Structural level differences in the mother-to-child HIV transmission rate in south Africa: A multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmission
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott, Williams & Wilkins
Abstract
In 2010, South Africa reported an early mother-to-child transmission (MTCT) rate of 3.5% at 4–8 weeks postpartum. Provincial early MTCT rates ranged from 1.4% [95% confidence interval (CI): 0.1 to 3.4] to 5.9% (95% CI: 3.8 to 8.0). We sought to determine reasons for these geographic differences in MTCT rates.This study used multilevel modeling using 2010 South African prevention of mother-to-child transmission (PMTCT) evaluation (SAPMTCTE) data from 530 facilities. Interview data and blood samples of infants were collected from 3085 mother–infant pairs at 4–8 weeks postpartum. Facility-level data on human resources, referral systems, linkages to care, and record keeping were collected through facility staff interviews. Provincial level data were gathered from publicly available data (eg, health professionals per 10,000 population) or aggregated at province-level from the SAPMTCTE (PMTCT maternal-infant antiretroviral (ARV) coverage). Variance partition coefficients and odds ratios (for provincial facility- and individual-level factors influencing MTCT) from multilevel modeling are reported.
Description
Keywords
Population-level variations, Mother-to-child transmission, HIV, Universal access, South Africa, Health facility
Citation
Woldesenbet, S. A. et al. (2017). Structural level differences in the mother-to-child HIV transmission rate in South Africa: A multilevel assessment of individual-, health facility-, and provincial-level predictors of infant HIV transmission. Journal of Acquired Immune Deficiency Syndromes, 74(5), 523–530. https://doi.org/10.1097/QAI.0000000000001289