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Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model

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BACKGROUND: Strategies to improve the uptake of Prevention of
                Mother-To-Child Transmission of HIV (PMTCT) are needed. We
                integrated HIV and maternal, newborn and child health services
                in a One Stop Clinic to improve the PMTCT cascade in a rural
                Tanzanian setting. METHODS: The One Stop Clinic of Ifakara
                offers integral care to HIV-infected pregnant women and their
                families at one single place and time. All pregnant women and
                HIV-exposed infants attended during the first year of Option B+
                implementation (04/2014-03/2015) were included. PMTCT was
                assessed at the antenatal clinic (ANC), HIV care and labour
                ward, and compared with the pre-B+ period. We also characterised
                HIV-infected pregnant women and evaluated the MTCT rate.
                RESULTS: 1,579 women attended the ANC. Seven (0.4%) were known
                to be HIV-infected. Of the remainder, 98.5% (1,548/1,572) were
                offered an HIV test, 94% (1,456/1,548) accepted and 38 (2.6%)
                tested HIV-positive. 51 were re-screened for HIV during late
                pregnancy and one had seroconverted. The HIV prevalence at the
                ANC was 3.1% (46/1,463). Of the 39 newly diagnosed women, 35
                (90%) were linked to care. HIV test was offered to >98% of
                ANC clients during both the pre- and post-B+ periods. During the
                post-B+ period, test acceptance (94% versus 90.5%, p<0.0001)
                and linkage to care (90% versus 26%, p<0.0001) increased. Ten
                additional women diagnosed outside the ANC were linked to care.
                82% (37/45) of these newly-enrolled women started antiretroviral
                treatment (ART). After a median time of 17 months, 27% (12/45)
                were lost to follow-up. 79 women under HIV care became pregnant
                and all received ART. After a median follow-up time of 19
                months, 6% (5/79) had been lost. 5,727 women delivered at the
                hospital, 20% (1,155/5,727) had unknown HIV serostatus. Of
                these, 30% (345/1,155) were tested for HIV, and 18/345 (5.2%)
                were HIV-positive. Compared to the pre-B+ period more women were
                tested during labour (30% versus 2.4%, p<0.0001). During the
                study, the MTCT rate was 2.2%. CONCLUSIONS: The implementation
                of Option B+ through an integrated service delivery model
                resulted in universal HIV testing in the ANC, high rates of
                linkage to care, and MTCT below the elimination threshold.
                However, HIV testing in late pregnancy and labour, and retention
                during early ART need to be improved.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model