother-infant pairs were enrolled and included in this analysis. The median age of the infants at their first HIV DNA test was 6 months. The majority of the mothers (85%) and infants (75%) received antiretroviral drugs to prevent mother-to-child transmission of HIV. The proportion of mothers that received the combination ART increased from 28% in 2010 to 91% in 2020. In 2010-2020, 103 (8%) infants tested positive for HIV. The proportion of infants testing positive decreased from 12% in 2010-2013 to 4% in 2016-2020 (P< 0.0001). The proportion of infants who tested positive differed significantly by maternal receipt of PMTCT. Among infants whose mothers did not receive any PMTCT, 38% tested positive compared to 2% among infants whose mothers received cART for PMTCT (P<0.0001).Conclusion: Comparing these data collected at different time periods in the Macha area indicates that there was a significant improvement in preventing mother-to-child transmission of HIV from 2010 to 2020. Over the period of the studies, the proportion of mothers receiving cART regimens and the proportion of infants receiving HIV prophylaxis increased, leading to a decrease in the proportion of infants becoming infected with HIV. To continue with these gains, a concerted focus will be needed to target and improve on the integration of new guidelines into clinical practice at a facility level.