Use of service data to inform pediatric HIV-free survival following prevention of mother-to-child transmission programs in rural Malawi
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Date
2012
Authors
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Publisher
BMC Public Health
Abstract
Background: Recent years have seen rapid and significant progress in science and implementation of programs to
prevent mother-to-child transmission of HIV. Programs that support PMTCT routinely monitor service provision but
very few have measured their effectiveness. The objective of the study was to use service data to inform HIV-free
survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission
(PMTCT) of HIV. The study was conducted in two rural districts in Malawi with support from FHI 360.
Methods: A descriptive observational study of PMTCT outcomes was conducted between June 2005 and June
2009. The dataset included patient-level data of all pregnant women 1) that tested HIV-positive, 2) that were
dispensed with antiretroviral prophylaxis, and 3) whose addresses were available for home visits. The data were
matched to each woman’s corresponding antenatal clinic data from home visit registers.
Results: Out of 438 children whose home addresses were available, 33 (8%) were lost to follow-up, 35 (8%) were
alive but not tested for HIV by the time home visit was conducted, and 52 (12%) were confirmed deceased. A total
of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15
months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among
children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and
among those who did receive NVP syrup the estimate was 82%.
Conclusions: When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free
survival among children was high at 82% (CI: 54% to 99%). However this conclusion should be interpreted
cautiously 1) due to the wide confidence interval; and 2) because the confidence interval range includes 55%,
which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This analysis highlighted the
need of quality data and well-structured home visits to assess PMTCT effectiveness.
Description
Research Article
Keywords
HIV, Prevent mother-to-child transmission (PMTCT), Malawi