Assessment of the utilization of prevention of mother-to-child transmission of HIV services and health outcomes of infants born to HIV positive mothers in Greater Accra Region, Ghana Vera Opata, Fred N. Binka, Priscilla A. Nortey, Jon O. Gypong School of Public Health, Department of Epidemiology and Disease Control, College of Health Science, University of Ghana, Legon

Presentation outline Background Objectives Methods Results Conclusions

Background - PMTCT of HIV: Ghana’s situation second most common mode of transmission of HIV Contributed up to 15% to all new HIV infections PMTCT interventions Countrywide implementation of PMTCT services from 2003 Changing recommendations: year 2003, 2008, 2010, 2014…. Availability of PMTCT services Services available Staff trained

Need for the study What is the situation regarding the utilization of PMTCT services and survival of HIV exposed infants?

Objective of the study To evaluate the effectiveness of key PMTCT interventions in the context of its effectiveness in reducing new pediatric HIV infections Determine probability of the 12 months HIV-free survival of exposed infants Identify risk factors for HIV positivity in exposed infants Document loss to follow up

Methodology 8 study sites across the GAR region Observational cohort study 580 HIV infected pregnant women enrolled and later their live born infants prospectively followed till 12 months postnatal

Methodology ct. Data source Analysis record review interviews assessment of infants Analysis Kaplan-Meier survival analysis Cox regression model Descriptive statistics

Findings

Findings: HIV-free infant survival 1 mt – 97.37% 2 mt– 95.87% 6 mt – 94.03% 12 mt – 90.58% Figure 1. Kaplan-Meier probability of infant’s HIV-free survival by age

Findings: HIV-free infant survival ct. Complete – 96.59% Incomplete – 82.97% None – 80.61% Figure 2. Kaplan-Meier cumulative probabilities of infant HIV-free survival by 12 months of age adjusted by mothers ARVs received

Findings: Risk factors Risk factors for infant’s HIV positivity Mothers non-receipt of ARVs by mothers incomplete use of ARVs by mothers Infants non-receipt of ARV prophylaxis by newborns

Findings: MTCT rates MTCT rates Cumulative MTCT in the cohort by 12 months: 5.54% Grouped by use of ARVs Received complete course of ARVs: 1.4% Received incomplete course of ARVs: 10.2% Received no ARVs: 14.6%

Findings: Loss to follow up Out of the cohort of 580 HIV positive mothers enrolled in PMTCT, the cumulative loss to follow up was as follow: 76 (13.10%, CI: 10.34 – 15.85) during antenatal period 147 (26.01%, CI: 22.38 – 29.64) by 6 weeks postnatal 188 (33.27%, CI: 29.37 – 37.17) by 12 months postnatal

Conclusion Timely initiation and recommended use of ARVs is directly linked to better HIV-free infant survival High Loss to follow up that was documented in this study can have serious implication for the programme and negatively affect HIV-free child survival

Recommendations Addressing Loss to follow up Need for development of tracking system which will improve identification and follow-up of clients along continuum of care Addressing compliance with guidelines Regular re-fresher training of staff Use of lay HIV counselors and peer educators

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