Low mother-to-child HIV transmission rate but high loss-to-follow-up among mothers and babies in Mandalay, Myanmar; a cohort study

Khine Wut Yee Kyaw; Myo Minn Oo; Nang Thu Thu Kyaw; Khaing Hnin Phyo; Thet Ko Aung; Theingi Mya; Nilar Aung; Htun Nyunt Oo; Petros Isaakidis

doi:10.1371/journal.pone.0184426

Low mother-to-child HIV transmission rate but high loss-to-follow-up among mothers and babies in Mandalay, Myanmar; a cohort study

PLoS One. 2017 Sep 8;12(9):e0184426. doi: 10.1371/journal.pone.0184426. eCollection 2017.

Authors

Khine Wut Yee Kyaw¹, Myo Minn Oo¹, Nang Thu Thu Kyaw¹, Khaing Hnin Phyo², Thet Ko Aung², Theingi Mya³, Nilar Aung⁴, Htun Nyunt Oo⁵, Petros Isaakidis⁶

Affiliations

¹ Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
² HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
³ Department of Obstetrics and Gynecology, Central Women Hospital, Mandalay, Myanmar.
⁴ Neonatology unit, Central Women Hospital, Mandalay, Myanmar.
⁵ National AIDS Program, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
⁶ Department of Operational Research, Médecins Sans Frontières (MSF) / Doctors Without Borders, Mumbai, India.

Abstract

Introduction: Loss-to-follow-up (LTFU) throughout the Prevention of Mother-To-Child Transmission (PMTCT) cascade remains one of the major threats to the success of PMTCT programs. In this study, we aimed to determine the mother-to-child transmission rate in a programmatic setting and to determine factors associated with LTFU among enrolled mothers and unfavorable outcomes among HIV-exposed babies which includes being HIV positive, death and LTFU.

Methods: A retrospective cohort study reviewing routinely collected data in an Integrated HIV care program, Mandalay, Myanmar in June 2016.LTFU means mother/infant missing appointed visit for more than three months.

Results: Of 678 pregnant women enrolled in PMTCT program between March 2011 and June 2014, one stillbirth and 607 live births were recorded in this cohort. Of 457 HIV-exposed babies with HIV-test recorded at the end of the intervention, nine (2%) were HIV-positive. Pregnant women's and exposed-babies' LTFU rate was 7 per 1000 person-years, and 10 per 1000 person-years respectively. PMTCT option B protocol was found to be significantly associate with maternal LTFU [adjusted Hazard Ratio (aHR) 95% CI: 3.52 (1.38-8.96)] when compare to mothers receiving option B+/lifelong antiretroviral therapy (ART). Weight <2.5 Kg at enrolment, receiving mixed-feeding, vaginal delivery and option B PMTCT protocol were significantly associated with unfavorable outcomes among exposed babies [aHR(95% CI): 5.40 (1.66-17.53), 5.91(1.68-20.84), 2.27 (1.22-4.22) and 2.33 (1.16-4.69) respectively].

Conclusion: Mother-to-child HIV transmission rate in this public hospital-based program was lower than the 5% national target, which indicates a successful PMTCT intervention. However, a high proportion of HIV-infected mothers and exposed babies LTFU was recorded. Lifelong ART provision to HIV-positive pregnant women was shown to reduce exposed babies' LTFU, death and transmission rate (unfavorable outcomes) in this setting. Lessons learned from this program could be used to inform policy and practice in the country, while the programmatic challenge of LTFU should be urgently addressed.

MeSH terms

Adolescent
Adult
CD4 Lymphocyte Count
Delivery, Obstetric
Female
HIV Infections / epidemiology*
HIV Infections / immunology
HIV Infections / transmission*
Humans
Infant
Infectious Disease Transmission, Vertical / statistics & numerical data*
Lost to Follow-Up
Middle Aged
Myanmar / epidemiology
Pregnancy
Pregnancy Complications, Infectious / epidemiology*
Pregnancy Outcome
Proportional Hazards Models
Retrospective Studies
Young Adult

Grants and funding

The training program was funded by the Department for International Development (DFID), UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.