Background
Methods
Study site
Study population
Study design
Sources of data and outcome definitions
Sample size estimation
Data analysis
Ethical considerations
Results
Baseline characteristics at enrollment into care
Standard Care | Active follow up | Overall Care | ||
---|---|---|---|---|
Infants Characteristics | N = 537 [%] | N = 97 [%] | N = 634 [%] | |
Gender | Male | 224 [41.7] | 44 [45.4] | 268 [42.3] |
Female | 313 [58.3] | 53 [54.6] | 366 [57.7] | |
Age at intake (months) | Median (IQR) | 0.9 (0.3–3.5) | 0.6 (0.3–1.5) | 0.8 (0.3–3.0) |
Age group at enrollment (months) | 0–3 | 394 [73.4] | 81 [83.5] | 475 [74.9] |
3–6 | 52 [9.7] | 13 [13.4] | 65 [10.3] | |
>6 | 91 [17.9] | 3 [3.1] | 94 [14.8] | |
Hospital distance (kilometers) | Median (IQR) | 7.4 (2.2–13.4) | 7.8 (2.2–17.7) | 7.4 (2.2–13.4) |
Hospital distance categories (kilometers) | 0–5 | 206 [38.4] | 40 [41.2] | 246 [38.8] |
5–10 | 136 [25.3] | 22 [22.7] | 158 [24.9] | |
>10 | 152 [28.3] | 34 [35.1] | 186 [29.3] | |
Missing | 43 [8.0] | 1 [1.0] | 44 [6.9] | |
Mothers Characteristics (at infant’s birth) | N = 364 [%] | N = 94 [%] | N = 458 [%] | |
Age (years) | Median (IQR) | 28.1 (23.3–33.5) | 28.9 (24.8–34.9) | 28.4 (23.7–33.8) |
Age group (years) | <25 | 120 [33.0] | 24 [25.5] | 144 [31.4] |
25–35 | 177 [48.6] | 47 [50.0] | 224 [48.9] | |
>35 | 67 [18.4] | 23 [24.5] | 90 [19.7] | |
Education status | No education | 133 [36.5] | 30 [31.9] | 163 [35.6] |
Primary | 165 [45.3] | 41 [43.6] | 206 [45.0] | |
>Secondary | 39 [10.7] | 11 [11.7] | 50 [10.9] | |
Missing | 27 [7.4] | 12 [12.8] | 39 [8.5] | |
BMI | Median (IQR) | 21.0 (19.2–23.4) | 21.4 (19.1–23.2) | 21.0 (19.2–23.3) |
BMI categories | <18.5 | 56 [15.4] | 15 [16.0] | 71 [15.5] |
>18.5 | 296 [81.3] | 77 [81.9] | 373 [81.4] | |
Missing | 12 [3.3] | 2 [2.1] | 14 [3.1] | |
CD4 count | Median (IQR) | 409 (264–549) | 420 (300–640) | 410 (279–571) |
CD4 count categories | <350 | 85 [23.4] | 25 [26.6] | 110 [24.0] |
>350 | 121 [33.2] | 40 [42.6] | 161 (35.2) | |
Missing | 158 [43.4] | 29 [30.9] | 187 (40.8) | |
Duration on HAART (months) | Median (IQR) | 20.6 (2.9–36.9) | 28.1 (7.1–44.6) | 24.9 (3.4–39.3) |
Duration on HAART categories (months) | Not on HAARTa | 229 [62.9] | 50 [53.2] | 279 [60.9] |
0–24 | 71 [19.5] | 17 [18.1] | 88 [19.2] | |
>24 | 64 [17.6] | 27 [28.7] | 91 [19.8] |
Malnutrition at enrollment into care
aWasting, n = 479 [%] | bUnderweight n = 526 [%] | cStunting n = 528 [%] | dAny n = 537 [%] | eAll n = 539 [%] | ||
---|---|---|---|---|---|---|
