The HIV/AIDS epidemic remains a critical global health issue, with Mozambique bearing a significant burden. The HIV prevalence among individuals aged 15–49 years is 12.4%, with disproportionately higher rates among women. Approximately 8.2% of pregnant or breastfeeding women in Mozambique are HIV-positive, contributing to a vertical transmission rate of 15%. Access to healthcare services remains limited, particularly in rural areas, posing significant challenges for the prevention of mother-to-child transmission (PMTCT). The "ProTeggiMi" project, launched in 2021 by MMI and the University of Brescia in collaboration with Mozambique's Ministry of Health, aimed to strengthen PMTCT services in rural areas of Inhambane Province through the deployment of mobile clinics. This study evaluated the trends in uptake and adherence to PMTCT services among HIV-positive women and their infants in mobile clinic settings and investigated factors influencing clinical and therapeutic outcomes. This observational, retrospective, multicenter study enrolled 240 women living with HIV (WLHIV) who were pregnant or breastfeeding and 252 HIV-exposed infants from August 2021 to July 2023. Data on sociodemographic, clinical, and epidemiological factors, adherence to antiretroviral therapy (ART), viral load (VL) testing, and follow-up were analyzed. Forty percent of WLHIV received their HIV diagnosis during pregnancy or breastfeeding, and recent diagnoses were associated with poorer adherence to medical visits, particularly in areas not served by monthly held mobile clinics. VL testing in the peripartum period was performed in only 41% of eligible women, with 62% achieving undetectable VL. The loss to follow-up (LTFU) rates were 11% during pregnancy, 11% postpartum, and 25% among breastfeeding infants. Vertical transmission was observed in 4.9% of cases, with eight infants testing positive for HIV, two of whom died during the study period. Anyway, the observational period was over for only 9% of exposed infants during pregnancy and 46% of those exposed during breastfeeding by the end of the current analysis. The findings highlight the essential role of mobile clinics in improving access to PMTCT services in underserved rural communities. These services mitigate barriers to care, enhance adherence to ART, and contribute to reducing vertical transmission rates, underscoring the need for targeted interventions to address gaps in healthcare access and follow-up adherence.
L'epidemia di HIV/AIDS rappresenta una questione cruciale per la salute pubblica globale. Con una prevalenza di infezione da HIV nella popolazione di età compresa tra i 15 e i 49 anni pari al 12,4%, con tassi significativamente più alti tra le donne, il Mozambico è uno dei Paesi più gravemente colpiti. Circa l'8,2% delle donne in gravidanza o in allattamento in Mozambico è sieropositiva, contribuendo a un tasso di trasmissione verticale del 15%. L'accesso limitato ai servizi sanitari, in particolare nelle aree rurali, rappresenta un ostacolo significativo alla prevenzione della trasmissione madre-figlio (PMTCT). Il progetto "ProTeggiMi", avviato nel 2021 da MMI e dall'Università di Brescia in collaborazione con il Ministero della Salute del Mozambico, ha mirato a rafforzare i servizi di PMTCT nelle aree rurali della provincia di Inhambane mediante l’utilizzo di cliniche mobili. Obiettivo del presente studio è stato valutare le tendenze nell'accesso e nell'aderenza ai servizi di PMTCT offerti nel contesto delle cliniche mobili tra le donne sieropositive e i loro neonati, indagando i fattori che influenzano gli esiti clinici e terapeutici. Abbiamo effettuato uno studio osservazionale, retrospettivo e multicentrico, che ha coinvolto 240 donne sieropositive in gravidanza o in allattamento e 252 neonati esposti all’HIV nel periodo compreso tra agosto 2021 e luglio 2023. Sono stati analizzati dati relativi a fattori sociodemografici, clinici ed epidemiologici, aderenza alla terapia antiretrovirale (ART), test della carica virale (VL) e follow-up. Il 40% delle donne ha ricevuto la diagnosi di HIV durante la gravidanza o l'allattamento; le diagnosi recenti si sono associate a una minore aderenza alle visite mediche, specialmente nelle aree non servite dalle cliniche mobili operative mensilmente. Il test della carica virale nel periodo peripartum è stato effettuato solo nel 41% delle donne eleggibili, con il 62% che ha raggiunto una VL non rilevabile. I tassi di abbandono del follow-up (LTFU) sono stati dell'11% durante la gravidanza, dell'11% nel postpartum e del 25% tra i neonati allattati al seno. La trasmissione verticale è stata osservata nel 4,9% dei casi, con otto neonati risultati sieropositivi, due dei quali deceduti durante il periodo di studio. Tuttavia, il periodo di osservazione era concluso solo per il 9% dei neonati esposti in gravidanza e per il 46% di quelli esposti durante l’allattamento al momento dell’analisi. I risultati evidenziano il ruolo fondamentale delle cliniche mobili nel migliorare l'accesso ai servizi di PMTCT nelle comunità rurali svantaggiate. Questi interventi contribuiscono a superare le barriere di accesso alle cure, aumentano l'aderenza all’ART e riducono i tassi di trasmissione verticale, sottolineando la necessità di interventi mirati per colmare le lacune nell'accesso alle cure e nell'aderenza al follow-up
Evaluation of decentralized strategies in the implementation of Prevention of Mother To Child Transmission of HIV services in a rural area of Mozambique
Magro, Paola
2025
Abstract
The HIV/AIDS epidemic remains a critical global health issue, with Mozambique bearing a significant burden. The HIV prevalence among individuals aged 15–49 years is 12.4%, with disproportionately higher rates among women. Approximately 8.2% of pregnant or breastfeeding women in Mozambique are HIV-positive, contributing to a vertical transmission rate of 15%. Access to healthcare services remains limited, particularly in rural areas, posing significant challenges for the prevention of mother-to-child transmission (PMTCT). The "ProTeggiMi" project, launched in 2021 by MMI and the University of Brescia in collaboration with Mozambique's Ministry of Health, aimed to strengthen PMTCT services in rural areas of Inhambane Province through the deployment of mobile clinics. This study evaluated the trends in uptake and adherence to PMTCT services among HIV-positive women and their infants in mobile clinic settings and investigated factors influencing clinical and therapeutic outcomes. This observational, retrospective, multicenter study enrolled 240 women living with HIV (WLHIV) who were pregnant or breastfeeding and 252 HIV-exposed infants from August 2021 to July 2023. Data on sociodemographic, clinical, and epidemiological factors, adherence to antiretroviral therapy (ART), viral load (VL) testing, and follow-up were analyzed. Forty percent of WLHIV received their HIV diagnosis during pregnancy or breastfeeding, and recent diagnoses were associated with poorer adherence to medical visits, particularly in areas not served by monthly held mobile clinics. VL testing in the peripartum period was performed in only 41% of eligible women, with 62% achieving undetectable VL. The loss to follow-up (LTFU) rates were 11% during pregnancy, 11% postpartum, and 25% among breastfeeding infants. Vertical transmission was observed in 4.9% of cases, with eight infants testing positive for HIV, two of whom died during the study period. Anyway, the observational period was over for only 9% of exposed infants during pregnancy and 46% of those exposed during breastfeeding by the end of the current analysis. The findings highlight the essential role of mobile clinics in improving access to PMTCT services in underserved rural communities. These services mitigate barriers to care, enhance adherence to ART, and contribute to reducing vertical transmission rates, underscoring the need for targeted interventions to address gaps in healthcare access and follow-up adherence.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/217802
URN:NBN:IT:UNIBS-217802