Viral load testing among women on ‘option B+’ in Mazowe, Zimbabwe: How well are we doing?


Autoři: Justice Nyakura aff001;  Hemant Deepak Shewade aff002;  Serge Ade aff002;  Angela Mushavi aff001;  Solomon Huruva Mukungunugwa aff001;  Anesu Chimwaza aff001;  Philip Owiti aff002;  Mbazi Senkoro aff007;  Owen Mugurungi aff001
Působiště autorů: AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe aff001;  International Union Against Tuberculosis and Lung Disease (The Union), Paris, France aff002;  The Union South-East Asia, New Delhi, India aff003;  Karuna Trust, Bengaluru, Karnataka, India aff004;  Faculté de Médecine, Université de Parakou, Parakou, Benin aff005;  National Tuberculosis, Leprosy and Lung Disease Programme, Nairobi, Kenya aff006;  National Institute for Medical Research- Muhimbili Medical Research Centre, Dar es Salaam, Tanzania aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225476

Souhrn

Background

Globally, ten percent of new HIV infections are among children and most of these children acquire infection through mother-to-child transmission. To prevent this, lifelong ART among pregnant and breast feeding (PBF) women living with HIV, irrespective of the WHO clinical stage, was adopted (option B+). There is limited cohort-wise assessment of VL testing among women on ‘option B+’.

Objective

Among a pregnancy cohort on antiretroviral therapy in public hospitals and clinics of Mazowe district, Zimbabwe (2017), to determine the i) proportion undergoing VL testing anytime up to six months post child birth and associated factors; ii) turnaround time (TAT) from sending the specimen to results receipt and VL suppression among those undergoing VL testing.

Methods

This was a cohort study involving secondary programme data. Modified Poisson regression using robust variance estimates was used to determine the independent predictors of VL testing.

Results

Of 1112 women, 354 (31.8%, 95% CI: 29.2–34.6) underwent VL testing: 113 (31.9%) during pregnancy, 124 (35%) within six months of child birth and for 117 (33.1%), testing period was unknown. Of 354, VL suppression was seen in 334 (94.4%) and 13 out of 20 with VL non-suppression underwent repeat VL testing. Among those with available dates (125/354), the median TAT was 93 days (IQR 19.3–255). Of 1112, VL results were available between 32 weeks and child birth in 31 (2.8%) women. When compared to hospitals, women registered for antenatal care in clinics were 36% less likely to undergo VL testing [aRR: 0.64 (95% CI: 0.53, 0.76)].

Conclusion

Among women on option B+, the uptake of HIV VL testing was low with unacceptably long TAT. VL suppression among those tested was satisfactory. There is an urgent need to prioritize VL testing among PBF women and to consider use of point of care machines. There is a critical need to strengthen the recording and local utilisation of routine clinic data in order to successfully monitor progress of healthcare services provided.

Klíčová slova:

anémia – Antenatal care – Pregnancy – Viral load – Zimbabwe


Zdroje

1. Dieleman JL, Singh L, Birger M, Schneider M, Chapin A. Tracking development assistance for HIV/AIDS by type of investment, 1990–2015. Lancet Glob Heal. 2016;4: S35. doi: 10.1016/S2214-109X(16)30040-7

2. United Nations programme on HIV/AIDS. UNAIDS Data 2018. Geneva, Switzerland; 2018.

3. United Nations programme on HIV/AIDS. Fast track: Ending the AIDS epidemic by 2030. Geneva, Switzerland; 2014.

4. World Health Organisation. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd Edition. Geneva, Switzerland; 2016.

5. United Nations programme on HIV/AIDS. UNAIDS report on the global AIDS epidemic 2010. Geneva, Switzerland: World Health Organization; 2010.

6. Myer L, Essajee S, Broyles LN, Watts DH, Lesosky M, El-Sadr WM, et al. Pregnant and breastfeeding women: A priority population for HIV viral load monitoring. PLOS Med. 2017;14: e1002375. doi: 10.1371/journal.pmed.1002375 28809929

7. United Nations programme on HIV/AIDS. Get on the Fast-Track:The life-cycle approach to HIV. Geneva Switzerland; 2016.

8. Townsend CL, Byrne L, Cortina-Borja M, Thorne C, de Ruiter A, Lyall H, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000–2011. AIDS. 2014;28: 1049–57. doi: 10.1097/QAD.0000000000000212 24566097

9. United Nations programme on HIV/AIDS. Knowledge is Power Know Your Status, Know Your Viral Load. Geneva, Switzerland; 2018.