Infants Characteristics | 67/479 [14.0]f | 135/526 [24.1]f | 219/528 [41.5]f | 285/537 [53.1]f | 26/539 [4.8]f | |
Gender | Male | 34/212 [16.0] | 67/241 [27.8] | 100/229 [43.7] | 128/233 [54.9] | 15/232 [6.5] |
Female | 33/267 [12.4] | 68/319 [21.3] | 119/299 [39.8] | 157/304 [51.6] | 11/307 [3.6] | |
Age group (months) | 0–3 | 38/352 [10.8] | 80/425 [18.8] | 157/403 [39.0] | 202/407 [49.6] | 9/407 [2.2] |
3–6 | 9/51 [17.7] | 19/56 [33.9] | 23/48 [47.9] | 33/52 [63.5] | 4/53 [7.6] | |
>6 | 20/76 [26.3] | 36/79 [45.6] | 39/77 [50.7] | 50/78 [64.1] | 13/79 [16.5] | |
Hospital distance (kilometers) | 0–5 | 23/184 [12.5] | 49/221 [22.2] | 85/208 [40.9] | 110/209 [52.6] | 8/215 [3.7] |
5–10 | 15/125 [12.0] | 41/144 [28.5] | 56/135 [41.5] | 75/141 [53.2] | 5/134 [3.7] | |
>10 | 23/146 [15.8] | 39/168 [23.2] | 69/161 [42.9] | 86/161 [53.4] | 10/164 [6.1] | |
Cohort | Standard Care | 58/395 [14.7] | 127/465 [27.3] | 185/436 [42.4] | 243/445 [54.6] | 23/443 [5.2] |
Active follow up | 9/84 [10.7] | 8/95 [8.4] | 34/92 [37.0] | 42/92 [45.7] | 3/96 [3.1] | |
Mothers’ Characteristics | ||||||
Age at infant’s birth (years) | <25 | 18/116 [15.5] | 32/141 [22.7] | 52/134 [38.8] | 70/135 [51.9] | 5/134 [3.7] |
25–35 | 24/191 [12.6] | 39/220 [17.7] | 81/209 [38.8] | 106/212 [50.0] | 8/214 [3.7] | |
>35 | 6/74 [8.1] | 12/87 [13.8] | 32/82 [39.0] | 40/85 [47.1] | 1/82 [1.2] | |
Education status | No education | 15/129 [11.6] | 34/159 [21.4] | 64/148 [43.2] | 81/150 [54.0] | 6/149 [4.0] |
Primary | 24/176 [13.6] | 38/202 [18.8] | 69/194 [35.6] | 95/197 [48.2] | 6/196 [3.1] | |
>Secondary | 6/44 [13.6] | 6/50 [12.0] | 17/49 [34.7] | 23/50 [46.0] | 1/48 [2.1] | |
BMI at infants birth | <18.5 | 9/55 [16.4] | 17/69 [24.6] | 29/66 [43.9] | 38/67 [56.7] | 3/63 [4.8] |
>18.5 | 37/315 [11.8] | 63/366 [17.2] | 133/346 [38.4] | 173/353 [49.0] | 11/354 [3.1] | |
CD4 count at infants birth | <350 | 13/88 [14.8] | 21/107 [19.6] | 40/100 [40.0] | 55/104 [52.9] | 4/104 [3.9] |
>350 | 15/136 [11.0] | 23/158 [14.6] | 55/154 [35.7] | 68/153 [44.4] | 4/152 [2.6] | |
missing | 39/255 [15.3] | 91/295 [30.9] | 124/274 [45.3] | 162/280 [57.9] | 18/283 [6.4] | |
Duration on HAART (months) | Not on HAARTg | 34/238 [14.3] | 56/273 [20.5] | 101/255 [39.6] | 135/262 [51.5] | 11/265 [4.2] |
0–24 | 6/70 [8.6] | 11/86 [12.8] | 28/80 [35.0] | 34/81 [42.0] | 2/81 [2.5] | |
>24 | 8/73 [11.0] | 16/89 [18.0] | 36/90 [40.0] | 47/89 [52.8] | 1/84 [1.2] |
Retention in care over the recommended PMTCT 18-month period
Non-retention | Cox Univariable analysis | Cox Multivariable analysis | ||||
---|---|---|---|---|---|---|
