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In 2013, the Ministry of Health revised PMTCT guidelines from CD4 based criteria for ART initiation to treatment as prevention also called PMTCT option B+. At introduction of the new guidelines, about 50% of all HIV infected pregnant women receiving antenatal care were initiated on ART but following training of midwives and ART focal persons in the new PMTCT option B+ guidelines, the regional linkage to care among HIV positive pregnant women attending antenatal clinics gradually improved to over 95% (October 2019). This achievement was also attributed to integration of HIV testing and ART initiation into routine ANC and PNC. Baylor-Uganda continues to support targeted and data driven mentorships in PMTCT option B+ to problematic sites.

Early Infant Diagnosis (EID) is also vital in ensuring early access to treatment and prevention services. Baylor-Uganda innovated a paper based 1st PCR tracker intended to identify the unborn baby exposed infant at the time the HIV positive pregnant woman attends antenatal care. Data on the maternal expected data of delivery, physical address and expected date of return to six weeks immunization is documented in the mother’s clinic records. A week before the EDD, the peer mothers contact mothers to remind them to deliver at health facility and they also remind those who have delivered and are due for their six weeks immunization appointment; that way majority of exposed infants received HIV testing within the recommended two months and they and enrolled into EID care immediately. This approach led to improvement in EID testing at 2 months from less than 50% in 2016 to 85% by December 2019. Due to lack of point of care testing, all blood samples from exposed infants and transported to the Uganda National Health Laboratory in Kampala for analysis and this leads to delays in processing of samples and relaying results to parent health facilities.

In order to track HIV free survival among HIV exposed infants, Baylor-Uganda provides technical assistance to ART accredited sites in the application of the birth cohort and early retention monitoring approach which involves registering exposed infants in their birth months and following them throughout the period of exposure. All exposed children who were born 18 months earlier are tested for HIV before discharge to determine their final HIV status. The regional vertical transmission rate has gradually reduced from over 5% in 2016 to about 2.3% in 2019. HIV exposed children who are lost to follow before 18 months are tracked using peer mothers attached to high volume sites; this Bring Back Mother-Baby approach led to a reduction in lost to follow up from over 26% in 2016 to 5% by December 2019.

Recording and reporting of PMTCT and EID results is tracked through the weekly surge and option B+ online dashboards and the monthly Health Management Information System which is controlled and managed by district biostatisticians. PMTCT program performance is conducted quarterly and is integrated into routine quarterly HIV care performance review meetings. In order to understand the factors associated with vertical transmission of HIV in the era of PMTCT option B+, a cross-sectional study in Kyegegwa district showed that maternal ART during pregnancy and missed opportunities in nevirapine prophylaxis drive vertical transmission of HIV.

 

210,616

pregnant &
breast feeding
women tested
for HIV

7,202

exposed
infants tested
for HIV 1st
PCR

9,368

identified
positives

321

HIV positive at
1st PCR

9,150

Enrolled
on ART for
EMTCT

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