BMC Pregnancy and Childbirth (Dec 2018)

Uptake of antiretroviral therapy in HIV-positive women ever enrolled into ‘prevention of mother to child transmission’ programme, Mandalay, Myanmar—a cohort study

  • Khine Wut Yee Kyaw,
  • Srinath Satyanarayana,
  • Khaing Hnin Phyo,
  • Nang Thu Thu Kyaw,
  • Aye Aye Mon,
  • Than Than Lwin,
  • Thet Ko Aung,
  • Myo Minn Oo,
  • Zaw Zaw Aung,
  • Thurain Htun,
  • Nang Seng Noon Kham,
  • Theingi Mya,
  • Ajay M. V. Kumar,
  • Htun Nyunt Oo

DOI
https://doi.org/10.1186/s12884-018-2099-0
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 8

Abstract

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Abstract Background Early initiation and longer duration of anti-retroviral therapy either as prophylaxis (pARV) or lifelong treatment (ART) in HIV-positive pregnant women prior to delivery has a huge impact in reducing mother to child transmission (MTCT) of HIV, maternal morbidity, mortality and increasing retention in care. In this study, we aimed to determine the following in a ‘prevention of mother-to-child transmission’ (PMTCT) programme in Central Women Hospital, Mandalay, Myanmar: i) uptake of ART and factors associated with the uptake ii) duration of ART/ pARV received by HIV-positive pregnant women prior to delivery, iii) factors associated with ART/ pARV initiation after delivery and iv) factors associated with shorter duration of ART/ pARV (≤ 8 weeks prior to delivery). Method This was a retrospective cohort study using routinely collected data from PMTCT programme. We used multivariable Cox proportional Hazard model or log binomial models to assess the association between socio-demographic and clinical factors with a) uptake of ART/pARV, b) initiation of ART/pARV after delivery, c) shorter (≤8 weeks) duration of ART/PARV prior to delivery. Results Of the 670 ART naïve HIV-positive women enrolled to PMTCT programme between March 2011 and December 2016, 588 (88%) were initiated on ART/pARV. In adjusted analysis, only pregnancy stage at enrolment was significantly associated with initiation of ART/pARV. Of 585 who had delivered babies on or before the censor date, 522 (89%) were on ART/pARV. Women who lived outside Mandalay were more likely to be initiated on ART after delivery (i.e., delayed ART initiation in those on ART). Among women who were initiated on ART/pARV before delivery (n = 468), only 59% got ART/pARV for > 8 weeks before delivery. Women whose spouses’ HIV status was not recorded had 40% higher risk of short duration of ART/pARV. Conclusions This study shows high uptake of ART/pARV among those enrolled into the PMTCT programme. However, about one in eight pregnant women did not receive ART before delivery. Among those initiated on ART/pARV before delivery, nearly half of them received ART/pARV for less than 8 weeks prior to delivery. These aspects need to be improved in order to eliminate mother-to-child transmission of HIV.

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