Peer-reviewed article
976. A Descriptive Retrospective Data Analysis of Maternal Sociodemographic Factors and Access of Healthcare Resources within the African Cohort Study, an Integrated Multicountry Preventative Mother to Child Transmission Program
Traver J, Esber A, Dear N, Polston E, Iroezindu M et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed 5,591 pregnancies from HIV-infected women across 5 African regions participating in a prevention of mother-to-child transmission (PMTCT) program. Women who were followed prospectively during the study had much higher access to PMTCT services, skilled birth attendance, and antiretroviral therapy (ART) compared to those whose pregnancies were only reported retrospectively. High ART adherence was associated with significant reductions in preterm delivery and infant mortality. The findings demonstrate that linkage to care is crucial for preventing mother-to-child transmission of HIV in resource-limited settings.
Key points
- Prospectively followed pregnancies had 92.5% linkage to PMTCT services prenatally versus 6.8% for retrospectively reported pregnancies
- Skilled birth attendance was 93.4% in the prospective group compared to 66.7% in the retrospective group
- ART adherence (96.5%) was associated with a 76% reduction in preterm delivery and infant mortality (adjusted OR 0.24)
- 51.8% of infants in the prospective group received ART with good adherence compared to 0.3% in the retrospective group
- Both groups had similar rates of intrapartum ART prescription (98.7% vs 97.9%), suggesting better prenatal and postnatal care gaps
Limitations
The study is limited by a low number of prospectively followed pregnancies (228 of 5,591) relative to retrospectively reported ones, which may not fully represent ongoing program effectiveness. The retrospective design for most pregnancies introduces recall bias and may not capture the full complexity of barriers to accessing PMTCT services.
Abstract
Abstract Background Global reduction in new infant HIV infections is largely due to the expansion of prevention of mother-to-child transmission (PMTCT) programs. Identification of gaps in healthcare services is paramount in targeting interventions that identify high-risk populations and healthcare barriers that could lead to increased risk of mother to child transmission (MTCT) of HIV. Methods HIV infected women from 5 regions of Africa enrolled in the African Cohort Study (AFRICOS) were followed prospectively with assessments performed every 6 months. Sociodemographic factors, pregnancy outcomes, and access of PMTCT resources were reviewed for retrospectively reported pregnancies and those followed prospectively from study enrollment. Statistical analysis compared the impact of clinical factors on infant mortality and preterm delivery. Results The study reported 5591 pregnancies from January 2013 to June 2019 of which 5363 were retrospectively reported prior to study enrollment and 228 occurred after enrollment. Pregnancies followed prospectively had higher rates of linkage to PMTCT services prenatally (92.5% vs 6.8%, P< 0.001), intrapartum (64.5% vs 3.5%, P< 0.001), and post-partum (64.5% vs 2.9%, P< 0.001). This group had higher rates of delivery by a skilled birth attendant (93.4% vs 66.7%, P< 0.001) and antiretroviral therapy (ART) prescribed antepartum (96.1% vs 5.5%, P< 0.001) and post-partum (74.6% vs 3.6%, P< 0.001). Both groups had similar rates of prescriptions for intrapartum ART (98.7% vs 97.9%). The majority of women reported ART adherence (96.5%, P< 0.001) which was associated with a decrease in both preterm delivery and infant mortality (adjusted OR 0.24, 95% CI 0.15-0.39). A significant proportion of women followed prospectively reported their infants received ART with good adherence (51.8% vs 0.3% and 93.4% vs 6.3%, respectively P< 0.001). Conclusion Participation in AFRICOS increased linkage to PMTCT programs which resulted in increased likelihood of skilled delivery and appropriate ART use for women and their infants. It highlights that linkage to care continues to be a crucial factor in limiting MTCT of HIV especially in resource-limited settings. Limitations in this study exist due to the low number of prospectively followed pregnancies. Disclosures All Authors: No reported disclosures
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Participation in the African Cohort Study (AFRICOS), an integrated multicountry preventative PMTCT program providing prospective follow-up, linkage to PMTCT services, and monitoring of pregnant women living with HIV and their infants