Prevention of mother-to-child transmission of HIV services in East Africa

: investigating determinants, inequalities, and effects for scaling-up policy interventions

Abstract

Globally, remarkable progress has been achieved in combating paediatric HIV epidemic through the implementation of prevention of mother-to-child transmission (PMTCT) services. However, HIV/AIDS remains a critical public health problem in East Africa, where the uptake of PMTCT services remains sub-optimal despite various programs, strategies and initiatives aimed at scaling up PMTCT program. While several sub-national studies have been conducted to assess PMTCT service uptake in the region, existing evidence is inadequate and not well documented. This is primarily due to the fact that most studies were facility-based and excluded women who have no access to health facilities. Moreover, the socioeconomic inequalities in the services uptake and the effects of ART coverage during pregnancy on mother-to-child HIV infection have not been well examined. Therefore, this PhD thesis aimed to investigate determinants, inequalities, and effects of PMTCT services uptake in East Africa.
This thesis revealed that the uptake of PMTCT services is found to be promising, however, much work remains to achieve the UNAIDS target by 2030. It identified several individual, community, and health system factors that prevent women from utilizing the service. The thesis also showed notable inequalities in service uptake, with higher uptake among socially and economically advantaged women compared to their counterparts. Moreover, it demonstrated a population-level correlation between ART coverage during pregnancy and mother-to-child HIV transmission. Therefore, to improve PMTCT service uptake and curb mother-to-child HIV transmission, tailored interventions are needed at both policy and service delivery levels. These interventions should focus on addressing socioeconomic and demographic inequalities, increasing maternal knowledge, enhancing partner support, strengthening health systems, expanding ART coverage, and reducing HIV incidence.

Date of Award	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Elizabeth Conroy (Supervisor)