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

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dc.contributor.authorStringer, Jeffrey S Aen_ZA
dc.contributor.authorStinson, Kathrynen_ZA
dc.contributor.authorTih, Pius Men_ZA
dc.contributor.authorGiganti, Mark Jen_ZA
dc.contributor.authorEkouevi, Didier Ken_ZA
dc.contributor.authorCreek, Tracy Len_ZA
dc.contributor.authorWelty, Thomas Ken_ZA
dc.contributor.authorChi, Benjamin Hen_ZA
dc.contributor.authorWilfert, Catherine Men_ZA
dc.contributor.authorShaffer, Nathanen_ZA
dc.date.accessioned2015-11-16T04:08:02Z
dc.date.available2015-11-16T04:08:02Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: 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' Summaryen_ZA
dc.identifier.apacitationStringer, 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/11427/14985en_ZA
dc.identifier.chicagocitationStringer, 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/11427/14985en_ZA
dc.identifier.citationStringer, 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.1001424en_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
dc.identifier.urihttp://hdl.handle.net/11427/14985
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pmed.1001424
dc.identifier.vancouvercitationStringer 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2013 Stringer et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLOS Medicinceen_ZA
dc.source.urihttp://journals.plos.org/plosmedicineen_ZA
dc.subject.otherInfantsen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherPregnancyen_ZA
dc.titleMeasuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countriesen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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