Prevention of mother-to-child transmission of HIV: a cross-sectional study in Malawi

• Published in: Bulletin of the World Health Organization Vol. 96; no. 4; pp. 256 - 265
• Main Authors: van Lettow, M, Landes, M, van Oosterhout, J J, Schouten, E, Phiri, H, Nkhoma, E, Kalua, T, Gupta, S, Wadonda, N, Jahn, A, Tippett-Barr, B
• Format: Journal Article
• Language: English
• Published: Switzerland World Health Organization 01.04.2018
• Subjects: Acquired immune deficiency syndrome; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Babies; Breastfeeding & lactation; Chemoprevention - methods; Child; Child, Preschool; Confidence intervals; Cross-Sectional Studies; Disease prevention; Disease transmission; Drug therapy; Female; Health facilities; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Immune system; Infant; Infants; Infectious Disease Transmission, Vertical - prevention & control; Malawi - epidemiology; Medical tests; Medical treatment; Mothers; Nevirapine; Older people; Older women; Postpartum; Postpartum women; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - prevention & control; Prenatal testing; Prevention; Prevention programs; Prophylaxis; Ratios; Risk; Subgroups; Tests; Therapy; Trust; Uptake; Viruses; Womens health; Young women; Malawi; South Africa
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.17.203265

To estimate the use and outcomes of the Malawian programme for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). In a cross-sectional analysis of 33 744 mother-infant pairs, we estimated the weighted proportions of mothers who had received antenatal HIV testing and/or maternal antiretroviral therapy and infants who had received nevirapine prophylaxis and/or HIV testing. We calculated the ratios of MTCT at 4-26 weeks postpartum for subgroups that had missed none or at least one of these four steps. The estimated uptake of antenatal testing was 97.8%; while maternal antiretroviral therapy was 96.3%; infant prophylaxis was 92.3%; and infant HIV testing was 53.2%. Estimated ratios of MTCT were 4.7% overall and 7.7% for the pairs that had missed maternal antiretroviral therapy, 10.7% for missing both maternal antiretroviral therapy and infant prophylaxis and 11.4% for missing maternal antiretroviral therapy, infant prophylaxis and infant testing. Women younger than 19 years were more likely to have missed HIV testing (adjusted odds ratio, aOR: 4.9; 95% confidence interval, CI: 2.3-10.6) and infant prophylaxis (aOR: 6.9; 95% CI: 1.2-38.9) than older women. Women who had never started maternal antiretroviral therapy were more likely to have missed infant prophylaxis (aOR: 15.4; 95% CI: 7.2-32.9) and infant testing (aOR: 13.7; 95% CI: 4.2-83.3) than women who had. Most women used the Malawian programme for the prevention of MTCT. The risk of MTCT increased if any of the main steps in the programme were missed.