2. 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

3. Presentation outline
Background
Objectives
Methods
Results
Conclusions

4. 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

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

6. 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

7. 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

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

9. Findings

10. 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

11. Findings: HIV-free infant survival ct.
Complete – %
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

12. 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

13. 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%

14. 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: – 15.85) during antenatal period
147 (26.01%, CI: – 29.64) by 6 weeks postnatal
188 (33.27%, CI: – 37.17) by 12 months postnatal

15. 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

16. 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

17. Thank you for listening.