Infants Characteristics | d/y [rate/100 pmo]a | Crude HR [95 % CI] | LRT p-valueb | Adjusted HR [95 % CI]b | LRT p-valueb | |
Gender | Male | 105/28.5 [3.7] | Reference | Reference | ||
Female | 142/37.3 [3.8] | 1.0 [0.8–1.3] | 0.810 | 1.1 [0.8–1.4] | 0.662 | |
Age group at intake (months) | 0–3 | 179/56.9 [3.1] | Reference | Reference | ||
3–6 | 30/5.1 [5.8] | 1.8 [1.2–2.7] | 2.1 [1.2–3.4] | |||
>6 | 38/3.8 [10.1] | 2.6 [1.8–3.8] | <0.001 | 1.8 [1.1–3.0] | 0.005 | |
Year of intake | 2009 | 113/19.2 [5.9] | Reference | Reference | ||
2010 | 69/20.2 [3.4] | 0.6 [0.4–0.8] | 0.5 [0.4–0.8] | |||
2011 | 37/19.7 [1.9] | 0.3 [0.2–0.5] | 0.5 [0.3–0.8] | |||
2012 | 28/6.7 [4.2] | 0.7 [0.5–1.1] | <0.001 | 0.7 [0.4–1.4] | 0.003 | |
Any malnutrition at enrollment (WHZ/WAZ/HAZ <−2.0) | No | 78/31.3 [2.5] | Reference | Reference | ||
Yes | 111/29.7 [3.7] | 1.5 [1.1–2.0] | 0.008 | 1.5 [1.1–2.0] | 0.018 | |
All malnutrition at enrollment (WHZ & WAZ & HAZ < −2.0) | No | 175/59.6 [2.9] | Reference | Reference | ||
Yes | 13/1.2[10.7] | 3.4 [1.9–6.0] | <0.001 | 2.5 [1.3–4.7] | 0.014 | |
Hospital distance (kilometers) | 0–5 | 95/27.1 [3.5] | Reference | Reference | ||
5–10 | 57/17.2 [3.3] | 0.9 [0.7–1.3] | 0.9[0.6–1.4] | |||
>10 | 70/18.6 [3.8] | 1.1 [0.8–1.4] | 0.818 | 1.1[0.8–1.6] | 0.624 | |
Cohort | Active follow up | 7/14.7 [0.5] | Reference | Reference | ||
Standard Care | 240/51.1 [4.7] | 9.2 [4.3–19.5] | <0.001 | 6.6 [2.9–14.6] | <0.001 | |
Mothers Characteristics | ||||||
Age at infants birth (years) | <25 | 53/17.3 [3.1] | Reference | Reference | ||
25–35 | 81/28.0 [2.9] | 1.0 [0.7–1.3] | 1.2 [0.8–1.8] | |||
>35 | 24/11.4 [2.1] | 0.7 [0.4–1.1] | 0.247 | 0.9 [0.5–1.6] | 0.379 | |
Education status | No education | 52/20.6 [2.5] | Reference | Reference | ||
Primary | 73/25.4 [2.9] | 1.2 [0.8–1.7] | 1.2 [0.8–1.7] | |||
>Secondary | 17/6.4 [2.7] | 1.1 [0.6–1.8] | 0.712 | 1.0 [0.5–1.8] | 0.677 | |
BMI at infants birth | <18.5 | 33/8.5 [3.9] | 1.6 [1.1–2.4] | 1.6 [1.1–2.5] | ||
>18.5 | 114/47.4 [2.4] | Reference | 0.016 | Reference | 0.036 | |
CD4 count at infants birth | >350 | 54/21.6 [2.5] | Reference | Reference | ||
<350 | 39/15.2 [2.6] | 1.0 [0.7–1.6] | 1.2 [0.7–1.8] | |||
Missing | 65/19.9 [3.3] | 1.3 [0.9–1.9] | 0.254 | 1.2 [0.8–1.8] | 0.685 | |
Duration on HAART (months) | Not on HAARTc | 112/31.1 [3.6] | 2.7 [1.6–4.5] | 2.7 [1.5–4.7] | ||
0–24 | 28/12.2 [2.3] | 1.7 [0.9–3.1] | 1.9 [1.0–3.7] | |||
>24 | 18/13.3 [1.4] | Reference | <0.001 | Reference | <0.001 |
Correlates of MTCT of HIV-1 infection amongst infants enrolled for PMTCT care
