Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

Pregnant women’s retention and associated health facility characteristics in the prevention of mother-to-child HIV transmission in Indonesia: cross-sectional study

ObjectivesDespite the national effort to integrate the Prevention of Mother-to-Child Transmission (PMTCT) programme into antenatal care clinics in Indonesia, the rate of mother-to-child HIV transmission remains high. This national study was conducted to describe PMTCT programme performance and to identify health facility characteristics associated with this performance in order to inform programme planning and policy development.DesignA retrospective cross-sectional study in December 2017.SettingAll health facilities providing PMTCT programmes in Indonesia.ParticipantsAll health facilities registering at least one woman in antenatal care in 2017.InterventionPMTCT data extraction from the national reporting system on HIV/AIDS and government reports.OutcomesWomen retention in the PMTCT programme for at least 3 months and associated health facility characteristics.ResultsA total of 373 health facilities registering 6502 HIV-positive women in antenatal care were included in the analysis. One-third of women (2099) never started antiretroviral treatment. Of the 4403 women who started, 2610 (57%) were retained; 462 (10%) were not retained; and the retention status of 1252 (28%) women referred out of the health facilities was unknown. Compared with primary health centres, hospitals were more likely to retain women (OR=2.88, 95% CI 2.19 to 3.79). The odds of retention were higher in hospital types A and B (OR=3.89, 95% CI 3.19 to 4.76), located within concentrated HIV epidemic areas (OR=2.09, 95% CI 1.83 to 2.38) and a high-priority area for the HIV programme (OR=1.83, 95% CI 1.60 to 2.09). We observed no differential retention between women who initiated PMTCT under different options (B+/non-B+).ConclusionsWe observed low retention of HIV-positive pregnant women in the PMTCT programme in Indonesia in 2017. Additional efforts are needed to improve women’s retention in the PMTCT programme. Retention could be increased through the delivery of PMTCT programmes by replicating strategies implemented at hospital types A and B located in concentrated HIV epidemic areas where an HIV programme is a high priority.

Modifiable factors within the prevention of mother-to-child transmission programme associated with failure to prevent HIV transmission in the Onandjokwe district of Namibia

Background: Ending new paediatric HIV infections continues to be a global health priority. Cuba and other countries have demonstrated that elimination of mother-to-child transmission is possible through Prevention of Mother-to-Child Transmission (PMTCT) interventions. As Namibia works on improving PMTCT there is a need to identify the local modifiable factors to achieve zero new HIV infections.Aim: This study aimed to identify the modifiable factors within the PMTCT programme, which contributed to the acquisition of HIV infection among children.Setting: The study was carried out in the Onandjokwe District, Northern Namibia.Methods: A descriptive audit was undertaken of 59 medical records of mothers and their children under two years, who acquired HIV despite the PMTCT programme between 2014 and 2016.Results: The study found that overall HIV transmission was only 2%, but 80% of the paediatric HIV infections could be prevented by implementing the existing Namibian PMTCT recommendations. Overall 61% of modifiable factors were related to mothers, 30% to health workers and 10% to the health system. The top three modifiable factors were the mother defaulting on ART during pregnancy or breastfeeding, the health worker not intervening when the mother failed the first-line ART regimen, and poor coordination of care between the hospital and primary care.Conclusion: Although overall transmission is low with the PMTCT programme, the majority of remaining HIV infections among children under two years could be prevented by addressing the modifiable factors identified in this study.

Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho

Background: The balance between the risks of transmission of human immunodeficiency virus (HIV) through breastfeeding and its life-saving benefits complicates decisions about infant feeding among HIV-positive mothers in the first 6 months.Objective: The aim of this study was to assess the knowledge, attitude and practice of infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission services in Maseru, Lesotho.Method and setting: This observational cross-sectional study was done by collecting data from HIV-positive mothers attending the filter clinics of Queen Mamohato Memorial hospital in Maseru, Lesotho. HIV-positive mothers with infants below the age of 6 months attending the clinics at the time of the study were interviewed using a standardised questionnaire. We described the sociodemographic profile of the mothers, the information and education received on prevention of mother-to-child transmission (PMTCT) infant feeding options, the mothers’ knowledge, attitudes and practices of infant feeding, and assessed risk factors for improved knowledge, attitudes and practices. Results: The majority (96%) of the 191 HIV-positive mothers who participated in the survey knew about the PMTCT programme and related breastfeeding services. Most of the participants chose to breastfeed (89%), while only 8% formula-fed their infants. Knowledge received during the PMTCT programme was significantly associated with the decision to exclusively breastfeed their infants. Earlier infant feeding counselling and education was associated with more exclusively breastfeeding as compared to late infant feeding counselling (p < 0.001). Conclusion: The study found that HIV-positive mothers attending health clinics in Maseru, Lesotho, had high knowledge, and appropriate attitudes and practices with respect to infant feeding; and that early counselling and education improved infant feeding methods among these mothers.

HIV testing among male partners of pregnant women in Nigeria: a missing link in the elimination of mother-to-child transmission of HIV

In this study, we assessed male partner testing and the serodiscordance rate among pregnant women and their partners in the prevention of mother-to-child transmission (PMTCT) programme in Nigeria. We conducted a retrospective analysis of the consolidated national health sector PMTCT data over a five-year period (2012–2016). Over the period, a total of 11,833,062 pregnant women were tested for HIV with a positivity rate of 2.2%. About 266,188 (2.2%) of sexual partners of pregnant women who presented at PMTCT clinics had an HIV test within the period. The uptake of male partner testing varied across the years, ranging from 22,269 (1.7%) in 2012 to 90,603 (2.9%) in 2014 (χ2 for trend = 1320; p < 0.001). Overall, the proportion of partners of HIV-negative pregnant women who tested was higher than the proportion of partners of HIV-positive pregnant women (81% versus 19%, respectively). The serodiscordance rate among partners who tested over the five-year period was 18%. The serodiscordance rate declined from 24% in 2012 to 13% in 2016 (χ2 for trend = 1202; p < 0.001). Partner testing in the PMTCT programme in Nigeria has remained low in the last five years while the clinic-based serodiscordance rate among partners appears to be declining. There is a need for multilevel interventions to address the possible barriers to partner testing in the PMTCT programme and intensification of the HIV combination prevention approach in the HIV response.