Factors Associated with PMTCT Cascade Completion in Four African Countries

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health

Background:

• Global efforts are underway to eliminate mother-to-child transmission (MTCT) of HIV.
• Current prevention of mother-to-child HIV transmission (PMTCT) cascade completion rates during and after pregnancy remain low.
• Understanding factors influencing cascade completion is crucial for improving PMTCT strategies.

Purpose of the Study:

• To identify factors associated with the completion of the PMTCT cascade among HIV-infected pregnant women in sub-Saharan Africa.
• To analyze the impact of partner HIV status awareness and timing of HIV diagnosis on PMTCT cascade completion.

Main Methods:

• A cross-sectional survey was conducted in 26 communities across Cameroon, Cote d'Ivoire, South Africa, and Zambia.
• 976 HIV-infected women with a pregnancy within the last two years were enrolled.
• PMTCT cascade completion was defined by antenatal visit, HIV testing, result receipt, maternal prophylaxis, and infant prophylaxis initiation; multivariable logistic regression was used for analysis.

Main Results:

• Only 36.4% (355/976) of HIV-infected women completed the PMTCT cascade.
• Awareness of partner's HIV status was associated with increased cascade completion (aOR 1.4, 95% CI 1.01-2.0).
• Diagnosis of HIV prior to pregnancy was strongly associated with cascade completion compared to diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2-38.6).

Conclusions:

• HIV-infected pregnant women in Africa who knew their partner's HIV status were more likely to complete the PMTCT cascade.
• Women diagnosed with HIV before pregnancy demonstrated significantly higher PMTCT cascade completion rates.
• These findings highlight the importance of partner involvement and early HIV diagnosis for effective PMTCT programs.