In rural settings, HIV-infected pregnant women often live
significant distances from facilities that provide prevention of
mother-to-child transmission (PMTCT) services.
We offered universal maternal combination antiretroviral
regimens in 4 pilot sites in rural Zambia. To evaluate the impact of services,
we conducted a household survey in communities surrounding each facility. We
collected information about HIV status and antenatal service utilization from
women who delivered in the past 2 years. Using household Global Positioning
System coordinates collected in the survey, we measured Euclidean (i.e.,
straight line) distance between individual households and clinics.
Multivariable logistic regression and predicted probabilities were used to
determine associations between distance and uptake of PMTCT regimens.
From March to December 2011, 390 HIV-infected mothers were
surveyed across four communities. Of these, 254 (65%) had household
geographical coordinates documented. One hundred sixty-eight women reported use
of a PMTCT regimen during pregnancy including 102 who initiated a combination
antiretroviral regimen. The probability of PMTCT regimen initiation was the
highest within 1.9 km of the facility and gradually declined. Overall, 103 of
145 (71%) who lived within 1.9 km of the facility initiated PMTCT versus 65 of
109 (60%) who lived farther away. For every kilometer increase, the association
with PMTCT regimen uptake (adjusted odds ratio: 0.90, 95% confidence interval:
0.82 to 0.99) and combination antiretroviral regimen uptake (adjusted odds
ratio: 0.88, 95% confidence interval: 0.80 to 0.97) decreased.
In this rural African setting, uptake of PMTCT regimens was
influenced by distance to health facility. Program models that further
decentralize care into remote communities are urgently needed.
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By:
- 1*Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL; †Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; ‡Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC; §Institute for Global Health, Vanderbilt University, Nashville, TN; ‖Society for Family Health, Lusaka, Zambia; ¶Zambian Ministry of Community Development and Mother-Child Health, Lusaka, Zambia; #Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia; **Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC; ††Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC; and ‡‡Currently at Departments of Medicine and Pediatrics, Massachusetts General Hospital; Boston, MA.
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