Level and predictors of receiving essential mother-infant PMTCT services in Tanzania: maternal ART adherence, infant ARV prophylaxis and early diagnosis
Background: Full PMTCT service adherence,
including maternal ART, HIV-exposed infant (HEI) nevirapine (NVP) dosing, and
early infant diagnosis (EID), is not routinely measured in Tanzania''s PMTCT program.
This secondary cohort analysis from 27 PMTCT clinics describes the level and
predictors of full PMTCT adherence.
Methods: The
Supporting Attendance for Facility Delivery and Infant Health study recruited HIV-positive
pregnant women, administering interviews at
enrollment and 12-weeks postpartum, with medical-record-abstraction of outcomes. Mother-infant PMTCT adherence--defined as maternal ARV
adherence (zero self-reported missed ARV doses in past seven days and not
missing two consecutive days of ARV dosing in past six months) HEI NVP birth/6-week
dosing, and EID--is described among 584 women-infant pairs. Generalized-estimating-equation
regression methods were used to predict PMTCT adherence, adjusting for age,
education and site cluster. Hypothesized predictors included
known/new HIV-positive, phone access/contact with health providers, ART/MTCT
knowledge, facility delivery and clinic volume.
Results: Among HEI overall, 75%
received the full NVP regimen; and 70% received both NVP and EID. Maternal ART
adherence was 83%, and predicted receipt of HEI services. Eighty-one percent of
ART-adherent mothers'' HEI received NVP and EID compared to only 51% of
non-adherent mothers (p< .0001). Overall, 67% of mother-infant pairs were PMTCT
adherent.
Factors
reducing PMTCT adherence were pre-ART status compared to women on ART before
pregnancy (known-positive, pre-ART: adjusted odds ratio [AOR] 0.28,p< .0001; newly
diagnosed HIV-positive, pre-ART: AOR 0.25,p< .0001); and loss of mobile phone
access (AOR 0.48,p=.006) compared to maintaining access from baseline to
follow-up. Factors positively associated with PMTCT adherence included knowing
that ARVs reduce MTCT risk (AOR 3.18,p< .0001), delivering in a facility (AOR
2.90,p< .0001), having phone contact with a health provider (AOR 2.33,p< .0001),
and attending a low-volume ANC facility compared to a high-volume ANC (AOR 5.28,p< .0001;
< 90 new patients/quarter vs. >=200).
Conclusions: Increased client-provider
interaction may improve PMTCT adherence through promoting ART/PMTCT knowledge
and access to facility delivery. Special attention should be focused on newly diagnosed
and newly ART-initiated. Facilitating provider-client communication using
mobile phones may enhance effectiveness of PMTCT service models. Further
investigation is needed to understand why lower volume ANC clinics are associated
with better adherence.
G. Antelman1, G. Mbita2, T. Machalo2, A. Maijo2, P. Njau3, J. van 't Pad Bosch2, R. van de Ven2, G. Woelk4
1Elizabeth Glaser Pediatric AIDS Foundation, Strategic Information and Evaluation, Dar es Salaam, Tanzania, United Republic of, 2Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania, United Republic of, 3Ministry of Health, Community Development, Gender, Elderly and Children, PMTCT Unit, Dar es Salaam, Tanzania, United Republic of, 4Elizabeth Glaser Pediatric AIDS Foundation, Washington, United States