Spatial-temporal trend for mother to child transmission of HIV up to infancy and during Pre-Option B+ in western Kenya, 2007-13


Abstract

Introduction: Using spatial-temporal analyses to understand coverage and trends in elimination of mother-to-child transmission of HIV (eMTCT) efforts may be helpful in ensuring timely services are delivered to the right place. We present spatial-temporal analysis of 7-years of HIV early infant diagnosis data collected from 12 districts in western Kenya from January 2007 to November 2013, during pre-Option B+ use. Methods: We included in the analysis infants up to one year old. We performed trend analysis using extended Cochran–Mantel–Haenszel stratified test and logistic regression models to examine trends and associations of infant HIV status at first diagnosis with: early diagnosis (<8 weeks after birth), age at specimen collection, infant ever having breastfed, use of single dose nevirapine (sdNVP), and maternal antiretroviral therapy (ART) status. We examined these covariates and fitted spatial and spatial-temporal semi-parametric Poisson regression models to explain HIV-infection rates using R-Integrated Nested Laplace Approximation (INLA) package. We calculated new infections per 100,000 live births and used Quantum GIS to map fitted MTCT estimates for each district in Nyanza region. Results: Median age was 2 months, interquartile range (IQR) 1.5 to 5.8 months. Unadjusted pooled positive rate was 11.8% in the 7-years period and declined from 19.7% in 2007 to 7.0% in 2013, p<0.01. Uptake of testing ≤8 weeks after birth was under 50% in 2007 and increased to 64.1% by 2013, p<0.01. By 2013, the overall case rate was 447 infections per 100,000 live births. Based on Bayesian deviance information criterion comparisons, the spatial-temporal model with maternal and infant covariates was best in explaining geographical variation in MTCT. Discussion: Improved EID uptake and reduced MTCT rates are indicators of progress towards e-MTCT. Co-joined analysis of time and covariates in a spatial context provides a robust approach for explaining differences in programmatic impact over time. Conclusions: During this pre-Option B+ period, the PMTCT program in this region has not achieved e-MTCT target of ≤50 case rates per 100,000 live births. Geographical disparities in program achievements may signify gaps in spatial distribution of e-MTCT efforts and could indicate areas needing further resources and interventions.
Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. That said, if the manuscript is accepted for publication then the reviewer reports can be optionally signed and made public (see below).
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.

  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).
  • If the article is accepted, then the authors are given the option to reproduce the reviewer reports, and their full revision history, alongside their finally published article. In those instances, the comments of the reviewers will be made public (although reviewers' names will never be revealed unless the reviewer opted to sign their review, as noted above).

If you have any questions about submitting your review, please email us at peer.review@peerj.com.