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


METHODS
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 PMTCT components 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.
Department of Public Health Sciences Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; elin.larsson@ki.se.
Elin C
EC
Larsson
Department of Public Health Sciences Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Anna Mia
AM
Ekström
Deptartment of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.|Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
George
G
Pariyo
Department of Public Health Sciences Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden.|Department of Learning, Informatics, Management and Ethics (MMC), Karolinska Institutet, Stockholm, Sweden.
Göran
G
Tomson
Department of Public Health Sciences Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden.
Mohammad
M
Sarowar
Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
Rose
R
Baluka
Deptartment of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.|Iganga-Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
Edward
E
Galiwango
Department of Public Health Sciences Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Anna Ekéus
AE
Thorson
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008403:Mass Screening; D017146:Models, Organizational; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy*; D011295:Prenatal Care / Q000458:organization & administration*; D012424:Rural Population; D014454:Uganda; D055815:Young Adult
D044966:Anti-Retroviral Agents
HIV; cohort; effectiveness; population-based; prevention of mother-to-child transmission