PMID- 26462714
OWN - NLM
STAT- MEDLINE
DCOM- 20160517
LR  - 20181202
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 18
IP  - 1
DP  - 2015
TI  - Tracing defaulters in HIV prevention of mother-to-child transmission programmes 
      through community health workers: results from a rural setting in Zimbabwe.
PG  - 20022
LID - 10.7448/IAS.18.1.20022 [doi]
LID - 20022 [doi]
AB  - INTRODUCTION: High retention in care is paramount to reduce vertical human 
      immunodeficiency virus (HIV) infections in prevention of mother-to-child 
      transmission (PMTCT) programmes but remains low in many sub-Saharan African 
      countries. We aimed to assess the effects of community health worker-based 
      defaulter tracing (CHW-DT) on retention in care and mother-to-child HIV 
      transmission, an innovative approach that has not been evaluated to date. 
      METHODS: We analyzed patient records of 1878 HIV-positive pregnant women and 
      their newborns in a rural PMTCT programme in the Tsholotsho district of Zimbabwe 
      between 2010 and 2013 in a retrospective cohort study. Using binomial regression, 
      we compared vertical HIV transmission rates at six weeks post-partum, and 
      retention rates during the perinatal PMTCT period (at delivery, nevirapine [NVP] 
      initiation at three days post-partum, cotrimoxazole (CTX) initiation at six weeks 
      post-partum, and HIV testing at six weeks post-partum) before and after the 
      introduction of CHW-DT in the project. RESULTS: Median maternal age was 27 years 
      (inter-quartile range [IQR] 23 to 32) and median CD4 count was 394 cells/microL(3) 
      (IQR 257 to 563). The covariate-adjusted rate ratio (aRR) for perinatal HIV 
      transmission was 0.72 (95% confidence intervals [95% CI] 0.27 to 1.96, p=0.504), 
      comparing patient outcomes after and before the intervention. Among fully 
      retained patients, 11 (1.9%) newborns tested HIV positive. ARRs for retention in 
      care were 1.01 (95% CI 0.96 to 1.06, p=0.730) at delivery; 1.35 (95% CI 1.28 to 
      1.42, p<0.001) at NVP initiation; 1.78 (95% CI 1.58 to 2.01, p<0.001) at CTX 
      initiation; and 2.54 (95% CI 2.20 to 2.93, p<0.001) at infant HIV testing. 
      Cumulative retention after and before the intervention was 496 (85.7%) and 1083 
      (87.3%) until delivery; 480 (82.9%) and 1005 (81.0%) until NVP initiation; 303 
      (52.3%) and 517 (41.7%) until CTX initiation; 272 (47.0%) and 427 (34.4%) until 
      infant HIV testing; and 172 (29.7%) and 405 (32.6%) until HIV test result 
      collection. CONCLUSIONS: The CHW-DT intervention did not reduce perinatal HIV 
      transmission significantly. Retention improved moderately during the post-natal 
      period, but cumulative retention decreased rapidly even after the intervention. 
      We showed that transmission in resource-limited settings can be as low as in 
      resource-rich countries if patients are fully retained in care. This requires 
      structural changes to the regular PMTCT services, in which community health 
      workers can, at best, play a complementary role.
FAU - Vogt, Florian
AU  - Vogt F
AD  - Operational Centre Barcelona, Medecins Sans Frontieres/Doctors Without Borders, 
      Barcelona, Spain; florianvogt@hotmail.com.
FAU - Ferreyra, Cecilia
AU  - Ferreyra C
AD  - Operational Centre Barcelona, Medecins Sans Frontieres/Doctors Without Borders, 
      Barcelona, Spain.
FAU - Bernasconi, Andrea
AU  - Bernasconi A
AD  - Operational Centre Barcelona, Medecins Sans Frontieres/Doctors Without Borders, 
      Barcelona, Spain.
FAU - Ncube, Lewis
AU  - Ncube L
AD  - Tsholotsho Project, Medecins Sans Frontieres/Doctors Without Borders, Tsholotsho, 
      Zimbabwe.
FAU - Taziwa, Fabian
AU  - Taziwa F
AD  - Zimbabwe Mission, Medecins Sans Frontieres/Doctors Without Borders, Harare, 
      Zimbabwe.
FAU - Marange, Winnie
AU  - Marange W
AD  - Tsholotsho District Medical Office, Ministry of Health and Child Welfare, 
      Tsholotsho, Zimbabwe.
FAU - Wachi, David
AU  - Wachi D
AD  - Tsholotsho Project, Medecins Sans Frontieres/Doctors Without Borders, Tsholotsho, 
      Zimbabwe.
FAU - Becher, Heiko
AU  - Becher H
AD  - Department of Medical Biometry and Epidemiology, University Medical Centre 
      Hamburg-Eppendorf, Hamburg, Germany.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151012
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
RN  - 99DK7FVK1H (Nevirapine)
SB  - IM
MH  - Adult
MH  - Cohort Studies
MH  - Community Health Workers
MH  - Female
MH  - HIV Infections/*prevention & control
MH  - Humans
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/*prevention & control
MH  - Nevirapine/therapeutic use
MH  - Pregnancy
MH  - Retrospective Studies
MH  - Zimbabwe
PMC - PMC4604210
OTO - NOTNLM
OT  - HIV
OT  - Medecins Sans Frontieres/Doctors Without Borders
OT  - Zimbabwe
OT  - community health workers
OT  - defaulter tracing
OT  - prevention of mother-to-child transmission
OT  - retention in care
OT  - vertical transmission
EDAT- 2015/10/16 06:00
MHDA- 2016/05/18 06:00
PMCR- 2015/10/12
CRDT- 2015/10/15 06:00
PHST- 2015/01/22 00:00 [received]
PHST- 2015/08/29 00:00 [revised]
PHST- 2015/09/08 00:00 [accepted]
PHST- 2015/10/15 06:00 [entrez]
PHST- 2015/10/16 06:00 [pubmed]
PHST- 2016/05/18 06:00 [medline]
PHST- 2015/10/12 00:00 [pmc-release]
AID - 20022 [pii]
AID - 10.7448/IAS.18.1.20022 [doi]
PST - epublish
SO  - J Int AIDS Soc. 2015 Oct 12;18(1):20022. doi: 10.7448/IAS.18.1.20022. eCollection 
      2015.