Author:
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Gamell, Anna; Glass, Tracy R.; Luwanda, Lameck B.; Mapesi, Herry; Samson, Leila; Mtoi, Tom; Nyamtema, Angelo; Muri, Lukas; Ntamatungiro, Alex J.; Tanner, Marcel; Hatz, Christoph; Battegay, Manuel; Letang, Emilio; KIULARCO Study Group
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Abstract:
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BACKGROUND: Strategies to improve HIV diagnosis and linkage into
care, antiretroviral treatment coverage, and treatment outcomes
of mothers and children are urgently needed in sub-Saharan
Africa. METHODS: From December 2012, we implemented an
intervention package to improve prevention of mother-to-child
transmission (PMTCT) and pediatric HIV care in our rural
Tanzanian clinic, consisting of: (1) creation of a PMTCT and
pediatric unit integrated within the reproductive and child
health clinic; (2) implementation of electronic medical records;
(3) provider-initiated HIV testing and counseling in the
hospital wards; and (4) early infant diagnosis test performed
locally. To assess the impact of this strategy, clinical
characteristics and outcomes were compared between the period
before (2008-2012) and during/after the implementation
(2013-2014). RESULTS: After the intervention, the number of
mothers and children enrolled into care almost doubled. Compared
with the pre-intervention period (2008-2012), in 2013-2014,
children presented lower CD4% (16 vs. 16.8, P = 0.08) and more
advanced disease (World Health Organization stage 3/4 72% vs.
35%, P < 0.001). The antiretroviral treatment coverage rose
from 80% to 98% (P < 0.001), the lost-to-follow-up rate
decreased from 20% to 11% (P = 0.002), and mortality
ascertainment improved. During 2013-2014, 261 HIV-exposed
infants were enrolled, and the early mother-to-child
transmission rate among mother-infant pairs accessing PMTCT was
2%. CONCLUSIONS: This strategy resulted in an increased number
of mothers and children diagnosed and linked into care, a higher
detection of children with AIDS, universal treatment coverage,
lower loss to follow-up, and an early mother-to-child
transmission rate below the threshold of elimination. This study
documents a feasible and scalable model for family-centered HIV
care in sub-Saharan Africa. |