AI Article Synopsis
- The study aimed to assess the rates of mother-to-child HIV transmission (MTCT) in Mozambique, targeting under 50 new pediatric infections per 100,000 live births and a transmission rate of less than 5%.
- Conducted through a household survey, it involved 3486 mother-child pairs, revealing a community HIV-prevalence rate of 37.6% among mothers, with adjusted vertical transmission at 4.4% for HIV-exposed children.
- Despite high testing coverage of 96% for HIV-exposed children, early testing was only 69.1%, and the cumulative child mortality rate highlighted significant health challenges, with HIV-related factors contributing to pediatric deaths.
Article 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970736 | PMC |
| http://dx.doi.org/10.1186/s12889-021-10568-4 | DOI Listing |
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