BACKGROUND: Uganda was one of the first countries in sub-Saharan Africa to implement Option B+ as its national strategy for prevention-of-mother-to-child transmission (PMTCT) of HIV, doing so in 2013. We report on two evaluations designed to assess the capacity of the health care system to implement Option B+, and to obtain preliminary information on the maternal-to-child-transmission rate of HIV. METHODS: We performed: 1) a cross-sectional assessment in 2014 of 505 health care facilities (49 district hospitals, 83 Health Center [HC] IVs, and 373 HCIIIs) in 62 of Uganda's 112 districts to evaluate whether services and commodities required for Option B+ were being provided; and 2) a retrospective record review of 283 HIV-exposed infants enrolled in post-natal care in 2013 in the Central Region to evaluate infant outcomes at 18-months of age. RESULTS: Less than 50% of HCIIIs performed routine diagnostics, including syphilis, hemoglobin, and urinalysis testing, required at all ante-natal clinics; almost all facilities performed a baseline CD4 cell count, but only 44.5% of HCIIIs and 60.2% of HCIVs performed follow-up testing. The proportion of facilities monitoring antiretroviral therapy (ART) (47.2-69.4%) and clinic adherence (50.0-67.3%) was low. Many facilities (20.4-45.8%) reported stock-outs of ART and HIV test kits in the prior month. At 18 months, 53.7% of HIV-exposed infants were lost to follow-up (LTFU). Among those retained, 6.5% were HIV infected. CONCLUSION: Significant shortcomings in service provision and high LTFU of HIV-exposed infants are barriers to Uganda's ability to implement Option B+ successfully.
BACKGROUND: Uganda was one of the first countries in sub-Saharan Africa to implement Option B+ as its national strategy for prevention-of-mother-to-child transmission (PMTCT) of HIV, doing so in 2013. We report on two evaluations designed to assess the capacity of the health care system to implement Option B+, and to obtain preliminary information on the maternal-to-child-transmission rate of HIV. METHODS: We performed: 1) a cross-sectional assessment in 2014 of 505 health care facilities (49 district hospitals, 83 Health Center [HC] IVs, and 373 HCIIIs) in 62 of Uganda's 112 districts to evaluate whether services and commodities required for Option B+ were being provided; and 2) a retrospective record review of 283 HIV-exposed infants enrolled in post-natal care in 2013 in the Central Region to evaluate infant outcomes at 18-months of age. RESULTS: Less than 50% of HCIIIs performed routine diagnostics, including syphilis, hemoglobin, and urinalysis testing, required at all ante-natal clinics; almost all facilities performed a baseline CD4 cell count, but only 44.5% of HCIIIs and 60.2% of HCIVs performed follow-up testing. The proportion of facilities monitoring antiretroviral therapy (ART) (47.2-69.4%) and clinic adherence (50.0-67.3%) was low. Many facilities (20.4-45.8%) reported stock-outs of ART and HIV test kits in the prior month. At 18 months, 53.7% of HIV-exposed infants were lost to follow-up (LTFU). Among those retained, 6.5% were HIV infected. CONCLUSION: Significant shortcomings in service provision and high LTFU of HIV-exposed infants are barriers to Uganda's ability to implement Option B+ successfully.
Authors: Edward M Gardner; Shweta Sharma; Grace Peng; Katherine Huppler Hullsiek; William J Burman; Rodger D Macarthur; Margaret Chesney; Edward E Telzak; Gerald Friedland; Sharon B Mannheimer Journal: AIDS Date: 2008-01-02 Impact factor: 4.177
Authors: Alan R Lifson; Sale Workneh; Abera Hailemichael; Workneh Demisse; Lucy Slater; Tibebe Shenie Journal: J Int Assoc Provid AIDS Care Date: 2016-07-08
Authors: Rose Naigino; Fredrick Makumbi; Aggrey Mukose; Esther Buregyeya; Jim Arinaitwe; Joshua Musinguzi; Susan M Kiene; Rhoda K Wanyenze Journal: AIDS Behav Date: 2021-10-29
Authors: Aggrey David Mukose; Hilde Bastiaens; Esther Buregyeya; Rose Naigino; Fredrick Makumbi; Joshua Musinguzi; Jean-Pierre Van Geertruyden; Rhoda K Wanyenze Journal: J Int Assoc Provid AIDS Care Date: 2019 Jan-Dec