Reducing vertical HIV transmission in Kinshasa, Democratic Republic of Congo: trends in HIV prevalence and service delivery

Abstract

Scale-up of vertical HIV transmission prevention has been too slow in sub-Saharan Africa. We describe approaches, challenges, and results obtained in Kinshasa. Staff members of 21 clinics managed by public servants or non-governmental organizations were trained in improved basic antenatal care (ANC) including nevirapine (NVP)-based HIV transmission prevention. Program initiation was supported on-site logistically and technically. Aggregate implementation data were collected and used for program monitoring. Contextual information was obtained through a survey. Among 45,262 women seeking ANC from June 2003 through July 2005, 90% accepted testing; 792 (1.9%) had HIV of whom 599 (76%) returned for their result. Among 414 HIV+ women who delivered in participating maternities, NVP coverage was 79%; 92% of newborns received NVP. Differences were noted by clinic management in program implementation and HIV prevalence (1.2 to 3.0%). Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time. Scope and quality of service coverage should further increase; strategies to decrease loss to follow-up of HIV+ women should be identified to improve program effectiveness. The observed differences in HIV prevalence highlight the importance of selecting representative sentinel surveillance centers.

Keywords:

• vertical HIV transmission prevention
• antenatal service delivery
• DR Congo
• HIV prevalence
• HIV surveillance

Acknowledgements

We thank Ms. Karen Hawkins Reed, Mr. Kashamuka Mwandagalirwa, and Dr. Jack Kokolomami for their invaluable support.

Additional information

Notes on contributors

for the PTME Group

Luc Aertsen, Robin Briggs, Steven Callens, Maria Khan, Delphine Kizungu, Richard Matendo, Cecile Mbotama, Francoise Mbuyulu, Vera Melotte, Marie Therèse Mwela, Petra Sander