Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries

 

Show simple item record

dc.contributor.author Stringer, Jeffrey S A en_ZA
dc.contributor.author Stinson, Kathryn en_ZA
dc.contributor.author Tih, Pius M en_ZA
dc.contributor.author Giganti, Mark J en_ZA
dc.contributor.author Ekouevi, Didier K en_ZA
dc.contributor.author Creek, Tracy L en_ZA
dc.contributor.author Welty, Thomas K en_ZA
dc.contributor.author Chi, Benjamin H en_ZA
dc.contributor.author Wilfert, Catherine M en_ZA
dc.contributor.author Shaffer, Nathan en_ZA
dc.date.accessioned 2015-11-16T04:08:02Z
dc.date.available 2015-11-16T04:08:02Z
dc.date.issued 2013 en_ZA
dc.identifier.citation Stringer, J. S., Stinson, K., Tih, P. M., Giganti, M. J., Ekouevi, D. K., Creek, T. L., ... & Coetzee, D. (2012). Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries. PLoS medicine, 10(5), e1001424. doi:10.1371/journal.pmed.1001424 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14985
dc.identifier.uri http://dx.doi.org/10.1371/journal.pmed.1001424
dc.description.abstract BACKGROUND: Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children ≤24 mo of age in Cameroon, Côte D'Ivoire, South Africa, and Zambia. Methods and FINDINGS: We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo. We tested consenting mothers with rapid HIV antibody tests and tested the children of seropositive mothers with HIV DNA PCR or rapid antibody tests. Our primary outcome was 24-mo HIV-free survival, estimated with survival analysis. In an individual-level analysis, we evaluated the effectiveness of various PMTCT regimens. In a community-level analysis, we evaluated the relationship between HIV-free survival and community PMTCT coverage (the proportion of HIV-exposed infants in each community that received any PMTCT intervention during gestation or breastfeeding). We also compared our community coverage results to those of a contemporaneous study conducted in the facilities serving each sampled community. Of 7,985 surveyed children under 2 y of age, 1,014 (12.7%) were HIV-exposed. Of these, 110 (10.9%) were HIV-infected, 851 (83.9%) were HIV-uninfected, and 53 (5.2%) were dead. HIV-free survival at 24 mo of age among all HIV-exposed children was 79.7% (95% CI: 76.4, 82.6) overall, with the following country-level estimates: Cameroon (72.6%; 95% CI: 62.3, 80.5), South Africa (77.7%; 95% CI: 72.5, 82.1), Zambia (83.1%; 95% CI: 78.4, 86.8), and Côte D'Ivoire (84.4%; 95% CI: 70.0, 92.2). In adjusted analyses, the risk of death or HIV infection was non-significantly lower in children whose mothers received a more complex regimen of either two or three antiretroviral drugs compared to those receiving no prophylaxis (adjusted hazard ratio: 0.60; 95% CI: 0.34, 1.06). Risk of death was not different for children whose mothers received a more complex regimen compared to those given single-dose nevirapine (adjusted hazard ratio: 0.88; 95% CI: 0.45, 1.72). Community PMTCT coverage was highest in Cameroon, where 75 of 114 HIV-exposed infants met criteria for coverage (66%; 95% CI: 56, 74), followed by Zambia (219 of 444, 49%; 95% CI: 45, 54), then South Africa (152 of 365, 42%; 95% CI: 37, 47), and then Côte D'Ivoire (3 of 53, 5.7%; 95% CI: 1.2, 16). In a cluster-level analysis, community PMTCT coverage was highly correlated with facility PMTCT coverage (Pearson's r  = 0.85), and moderately correlated with 24-mo HIV-free survival (Pearson's r  = 0.29). In 14 of 16 instances where both the facility and community samples were large enough for comparison, the facility-based coverage measure exceeded that observed in the community. CONCLUSIONS: HIV-free survival can be estimated with community surveys and should be incorporated into ongoing country monitoring. Facility-based coverage measures correlate with those derived from community sampling, but may overestimate population coverage. The more complex regimens recommended by the World Health Organization seem to have measurable public health benefit at the population level, but power was limited and additional field validation is needed. Please see later in the article for the Editors' Summary en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLOS Medicince en_ZA
dc.source.uri http://journals.plos.org/plosmedicine en_ZA
dc.subject.other Infants en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Children en_ZA
dc.subject.other Pregnancy en_ZA
