1. Supporting Option B+ scale up and strengthening the prevention of mother-to-child transmission cascade in central Malawi: results from a serial cross-sectional study
- Author
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Charles van der Horst, Michael E Herce, Gerald Tegha, Eva Stein, Jacqueline Chinkonde, Tiwonge Mtande, Wiza Kumwenda, Francis Martinson, Frank Chimbwandira, Kathy E. Lancaster, Christine Chingondole, Innocent Mofolo, Nora E. Rosenberg, Irving F. Hoffman, Esmie Kamanga, and Mina C. Hosseinipour
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Malawi ,Nevirapine ,Cross-sectional study ,030231 tropical medicine ,Population ,Breastfeeding ,HIV Infections ,Prenatal care ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Interquartile range ,Pregnancy ,Antiretroviral Therapy, Highly Active ,medicine ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,10. No inequality ,education ,education.field_of_study ,business.industry ,Postpartum Period ,1. No poverty ,Infant, Newborn ,Infant ,Prenatal Care ,Infectious Disease Transmission, Vertical ,3. Good health ,Infectious Diseases ,Breast Feeding ,Cross-Sectional Studies ,Early Diagnosis ,Female ,business ,Post-Exposure Prophylaxis ,Breast feeding ,Postpartum period ,medicine.drug ,Research Article ,Program Evaluation - Abstract
Background We established Safeguard the Family (STF) to support Ministry of Health (MoH) scale-up of universal antiretroviral therapy (ART) for HIV-infected pregnant and breastfeeding women (Option B+) and to strengthen the prevention of mother-to-child transmission (PMTCT) cascade from HIV testing and counseling (HTC) through maternal ART provision and post-delivery early infant HIV diagnosis (EID). To these ends, we implemented the following interventions in 5 districts: 1) health worker training and mentorship; 2) couples’ HTC and male partner involvement; 3) women’s psychosocial support groups; and 4) health and laboratory system strengthening for EID. Methods We conducted a serial cross-sectional study using facility-level quarterly (Q) program data and individual-level infant HIV-1 DNA PCR data to evaluate STF performance on PMTCT indicators for project years (Y) 1 (April—December 2011) through 3 (January—December 2013), and compared these results to national averages. Results Facility-level uptake of HTC, ART, infant nevirapine prophylaxis, and infant DNA PCR testing increased significantly from quarterly baselines of 66 % (n/N = 32,433/48,804), 23 % (n/N = 442/1,958), 1 % (n/N = 10/1,958), and 52 % (n/N = 1,385/2,644) to 87 % (n/N = 39,458/45,324), 96 % (n/N = 2,046/2,121), 100 % (n/N = 2,121/2,121), and 62 % (n/N = 1,462/2,340), respectively, by project end (all p
- Published
- 2015