Early infant HIV-1 diagnosis programs in resource-limited settings: opportunities for improved outcomes and more cost-effective interventions

Early infant diagnosis (EID) of HIV-1 infection confers substantial benefits to HIV-infected and HIV-uninfected infants, to their families, and to programs providing prevention of mother-to-child transmission (PMTCT) services, but has been challenging to implement in resource-limited settings. In order to correctly inform parents/caregivers of infant infection status and link HIV-infected infants to care and treatment, a 'cascade' of events must successfully occur. A frequently cited barrier to expansion of EID programs is the cost of the required laboratory assays. However, substantial implementation barriers, as well as personnel and infrastructure requirements, exist at each step in the cascade. In this update, we review challenges to uptake at each step in the EID cascade, highlighting that even with the highest reported levels of uptake, nearly half of HIV-infected infants may not complete the cascade successfully. We next synthesize the available literature about the costs and cost effectiveness of EID programs; identify areas for future research; and place these findings within the context of the benefits and challenges to EID implementation in resource-limited settings

Factors associated with the lack of antiretroviral therapy initiation among eligible HIVpositive pregnant women in Swaziland

Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV.Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland.Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables.Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation.Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented

Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

BACKGROUND. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. OBJECTIVES. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. METHODS. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. RESULTS. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation. CONCLUSION. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implementedSchool of Health Systems and Public Health, University of Pretoria, Pretoria, South Africahttp://sajog.org.za/index.php/SAJOGhttp://www.journals.co.za/content/journalam2017School of Health Systems and Public Health (SHSPH