PMTCT cascade analysis in Côte d\u27Ivoire: Results from a national representative sample

Without treatment, an HIV-positive pregnant woman has a 30–35 percent chance of transmitting the infection to her child. Early detection and appropriate treatment during pregnancy, childbirth, and breastfeeding can reduce those odds to less than 5 percent. Consequently, WHO and countries around the world have instituted prevention of mother-to-child transmission of HIV (PMTCT) programs, consisting of the “PMTCT cascade”: testing for HIV at the first antenatal visit; CD4 test of HIV-positive patients; antiretroviral (ARV) prophylaxis to mother throughout pregnancy and breastfeeding; ARV prophylaxis to child at delivery and throughout breastfeeding; HIV testing of child and initiation of antiretroviral therapy (ART) for children found to be HIV infected. In Côte d’Ivoire, as in much of Africa, PMTCT programs have performed less than optimally due to bottlenecks throughout the cascade that cause delays in initiating care. To help inform the 2012 rollout of the WHO “Option B” treatment regimen in Côte d’Ivoire, an assessment of a sample of existing PMTCT programs in Côte d’Ivoire was carried out. The study’s objectives were to identify time delays in the PMTCT cascade, and suggest recommendations to improve current services to optimize the impact of Option B in Côte d’Ivoire