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


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.