TY - JOUR
T1 - Modeling the impact of retention interventions on mother-to-child transmission of HIV
T2 - Results from INSPIRE studies in Malawi, Nigeria, and Zimbabwe
AU - McCarthy, Elizabeth
AU - Joseph, Jessica
AU - Foster, Geoff
AU - Mangwiro, Alexio Zambezio
AU - Mwapasa, Victor
AU - Oyeledun, Bolanle
AU - Phiri, Sam
AU - Sam-Agudu, Nadia A.
AU - Essajee, Shaffiq
N1 - Publisher Copyright:
© Copyright 2017 Wolters Kluwer Health, Inc.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Background: Six implementation research studies in Malawi, Nigeria, and Zimbabwe tested approaches for improving retention in care among women living with HIV. We simulated the impact of their interventions on the probability of HIV transmission during pregnancy and breastfeeding. Methods: A computer-based state-transition model was developed to estimate the impact of the retention interventions. Patient-level data from the 6 studies were aggregated and analyzed, and weighted averages of mother-to-child transmission (MTCT) of HIV probabilities were presented. The average MTCT probability of the more successful interventions was applied to national estimates to calculate potential infections averted if these interventions were taken to scale. Results: Among the total cohort of 5742 HIV-positive women, almost 80% of all infant infections are attributed to the roughly 20% of HIV-positive pregnant and breastfeeding women not retained on antiretroviral therapy. Higher retention in the arms receiving interventions resulted in an overall lower estimated MTCT probability of 9.9% compared with 12.3% in the control arms. In the 2 studies that showed a statistically significant effect, Prevention of MTCT Uptake and Retention (PURE) and Mother Mentor (MoMent), the difference in transmission rates between intervention and control arms was 4.1% and 7.3%, respectively. Scaling up retention interventions nationally in the 3 countries could avert an average of almost 3000 infant infections annually. Conclusions: Linking HIV-positive pregnant women to antiretroviral therapy and retaining them is essential for addressing the remaining gaps and challenges in HIV/AIDS care and the elimination of MTCT. At national level, even modest improvements in retention translates into large numbers of infant infections averted.
AB - Background: Six implementation research studies in Malawi, Nigeria, and Zimbabwe tested approaches for improving retention in care among women living with HIV. We simulated the impact of their interventions on the probability of HIV transmission during pregnancy and breastfeeding. Methods: A computer-based state-transition model was developed to estimate the impact of the retention interventions. Patient-level data from the 6 studies were aggregated and analyzed, and weighted averages of mother-to-child transmission (MTCT) of HIV probabilities were presented. The average MTCT probability of the more successful interventions was applied to national estimates to calculate potential infections averted if these interventions were taken to scale. Results: Among the total cohort of 5742 HIV-positive women, almost 80% of all infant infections are attributed to the roughly 20% of HIV-positive pregnant and breastfeeding women not retained on antiretroviral therapy. Higher retention in the arms receiving interventions resulted in an overall lower estimated MTCT probability of 9.9% compared with 12.3% in the control arms. In the 2 studies that showed a statistically significant effect, Prevention of MTCT Uptake and Retention (PURE) and Mother Mentor (MoMent), the difference in transmission rates between intervention and control arms was 4.1% and 7.3%, respectively. Scaling up retention interventions nationally in the 3 countries could avert an average of almost 3000 infant infections annually. Conclusions: Linking HIV-positive pregnant women to antiretroviral therapy and retaining them is essential for addressing the remaining gaps and challenges in HIV/AIDS care and the elimination of MTCT. At national level, even modest improvements in retention translates into large numbers of infant infections averted.
KW - Africa
KW - HIV
KW - Implementation science
KW - Mathematical modeling
KW - PMTCT
KW - Retention
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U2 - 10.1097/QAI.0000000000001364
DO - 10.1097/QAI.0000000000001364
M3 - Article
C2 - 28498194
AN - SCOPUS:85020423708
SN - 1525-4135
VL - 75
SP - S233-S239
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
ER -