Open AccessTracing defaulters in HIV prevention of mother‐to‐child transmission programmes through community health workers: results from a rural setting in Zimbabwe
Author(s) -
Vogt Florian,
Ferreyra Cecilia,
Bernasconi Andrea,
Ncube Lewis,
Taziwa Fabian,
Marange Winnie,
Wachi David,
Becher Heiko
Publication year - 2015
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.18.1.20022
Subject(s) - medicine , nevirapine , confidence interval , pregnancy , transmission (telecommunications) , pediatrics , poisson regression , population , obstetrics , viral load , human immunodeficiency virus (hiv) , family medicine , environmental health , antiretroviral therapy , biology , electrical engineering , genetics , engineering
High retention in care is paramount to reduce vertical human immunodeficiency virus (HIV) infections in prevention of mother‐to‐child transmission (PMTCT) programmes but remains low in many sub‐Saharan African countries. We aimed to assess the effects of community health worker–based defaulter tracing (CHW‐DT) on retention in care and mother‐to‐child HIV transmission, an innovative approach that has not been evaluated to date. Methods We analyzed patient records of 1878 HIV‐positive pregnant women and their newborns in a rural PMTCT programme in the Tsholotsho district of Zimbabwe between 2010 and 2013 in a retrospective cohort study. Using binomial regression, we compared vertical HIV transmission rates at six weeks post‐partum, and retention rates during the perinatal PMTCT period (at delivery, nevirapine [NVP] initiation at three days post‐partum, cotrimoxazole (CTX) initiation at six weeks post‐partum, and HIV testing at six weeks post‐partum) before and after the introduction of CHW‐DT in the project. Results Median maternal age was 27 years (inter‐quartile range [IQR] 23 to 32) and median CD4 count was 394 cells/µL 3 (IQR 257 to 563). The covariate‐adjusted rate ratio (aRR) for perinatal HIV transmission was 0.72 (95% confidence intervals [95% CI] 0.27 to 1.96, p =0.504), comparing patient outcomes after and before the intervention. Among fully retained patients, 11 (1.9%) newborns tested HIV positive. ARRs for retention in care were 1.01 (95% CI 0.96 to 1.06, p =0.730) at delivery; 1.35 (95% CI 1.28 to 1.42, p <0.001) at NVP initiation; 1.78 (95% CI 1.58 to 2.01, p <0.001) at CTX initiation; and 2.54 (95% CI 2.20 to 2.93, p <0.001) at infant HIV testing. Cumulative retention after and before the intervention was 496 (85.7%) and 1083 (87.3%) until delivery; 480 (82.9%) and 1005 (81.0%) until NVP initiation; 303 (52.3%) and 517 (41.7%) until CTX initiation; 272 (47.0%) and 427 (34.4%) until infant HIV testing; and 172 (29.7%) and 405 (32.6%) until HIV test result collection. Conclusions The CHW‐DT intervention did not reduce perinatal HIV transmission significantly. Retention improved moderately during the post‐natal period, but cumulative retention decreased rapidly even after the intervention. We showed that transmission in resource‐limited settings can be as low as in resource‐rich countries if patients are fully retained in care. This requires structural changes to the regular PMTCT services, in which community health workers can, at best, play a complementary role.