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. 2022 Feb 8;22(1):134.
doi: 10.1186/s12879-022-07119-6.

Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis

Feleke Hailemichael Astawesegn  1   2 , Virginia Stulz  3 , Elizabeth Conroy  4 , Haider Mannan  4
Affiliations

Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis

Feleke Hailemichael Astawesegn et al. BMC Infect Dis. .

Abstract

Background: Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019.

Methods: Country-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010-2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model.

Results: ART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = - 0.18, 95% CI - 0.19-- 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18-8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate.

Conclusions: ART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.

Keywords: ART; And sub-Saharan Africa; Antiretroviral; Coverage; HIV; PMTCT; Pregnancy.

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Conflict of interest statement

The authors declare that they have no competing interests which may have inappropriately influenced them in writing this article.

Figures

Fig. 1
Fig. 1
Coverage of ART among HIV positive pregnant women for PMTCT of HIV (%) in 2010 A and in 2019 (B); the estimated annual percentage changes (EAPCs) between 2010 and 2019 C at national level
Fig. 2
Fig. 2
Mother-to-child HIV transmission rate (%) in 2010 A and in 2019 (B); the estimated annual percentage changes (EAPCs) between 2010 and 2019 C at national level
Fig. 3
Fig. 3
The trend of ART coverage for prevention of mother-to-child HIV transmission in Sub-saharan Africa from 2010 to 2019 by regions a and by income groups (b)
Fig. 4
Fig. 4
Trend of mother-to-child HIV transmission rate in Sub-saharan African from 2010 to 2019 by region a and by income group (b)
Fig. 5
Fig. 5
Scatter plot and linear fit between ART coverage during pregnancy (x) and MTCT rate (y) in sub-Saharan African countries from 2010–2019. Each dot represents one observation (n = 410). r is the Pearson pairwise correlation coefficient
See this image and copyright information in PMC

References

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