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Access to maternal health and prevention of mother-to-child HIV transmission services during the COVID-19 era in sub-Saharan Africa

Title
Access to maternal health and prevention of mother-to-child HIV transmission services during the COVID-19 era in sub-Saharan Africa
Presenter
Fatima Tsiouris
Authors
W. Reidy (1), E. Gusmao (2), G. Ekali (2), B. Nijirazana (2), F. Malele (2), R. Sahabo (2), E. Muigai (2), H.A. Worku (2), S. Aragaw (2), F. Tsiouris * (2)
Institutions
(1) Columbia University Mailman School of Public Health, ICAP / Epidemiology, New York, United States, (2) Columbia University Mailman School of Public Health, ICAP, New York, United States

BACKGROUND: In response to the COVID-19 pandemic, governments restricted travel and implemented modifications in service delivery during April-June 2020, while individuals changed behaviors to reduce risks. Impacts of these changes on essential health services such as maternal health and prevention of mother-to-child HIV transmission (PMTCT) services are not well-understood. We examined data from health facilities (HF) across 7 countries in sub-Saharan Africa (SSA) to assess trends in services.
METHODS: We analyzed aggregate data reported quarterly from 467 HF in 7 countries between October 2019-September 2020 (88 HF in Burundi; 74 in Cameroon;192 in Democratic Republic of Congo; 36 in Eswatini; 1 in Kenya; 58 in Mozambique; and 18 in South Sudan). For each country and quarter we calculated the number of pregnant women initiating care at antenatal clinics (ANC); number and proportion with HIV status determined and, for women living with HIV (WLHIV), number receiving antiretroviral therapy (ART) (Figure 1a-h).
RESULTS: Overall 370,570 pregnant women initiated ANC services during the period, including 91,167 during October-December 2019 (Q1); 93,165 during January-March 2020 (Q2); 91,084 during April-June 2020 (Q3); and 95,154 during July-September 2020 (Q4). Moderate declines in ANC attendance between Q2 and Q3 were observed in several countries, including Eswatini (Q2: 2063; Q3: 1822), Kenya (Q2: 642; Q3: 427), and South Sudan (Q2: 8846; Q3: 7817). High proportions of patients had HIV status determined, including 94% in Q1, 97% in Q2, 98% in Q3, and 99% in Q4. ART for WLHIV was near-universal, with 98% of these patients in Q1 and Q2, 99% of in Q3, and nearly 100% in Q4 receiving ART.


CONCLUSIONS: A moderate decline in ANC attendance was observed during April-June 2020; coverage of HIV services remained high. With a resurgence of cases of COVID-19 in SSA, monitoring the impact on maternal health and PMTCT services is critical.