Laura Fuente-Soro1,2,3, Sheila Fernández-Luis4,5, Elisa López-Varela4,5, Orvalho Augusto4, Tacilta Nhampossa4,6, Ariel Nhacolo4, Edson Bernardo7,8, Blanca Burgueño5, Bernadette Ngeno9, Aleny Couto10, Helga Guambe10, Kwalila Tibana10, Marilena Urso11, Denise Naniche4,5. 1. Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. laura.delafuente@isglobal.org. 2. Barcelona Institute for Global Health, Barcelona, Spain. laura.delafuente@isglobal.org. 3. ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain. laura.delafuente@isglobal.org. 4. Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. 5. Barcelona Institute for Global Health, Barcelona, Spain. 6. Instituto Nacional de Saúde, Maputo, Mozambique. 7. Manhiça District Health Services, Maputo, Mozambique. 8. Vanderbilt Institute for Global Health, Nashville, Tennessee, USA. 9. Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA. 10. Ministério da Saúde de Moçambique, Maputo, Mozambique. 11. Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.
Abstract
BACKGROUND: Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. METHODS: A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017-April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. RESULTS: Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8-39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1-5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. CONCLUSIONS: In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.
BACKGROUND: Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. METHODS: A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017-April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. RESULTS: Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8-39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1-5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative childmortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. CONCLUSIONS: In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Carol S Camlin; Alison M El Ayadi; Zachary A Kwena; Willi McFarland; Mallory O Johnson; Torsten B Neilands; Elizabeth A Bukusi; Craig R Cohen Journal: J Acquir Immune Defic Syndr Date: 2017-04-15 Impact factor: 3.731
Authors: Sheree R Schwartz; Kate Clouse; Nompumelelo Yende; Annelies Van Rie; Jean Bassett; Mamothe Ratshefola; Audrey Pettifor Journal: Matern Child Health J Date: 2015-09
Authors: Alison L Drake; Kerry A Thomson; Caitlin Quinn; Morkor Newman Owiredu; Innocent B Nuwagira; Lastone Chitembo; Shaffiq Essajee; Rachel Baggaley; Cheryl C Johnson Journal: J Int AIDS Soc Date: 2019-04 Impact factor: 5.396
Authors: Avina Sarna; Lopamudra Ray Saraswati; Jerry Okal; James Matheka; Danmark Owuor; Roopal J Singh; Nancy Reynolds; Sam Kalibala Journal: Glob Health Sci Pract Date: 2019-06-27
Authors: Jessie K Edwards; Peter Arimi; Freddie Ssengooba; Grace Mulholland; Milissa Markiewicz; Elizabeth A Bukusi; Judy T Orikiiriza; Arti Virkud; Sharon Weir Journal: J Int AIDS Soc Date: 2019-01 Impact factor: 5.396