Evaluation of person-centered interventions to eliminate perinatal HIV transmission in Kisumu County, Kenya: A repeated cross-sectional study using aggregated registry data.

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-08-15 eCollection Date: 2024-08-01 DOI:10.1371/journal.pmed.1004441
Francesca Odhiambo, Raphael Onyango, Edwin Mulwa, Maurice Aluda, Linda Otieno, Elizabeth A Bukusi, Craig R Cohen, Pamela M Murnane
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Abstract

Background: Following a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time.

Methods and findings: We conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother-infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother-infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference -2.6% [95% confidence interval (CI): -3.7, -1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference -7.5% [95% CI: -8.8, -6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group.

Conclusions: These findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women.

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评估以人为本的干预措施,消除肯尼亚基苏木县的围产期艾滋病毒传播:使用汇总登记数据的重复横断面研究。
背景:2010 年至 2017 年间,肯尼亚围产期艾滋病病毒传播率从 20% 下降到 10%,此后趋于平稳,预计 2021 年的传播率为 8%。2016 年 10 月至 2021 年 9 月期间,家庭艾滋病护理和教育服务(FACES)为肯尼亚基苏木县 61 家机构的艾滋病护理和治疗服务提供支持,重点是加强对感染艾滋病毒的孕妇和产后妇女的服务,以减少围产期艾滋病毒传播。这包括严格执行国家艾滋病指南,并针对妇女及其婴儿的独特需求实施 3 项经过本地调整的循证干预措施。我们研究了这些以人为本的项目改进措施是否与 FACES 支持地点的围产期 HIV 传播随时间推移而发生的变化有关:我们对 2016 年 10 月至 2021 年 9 月期间 FACES 支持机构每年收集的围产期 HIV 传播风险文件进行了重复横断面研究。数据包括 12,599 名具有产前护理基线指标的女性艾滋病毒感染者,以及 11,879 对母婴的单独数据集,这些母婴从出生到哺乳期结束一直接受跟踪(与两年前接受产前护理的母婴重叠)。FACES 在 2019 年为感染 HIV 的孕妇和产后妇女实施了 3 项干预措施:(1)高风险诊所;(2)个案管理;(3)支持参与治疗的移动应用程序。我们的主要结果是母乳喂养结束时(18 到 24 个月)婴儿感染 HIV 的情况。我们将 FACES 计划最后一年(2021 年)的婴儿感染 HIV 的风险与干预扩大前一年和实施 "全面治疗 "政策后一年(2018 年)的婴儿感染 HIV 的风险进行了比较。母婴对随访损失是次要结果。项目数据按年份和地点汇总,因此在多变量回归中,我们对地点水平特征进行了调整,包括设施类型、城市与农村、每年接受产前护理的女性艾滋病感染者人数以及其中 25 岁以下的比例。在 2016 年 10 月至 2021 年 9 月期间,有 81172 名孕妇在产前检查开始时接受了 HIV 检测,其中有 12599 人(15.5%)感染了 HIV,HIV 感染率随时间变化不大。24 个月大的婴儿感染艾滋病毒的风险从 2018 年的 4.9% (101/2,072)下降到 2021 年的 2.2%(48/2,156)(调整后风险差异 -2.6% [95% 置信区间 (CI):-3.7, -1.6]; p < 0.001)。随访丧失率从2018年的9.9%(253/2,556)下降到2021年的2.5%(59/2,393)(风险差异-7.5% [95% CI:-8.8,-6.2];P < 0.001)。同期,联合国艾滋病规划署估计的尼安萨大区和肯尼亚全国的围产期传播率并未下降。这项研究的主要局限性在于我们缺乏可比的对照组:这些研究结果表明,以人为本的干预措施的实施与围产期艾滋病病毒传播率以及孕妇和产后妇女失去随访率的显著下降有关。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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