title: Factors associated with uptake of services to prevent mother-to-child transmission of HIV in a community cohort in rural Tanzania.
abstract: OBJECTIVE
  This study aimed to identify factors associated with access to HIV care and antiretroviral (ARV) drugs for prevention of mother-to-child transmission (PMTCT) of HIV among HIV-positive pregnant women in a community cohort in rural Tanzania (Kisesa).
  
  
  METHODS
  Kisesa-resident women who tested HIV-positive during HIV serosurveillance and were pregnant (while HIV-positive) between 2005 and 2012 were eligible. Community cohort records were linked to PMTCT and HIV clinic data from four facilities (PMTCT programme implemented in 2009; referrals to city-based hospitals since 2005) to ascertain service use. Factors associated with access to HIV care and ARVs during pregnancy were analysed using logistic regression.
  
  
  RESULTS
  Overall, 24% of women accessed HIV care and 12% accessed ARVs during pregnancy (n=756 pregnancies to 420 women); these proportions increased over time. In multivariate analyses for 2005-2012, being married, prior voluntary counselling and testing, increasing age, increasing year of pregnancy and increasing duration of infection were independently associated with access to care and ARVs. Residence in roadside areas was an independent predictor of access to care but not ARVs. There was no evidence of an interaction with time period.
  
  
  CONCLUSIONS
  Access to PMTCT services was low in this rural setting but improved markedly over time. There were fairly few sociodemographic differentials although support for young women and those without partners may be needed. Further decentralisation of HIV services to more remote areas, promotion of voluntary counselling and testing and implementation of Option B+ are likely to improve uptake and may bring women into care and treatment sooner after infection.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Gourlay
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Caoimhe
authors.initials: C
authors.lastname: Cawley
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Denna
authors.initials: D
authors.lastname: Michael
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Richard
authors.initials: R
authors.lastname: Machemba
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Georges
authors.initials: G
authors.lastname: Reniers
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D012424:Rural Population; D013636:Tanzania; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AFRICA; ANTIRETROVIRAL THERAPY; HIV; PREGNANCY