title: Factors Associated with PMTCT Cascade Completion in Four African Countries.
abstract: Background.Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low.Methods.A cross-sectional survey was performed across 26 communities in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Women who reported a pregnancy within two years were enrolled. Participant responses were used to construct the PMTCT cascade with all of the following steps required for completion: at least one antenatal visit, HIV testing performed, HIV testing result received, initiation of maternal prophylaxis, and initiation of infant prophylaxis. Factors associated with cascade completion were identified using multivariable logistic regression modeling.Results.Of 976 HIV-infected women, only 355 (36.4%) completed the PMTCT cascade. Although most women (69.2%) did not know their partner's HIV status; awareness of partner HIV status was associated with cascade completion (aOR 1.4, 95% CI 1.01-2.0). Completion was also associated with receiving an HIV diagnosis prior to pregnancy compared with HIV diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2-38.6).Conclusions.Pregnant women with HIV infection in Africa who were aware of their partner's HIV status and who were diagnosed with HIV before pregnancy were more likely to complete the PMTCT cascade.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jodie
authors.identifier: 0000-0002-3625-5174
authors.initials: J
authors.lastname: Dionne-Odom
authors.affiliation: Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Welty
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.affiliation: Research Center INSERM U1219, ISPED, Université de Bordeaux, Bordeaux, France; PAC-CI Program, ANRS Site, Abidjan, Côte d'Ivoire.
authors.forename: Didier Koumavi
authors.initials: DK
authors.lastname: Ekouevi
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Margaret
authors.identifier: 0000-0001-7285-998X
authors.initials: M
authors.lastname: Kasaro
authors.affiliation: Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon.
authors.forename: Pius M
authors.initials: PM
authors.lastname: Tih
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Alan T N
authors.initials: AT
authors.lastname: Tita