Dataset Information

Spatial-temporal trend for mother-to-child transmission of HIV up to infancy and during pre-Option B+ in western Kenya, 2007-13.

ABSTRACT: Introduction:Using spatial-temporal analyses to understand coverage and trends in elimination of mother-to-child transmission of HIV (e-MTCT) efforts may be helpful in ensuring timely services are delivered to the right place. We present spatial-temporal analysis of seven years of HIV early infant diagnosis (EID) data collected from 12 districts in western Kenya from January 2007 to November 2013, during pre-Option B+ use. Methods:We included in the analysis infants up to one year old. We performed trend analysis using extended Cochran-Mantel-Haenszel stratified test and logistic regression models to examine trends and associations of infant HIV status at first diagnosis with: early diagnosis (<8 weeks after birth), age at specimen collection, infant ever having breastfed, use of single dose nevirapine, and maternal antiretroviral therapy status. We examined these covariates and fitted spatial and spatial-temporal semiparametric Poisson regression models to explain HIV-infection rates using R-integrated nested Laplace approximation package. We calculated new infections per 100,000 live births and used Quantum GIS to map fitted MTCT estimates for each district in Nyanza region. Results:Median age was two months, interquartile range 1.5-5.8 months. Unadjusted pooled positive rate was 11.8% in the seven-years period and declined from 19.7% in 2007 to 7.0% in 2013, p < 0.01. Uptake of testing ?8 weeks after birth was under 50% in 2007 and increased to 64.1% by 2013, p < 0.01. By 2013, the overall standardized MTCT rate was 447 infections per 100,000 live births. Based on Bayesian deviance information criterion comparisons, the spatial-temporal model with maternal and infant covariates was best in explaining geographical variation in MTCT. Discussion:Improved EID uptake and reduced MTCT rates are indicators of progress towards e-MTCT. Cojoined analysis of time and covariates in a spatial context provides a robust approach for explaining differences in programmatic impact over time. Conclusion:During this pre-Option B+ period, the prevention of mother to child transmission program in this region has not achieved e-MTCT target of ?50 infections per 100,000 live births. Geographical disparities in program achievements may signify gaps in spatial distribution of e-MTCT efforts and could indicate areas needing further resources and interventions.

SUBMITTER: Waruru A

PROVIDER: S-EPMC5861528 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Spatial-temporal trend for mother-to-child transmission of HIV up to infancy and during pre-Option B+ in western Kenya, 2007-13.

Waruru Anthony A Achia Thomas N O TNO Muttai Hellen H Ng'ang'a Lucy L Zielinski-Gutierrez Emily E Ochanda Boniface B Katana Abraham A Young Peter W PW Tobias James L JL Juma Peter P De Cock Kevin M KM Tylleskär Thorkild T

PeerJ 20180313

<h4>Introduction</h4>Using spatial-temporal analyses to understand coverage and trends in elimination of mother-to-child transmission of HIV (e-MTCT) efforts may be helpful in ensuring timely services are delivered to the right place. We present spatial-temporal analysis of seven years of HIV early infant diagnosis (EID) data collected from 12 districts in western Kenya from January 2007 to November 2013, during pre-Option B+ use.<h4>Methods</h4>We included in the analysis infants up to one year ...[more]

PMID: 29576942

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Project description:BackgroundMobile health (mHealth) approaches offer potentially affordable ways to support the care of HIV-infected patients in overstretched health care systems. However, only few studies have analyzed the costs associated with mHealth solutions for HIV care.ObjectiveThe aim of this study was to estimate the total incremental costs and incremental cost per beneficiary of an interactive SMS text messaging support intervention within a clinical trial.MethodsThe Mobile WAChX trial (NCT02400671) evaluates an interactive semiautomated SMS text messaging intervention to improve adherence to antiretroviral therapy and retention in care among peripartum women infected with HIV in Kenya to reduce the mother-to-child transmission of HIV. Women were randomized to receive one-way versus two-way SMS text messages. Messages were sent weekly, and these messages included motivational and educational content and visit reminders; two-way messaging enabled prompt consultation with the nurse as needed. Microcosting methods were used to collect resource-use data related to implementing the Mobile WAChX SMS text messaging intervention. At 2 sites (Nairobi and Western Kenya), we conducted semistructured interviews with health personnel to identify startup and recurrent activities by obtaining information on the personnel, supplies, and equipment. Data on expenditures and prices from project expense reports, administrative records, and published government salary data were included to estimate the total incremental costs. Using a public provider perspective, we estimated incremental unit costs per beneficiary and per contact during 2017.ResultsThe weighted average annual incremental costs for the two-way SMS text messaging group were US $3725 per facility, US $62 per beneficiary, and US $0.85 per contact to reach 115 beneficiaries. For the one-way SMS text messaging group, the weighted average annual incremental costs were US $2542 per facility, US $41 per beneficiary, and US $0.66 per contact to reach 117 beneficiaries. The largest cost shares were for the personnel: 48.2% (US $1794/US $3725) in two-way and 32.4% (US $825/US $2542) in one-way SMS text messaging groups. Costs associated with software development and communication accounted for 29.9% (US $1872/US $6267) of the costs in both intervention arms (US $1042 vs US $830, respectively).ConclusionsCost information for budgeting and financial planning is relevant for implementing mHealth interventions in national health plans. Given the proportion of costs related to systems development, it is likely that costs per beneficiary will decline with the scale-up of the interventions.

Project description:BackgroundThe associations among maternal depressive symptoms (MDS), mother-child interactions and early child development are poorly understood. This study aimed to explore the role of mother-child interactions on the associations between MDS and child development.MethodsA cross-sectional study with a multistage sampling method was conducted in rural areas of Central and Western China. MDS, child development outcomes (communication, gross motor function, fine motor function, problem solving and personal social skills) and mother-child interactions were assessed by The Edinburgh Postpartum Depression Scale, the Chinese version of the Ages and Stages Questionnaires and the Multiple Indicator Cluster Surveys, respectively. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS.ResultsA total of 2,548 participants (mothers: 1,274; children: 1,274) were included in our analyses. MDS was negatively associated with child development outcomes and mother-child interactions partly mediated these associations. The proportion of the mediating effect of mother-child interactions was 7.7% for communication, 8.2% for gross motor, 10.3% for fine motor, 10.1% for problem-solving and 9.5% for personal social domains. In addition, the interaction effects of MDS and mother-child interactions on the communication domain were significant (β = 0.070, 95% CI 0.016, 0.124; p = 0.011). The associations between MDS and child communication abilities were weaker at the high level (simple slope = -0.019, t = - 0.458, p = 0.647) of mother-child interactions than at the mean level (simple slope = -0.089, t = - 3.190, p = 0.002) and the low level (simple slope = -0.158, t = - 4.231, p < 0.001). Similar moderating effects were not observed in the other child development outcomes.ConclusionOur results suggest the important role of mother-child interactions on the associations between MDS and early childhood development. Due to the cross-sectional design of this study, these associations require further investigation in prospective studies.

Dataset Information

Spatial-temporal trend for mother-to-child transmission of HIV up to infancy and during pre-Option B+ in western Kenya, 2007-13.

Publications

Spatial-temporal trend for mother-to-child transmission of HIV up to infancy and during pre-Option B+ in western Kenya, 2007-13.

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