dc.title Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2013 Stringer et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Stringer, J. S. A., Stinson, K., Tih, P. M., Giganti, M. J., Ekouevi, D. K., Creek, T. L., ... Shaffer, N. (2013). Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries. <i>PLOS Medicince</i>, http://hdl.handle.net/11427/14985 en_ZA
dc.identifier.chicagocitation Stringer, Jeffrey S A, Kathryn Stinson, Pius M Tih, Mark J Giganti, Didier K Ekouevi, Tracy L Creek, Thomas K Welty, Benjamin H Chi, Catherine M Wilfert, and Nathan Shaffer "Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries." <i>PLOS Medicince</i> (2013) http://hdl.handle.net/11427/14985 en_ZA
dc.identifier.vancouvercitation Stringer JSA, Stinson K, Tih PM, Giganti MJ, Ekouevi DK, Creek TL, et al. Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries. PLOS Medicince. 2013; http://hdl.handle.net/11427/14985. en_ZA
dc.identifier.ris TY - Journal Article AU - Stringer, Jeffrey S A AU - Stinson, Kathryn AU - Tih, Pius M AU - Giganti, Mark J AU - Ekouevi, Didier K AU - Creek, Tracy L AU - Welty, Thomas K AU - Chi, Benjamin H AU - Wilfert, Catherine M AU - Shaffer, Nathan AB - BACKGROUND: Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children ≤24 mo of age in Cameroon, Côte D'Ivoire, South Africa, and Zambia. Methods and FINDINGS: We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo. We tested consenting mothers with rapid HIV antibody tests and tested the children of seropositive mothers with HIV DNA PCR or rapid antibody tests. Our primary outcome was 24-mo HIV-free survival, estimated with survival analysis. In an individual-level analysis, we evaluated the effectiveness of various PMTCT regimens. In a community-level analysis, we evaluated the relationship between HIV-free survival and community PMTCT coverage (the proportion of HIV-exposed infants in each community that received any PMTCT intervention during gestation or breastfeeding). We also compared our community coverage results to those of a contemporaneous study conducted in the facilities serving each sampled community. Of 7,985 surveyed children under 2 y of age, 1,014 (12.7%) were HIV-exposed. Of these, 110 (10.9%) were HIV-infected, 851 (83.9%) were HIV-uninfected, and 53 (5.2%) were dead. HIV-free survival at 24 mo of age among all HIV-exposed children was 79.7% (95% CI: 76.4, 82.6) overall, with the following country-level estimates: Cameroon (72.6%; 95% CI: 62.3, 80.5), South Africa (77.7%; 95% CI: 72.5, 82.1), Zambia (83.1%; 95% CI: 78.4, 86.8), and Côte D'Ivoire (84.4%; 95% CI: 70.0, 92.2). In adjusted analyses, the risk of death or HIV infection was non-significantly lower in children whose mothers received a more complex regimen of either two or three antiretroviral drugs compared to those receiving no prophylaxis (adjusted hazard ratio: 0.60; 95% CI: 0.34, 1.06). Risk of death was not different for children whose mothers received a more complex regimen compared to those given single-dose nevirapine (adjusted hazard ratio: 0.88; 95% CI: 0.45, 1.72). Community PMTCT coverage was highest in Cameroon, where 75 of 114 HIV-exposed infants met criteria for coverage (66%; 95% CI: 56, 74), followed by Zambia (219 of 444, 49%; 95% CI: 45, 54), then South Africa (152 of 365, 42%; 95% CI: 37, 47), and then Côte D'Ivoire (3 of 53, 5.7%; 95% CI: 1.2, 16). In a cluster-level analysis, community PMTCT coverage was highly correlated with facility PMTCT coverage (Pearson's r  = 0.85), and moderately correlated with 24-mo HIV-free survival (Pearson's r  = 0.29). In 14 of 16 instances where both the facility and community samples were large enough for comparison, the facility-based coverage measure exceeded that observed in the community. CONCLUSIONS: HIV-free survival can be estimated with community surveys and should be incorporated into ongoing country monitoring. Facility-based coverage measures correlate with those derived from community sampling, but may overestimate population coverage. The more complex regimens recommended by the World Health Organization seem to have measurable public health benefit at the population level, but power was limited and additional field validation is needed. Please see later in the article for the Editors' Summary DA - 2013 DB - OpenUCT DO - 10.1371/journal.pmed.1001424 DP - University of Cape Town J1 - PLOS Medicince LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries TI - Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries UR - http://hdl.handle.net/11427/14985 ER - en_ZA


Files in this item

This item appears in the following Collection(s)

Show simple item record

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.