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Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique.
Fuente-Soro, Laura; Fernández-Luis, Sheila; López-Varela, Elisa; Augusto, Orvalho; Nhampossa, Tacilta; Nhacolo, Ariel; Bernardo, Edson; Burgueño, Blanca; Ngeno, Bernadette; Couto, Aleny; Guambe, Helga; Tibana, Kwalila; Urso, Marilena; Naniche, Denise.
Afiliación
  • Fuente-Soro L; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. laura.delafuente@isglobal.org.
  • Fernández-Luis S; Barcelona Institute for Global Health, Barcelona, Spain. laura.delafuente@isglobal.org.
  • López-Varela E; ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain. laura.delafuente@isglobal.org.
  • Augusto O; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
  • Nhampossa T; Barcelona Institute for Global Health, Barcelona, Spain.
  • Nhacolo A; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
  • Bernardo E; Barcelona Institute for Global Health, Barcelona, Spain.
  • Burgueño B; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
  • Ngeno B; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
  • Couto A; Instituto Nacional de Saúde, Maputo, Mozambique.
  • Guambe H; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
  • Tibana K; Manhiça District Health Services, Maputo, Mozambique.
  • Urso M; Vanderbilt Institute for Global Health, Nashville, Tennessee, USA.
  • Naniche D; Barcelona Institute for Global Health, Barcelona, Spain.
BMC Public Health ; 21(1): 520, 2021 03 17.
Article en En | MEDLINE | ID: mdl-33731061
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%CI35.8-39.4%). 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% CI3.1-5.7%) 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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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Infecciones por VIH Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Pregnancy País/Región como asunto: Africa Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Mozambique

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Infecciones por VIH Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Female / Humans / Pregnancy País/Región como asunto: Africa Idioma: En Revista: BMC Public Health Asunto de la revista: SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Mozambique