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Girma, Marshet (2016): Effectiveness of prevention of mother-to child transmission (PMTCT) procedures in pregnant HIV infected women and their exposed infants at seven health centers in Addis Ababa, Ethiopia. Dissertation, LMU München: Medizinische Fakultät
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Abstract

Background: The purpose of this research is to assess PMTCT intervention uptake by HIV positive pregnant mothers and to assess the degree of linkage to HIV exposed infants to care and treatment services in selected. We conducted a prospective observational study in HIV positive pregnant mothers and their new-borns attending ANC and PMTCT health services at seven health centers in Addis Ababa, Ethiopia. Methods: Outcome evaluations included retention to PMCTC procedures, timing of ART initiation, self-reported ART adherence using a 5-item recall questionnaire, risk factors associated with poor treatment adherence, up-take of infant nevirapine prophylaxis, HIV early infant diagnosis (EID) procedures and mother-to-child transmission rates. Results: Of 494 women enrolled into the study 4.9% did not complete PMTCT procedures due to active refusal or loss to follow-up. First HIV diagnosis was done in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. The median time of ART initiation after HIV diagnosis was 1.3 weeks (IQR 0-4.3) and 17.4 weeks (IQR 11.7-23.9) before delivery. The majority received triple ART, except 37 (7.6%) women starting zidovudine monotherapy following Option A procedures. Poor self-reported treatment adherence was higher post-partum as compared to prior delivery (12.5% versus 7.0%, p=0.002), and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4 count (RR 1.7, 95% CI 1.0-3.0), and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive 98.6% initiated nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7%, but EID results were received only in 4.8% within 2 months, and cumulatively 46.6% within 3 months after birth. Conclusion: High retention to PMTCT services, triple maternal ART and high uptake of infant nevirapine prophylaxis was associated with a low mother-to-child HIV transmission rate. Declining post-partum antiretroviral treatment adherence and challenges of EID linkage procedures require focused interventions.