With more than a decade of implementing the National PMTCT program, Uganda has been successfully scaling up its PMTCT services to include almost all health facilities. Interventions to prevent mother to child transmission of HIV are now offered in the majority of antenatal clinics and maternity institutions country wide. The PMTCT efforts aim to meet the National Strategic Plan (NSP) and Global Plan targets of reducing the overall MTCT rate of HIV (18 months postpartum) to less than 5% by 2015. Uganda has been implementing Option B+ for more than 4 years thus the need for a rigorous and robust evaluation of the effectiveness of the PMTCT program.

The Ministry of Health (MoH) and its partners are now ready to start implementing the PMTCT Impact Evaluation after receiving the necessary approvals. The Evaluation will be implemented for over two years at 206 clinics across the country.

Primary Objectives:

  1. To determine the MTCT rate by 18 months post-delivery including early MTCT (measured at 4-12 weeks) and late MTCT measured at 18 months under Option B+
    1. At national level
    2. Within a cluster of 10 DREAMS districts
  2. To estimate maternal HIV incidence rate during the first 18 months post-delivery
    1. At national level
    2. Within a cluster of 10 DREAMS districts
  3. To determine the mortality among HIV exposed and unexposed infants during the 18 months post-delivery at national level

Secondary Objectives:

  1. To determine the mortality among biological mothers during the 18 months post-delivery
  2. To assess coverage of key PMTCT interventions along the PMTCT cascade and identify potential reasons for loss-to-follow-up.
  3. To estimate maternal HIV acquisition during pregnancy and its’ contribution to MTCT cases at national level and among the 10 DREAMS districts.
  4. To measure viral load level among HIV positive biological mothers at 6weeks, 6 months & 12months post-delivery and association between viral load and MTCT rates.
  5. To estimate timing of maternal HIV antibody decay in HIV-exposed infants
  6. To describe differences between infant feeding patterns including breastfeeding and complementary feeding among HIV+ biological mothers and HIV-negative biological mothers as well as growth indicators (height, weight and MUAC) of HIV-exposed vs. HIV-unexposed infants.
  7. To assess ART adherence for biological mothers of exposed infants and for the exposed infant.
  8. To determine patterns of ARV drug resistance among HIV+ biological mothers and infants.
  9. To assess unmet need of family planning among biological mothers.
  10. To assess the extent of male involvement in the PMTCT setting (Partner HCT & Disclosure)

A nationally representative sample of about 10,000 caregiver-infant (aged 4-12 weeks) pairs attending the 206 selected health facilities providing routine immunization for infants scheduled at 6 weeks to 12 weeks  will participate in the study.

A total of 1,838 HIV exposed infant and caregiver pairs and 9,523 HIV negative and eligible mother and infant pairs will be recruited to participate in the 18 months follow-up. The first follow-up visit will be scheduled four weeks after the baseline recruitment then every 3 months afterward (total of 6 follow-up visits) until the child is 18 months of age or diagnosed as HIV-infected or either the mother or child dies, whichever comes first.

Below are the some of the activities scheduled in the first four months of this evaluation:

  1. National launch of the evaluation of 8th September 2017 at 9:00 am
  2. Training of data collectors and country support team starting on 11th September.
  3. Participant recruitment starting on 18th September and ongoing until December.

For more information please contact:
Dr. Linda K. Nabitaka, National Coordinator (EMTCT), Tel: 0772447963 Email: lkisaakye@gmail.com