10. Swannet S, Decroo T, de Castro SMTL, Rose C, Giuliani R, Molfino L, et al. Journey towards universal viral load monitoring in Maputo, Mozambique: many gaps, but encouraging signs. Int Health. 2017;9: 206–214. doi: 10.1093/inthealth/ihx021 28810670

11. Hosseinipour M, Nelson JAE, Trapence C, Rutstein SE, Kasende F, Kayoyo V, et al. Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi’s Option B+ Program: Results From the PURE Malawi Study. J Acquir Immune Defic Syndr. 2017;75 Suppl 2: S149–S155. doi: 10.1097/QAI.0000000000001368 28498184

12. Ministry of Health and Child Care. Zimbabwe Population Based HIV Impact Assessment. Harare; 2017.

13. Zimbabwe Statistical Agency. Census 2012, National Report. Harare, Zimbabwe; 2012.

14. Zimbabwe Statistical Agency, The DHS Program ICF International. Zimbabwe Demographic and Health Survey. Harare, Zimbabwe; 2015.

15. Ministry of Health and Child Care. AIDS &TB Report 2017. Harare, Zimbabwe; 2018.

16. Ministry of Health and Child Care. The Plan for Elimination of Mother to Child Transmission of HIV & Syphilis in Zimbabwe 2018–2022. Harare, Zimbabwe; 2017.

17. Komtenza B, Satyanarayana S, Takarinda KC, Mukungunugwa SH, Mugurungi O, Chonzi P, et al. Identifying high or low risk of mother to child transmission of HIV: How Harare City, Zimbabwe is doing? PLoS One. 2019;14: e0212848. doi: 10.1371/journal.pone.0212848 30865646

18. Gamell A, Letang E, Jullu B, Mwaigomole G, Nyamtema A, Hatz C, et al. Uptake of guidelines on prevention of mother-to-child transmission of HIV in rural Tanzania: time for change. Swiss Med Wkly. 2013;143: w13775. doi: 10.4414/smw.2013.13775 23519621

19. Awungafac G, Amin ET, Fualefac A, Takah NF, Agyingi LA, Nwobegahay J, et al. Viral load testing and the use of test results for clinical decision making for HIV treatment in Cameroon: An insight into the clinic-laboratory interface. PLoS One. 2018;13: e0198686. doi: 10.1371/journal.pone.0198686 29889862

20. Etoori D, Kerschberger B, Staderini N, Ndlangamandla M, Nhlabatsi B, Jobanputra K, et al. Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland. BMC Public Health. 2018;18: 374. doi: 10.1186/s12889-018-5258-3 29558896

21. Yeap AD, Hamilton R, Charalambous S, Dwadwa T, Churchyard GJ, Geissler PW, et al. Factors influencing uptake of HIV care and treatment among children in South Africa–a qualitative study of caregivers and clinic staff. AIDS Care. 2010;22: 1101–1107. doi: 10.1080/09540121003602218 20824563

22. Mwaniki MK, Vaid S, Chome IM, Amolo D, Tawfik Y, Kwale Improvement Coaches. Improving service uptake and quality of care of integrated maternal health services: the Kenya Kwale District improvement collaborative. BMC Health Serv Res. 2014;14: 416. doi: 10.1186/1472-6963-14-416 25240834

23. Mwau M, Syeunda CA, Adhiambo M, Bwana P, Kithinji L, Mwende J, et al. Scale-up of Kenya’s national HIV viral load program: Findings and lessons learned. PLoS One. 2018;13: e0190659. doi: 10.1371/journal.pone.0190659 29324811

24. Minchella PA, Chipungu G, Kim AA, Sarr A, Ali H, Mwenda R, et al. Specimen origin, type and testing laboratory are linked to longer turnaround times for HIV viral load testing in Malawi. PLoS One. 2017;12: e0173009. doi: 10.1371/journal.pone.0173009 28235013

25. Chetty T, Newell M-L, Thorne C, Coutsoudis A. Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010–2015. Trop Med Int Heal. 2018;23: 79–91. doi: 10.1111/tmi.13001 29121445

26. Pearson L, Shoo R. Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet. 2005;88: 208–15. doi: 10.1016/j.ijgo.2004.09.027 15694109

27. Sarin E, Kole SK, Patel R, Sooden A, Kharwal S, Singh R, et al. Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India. BMC Pregnancy Childbirth. 2017;17: 134. doi: 10.1186/s12884-017-1318-4 28464842

28. Frank SC, Cohn J, Dunning L, Sacks E, Walensky RP, Mukherjee S, et al. Clinical effect and cost-effectiveness of incorporation of point-of-care assays into early infant HIV diagnosis programmes in Zimbabwe: a modelling study. lancet HIV. 2019;6: e182–e190. doi: 10.1016/S2352-3018(18)30328-X 30737187


Článek vyšel v časopise

PLOS One


2019 Číslo 12