HIV transmission [%] | Logistic Univariable analysis | Logistic Multivariable analysis | ||||
---|---|---|---|---|---|---|
Infants Characteristics | n = 57/444a [12.8] | Crude OR [95 % CI] | LRT p-valueb | Adjusted OR [95 % CI] | LRT p-valueb | |
Gender | Male | 21/195 [10.8] | Reference | Reference | ||
Female | 36/249 [14.5] | 1.4 [0.8–2.5] | 0.246 | 1.4 [0.6–2.9] | 0.431 | |
Age group (months) | 0–3 | 28/367 [7.6] | Reference | Reference | ||
3–6 | 10/42 [23.8] | 3.8 [1.7–8.5] | 3.9 [1.3–12.2] | |||
>6 | 19/35 [54.3] | 14.4 [6.7–31.0] | <0.001 | 23.3 [8.3–65.4] | <0.001 | |
Year of intake | 2009 | 23/145 [15.9] | Reference | Reference | ||
2010 | 16/131 [12.2] | 0.7[0.4–1.5] | 1.3 [0.5–3.6] | |||
2011 | 14/123 [11.4] | 0.7[0.3–1.4] | 2.0 [0.6–6.3] | |||
2012 | 4/45 [8.9] | 0.5 [0.2–1.6] | 0.553 | 0.6 [0.1–3.5] | 0.480 | |
Any malnutrition at intake (WHZ/WAZ/HAZ < −2.0) | No | 14/201 [7.0] | Reference | Reference | ||
Yes | 35/215 [16.3] | 2.6 [1.4–5.0] | 0.003 | 2.3 [1.0–5.2] | 0.038 | |
All malnutrition at intake (WHZ & WAZ & HAZ < −2.0) | No | 44/397 [11.1] | Reference | Reference | ||
Yes | 8/16 [50.0] | 8.0 [2.9–22.4] | <0.001 | 2.6 [0.6–10.8] | 0.203 | |
Hospital distance categories (kilometers) | 0–5 | 20/180 [11.1] | Reference | Reference | ||
5–10 | 9/117 [7.7] | 0.7 [0.3–1.5] | 0.6 [0.2–1.8] | |||
>10 | 24/130 [18.5] | 1.8 [1.0–3.4] | 0.032 | 2.2 [0.9–5.2] | 0.043 | |
Cohort | Active follow up | 7/96 [7.3] | Reference | Reference | ||
Standard Care | 50/348 [14.4] | 2.1 [0.9–4.9] | 0.052 | 0.6 [0.2–1.8] | 0.329 | |
Mothers Characteristics | ||||||
Age at infants birth (years) | <25 | 12/114 [10.5] | Reference | Reference | ||
25–35 | 14/192 [7.3] | 0.7 [0.3–1.5] | 0.9 [0.4–2.1] | |||
>35 | 8/74 [10.8] | 1.0 [0.4–2.7] | 0.518 | 1.7 [0.6–5.1] | 0.435 | |
Education status | No education | 11/133 [8.3] | Reference | Reference | ||
Primary | 16/175 [9.1] | 1.1 [0.5–2.5] | 1.1 [0.5–2.6] | |||
>Secondary | 2/41 [4.9] | 0.6 [0.1–2.7] | 0.641 | 0.6 [0.1–2.9] | 0.710 | |
BMI at infants birth | <18.5 | 6/59 [10.2] | 1.2 [0.5–2.9] | 1.3 [0.4–3.6] | ||
>18.5 | 28/315 [8.9] | Reference | 0.757 | Reference | 0.660 | |
CD4 count at infants birth | >350 | 9/144 [6.3] | Reference | Reference | ||
<350 | 7/98 [7.1] | 1.2 [0.4–3.2] | 1.5 [0.5–4.6] | 0.215 | ||
Missing | 18/138 [13.0] | 2.3 [1.0–5.2] | 0.113 | 2.2 [0.9–5.4] | ||
Duration on HAART (months) | Not on HAARTc | 28/220 [12.7] | 3.9 [1.1–13.2] | 6.5 [1.4–29.4] | ||
0–24 | 3/77 [3.9] | 1.1 [0.2–5.5] | 1.8 [0.3–11.2] | |||
>24 | 3/83 [3.6] | Reference | 0.006 | Reference | 0.004 |