Prevention of mother-to-child transmission of HIV in rural Uganda: Modelling effectiveness and impact of scaling-up PMTCT services

Elin C. Larsson, Anna Mia Ekström, George Pariyo, Göran Tomson, Mohammad Sarowar, Rose Baluka, Edward Galiwango, Anna Ekéus Thorson

Research output: Contribution to journalArticle

Abstract

Background: The reported coverage of any antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission (PMTCT) has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is subject to overestimations since it only considers enrolment and not completion of the PMTCT programme. The PMTCT programme is complex as it builds on a cascade of sequential interventions that should take place to reduce mother-to-child transmission (MTCT) of HIV: starting with antenatal care (ANC), HIV testing, and ARVs for the woman and the baby. Objective: The objective was to estimate the number of children infected with HIV in a district population, using empirical data on uptake of PMTCT components combined with data on MTCT rates. Design: This study is based on a population-based cohort of pregnant women recruited in the Iganga-Mayuge Health and Demographic Surveillance Site in rural Uganda 2008-2010. We later modelled different scenarios assuming increased uptake of specific PMTCTcomponents to estimate the impact on MTCT for each scenario. Results: In this setting, HIV infections in children could be reduced by 28% by increasing HIV testing capacity at health facilities to ensure 100% testing among women seeking ANC. Providing ART to all women who received ARV prophylaxis would give an 18% MTCT reduction. Conclusions: Our results highlight the urgency in scaling-up universal access to HIV testing at all ANC facilities, and the potential gains of early enrolment of all pregnant women on antiretroviral treatment for PMTCT. Further, to determine the effectiveness of PMTCT programmes in different settings, it is crucial to analyse at what stages of the PMTCT cascade that dropouts occur to target interventions accordingly.

Original languageEnglish (US)
Article number26308
JournalGlobal health action
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Cohort
  • Effectiveness
  • HIV
  • Population-based
  • Prevention of mother-to-child transmission

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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