Lyson Tenthani
(PhD 2016)

March 13, 2017

Lyson’s PhD project aims at identifying the programmatic issues that can impede the attainment of Prevention of Mother to Child Transmission (PMTCT) of HIV potential benefits in resource limited settings like Malawi. Using routine health records collected during antenatal, delivery, ART and exposed child follow-up, his project aims at identifying factors that determine uptake and retention along the PMTCT care cascade. The health records are drawn from 19 large health facilities in the central and southern Malawi. Lyson’s first analysis was based on the ART data and it aimed at assessing factors associated with retention in care for women in the ART program after the adoption of the Option B+ approach in Malawi. He found that 17% (n-219239) were lost at six months with most of the loss occurring in the first 3 months. Compared to women who started ART for their own health, pregnant women who started ART because of their pregnancy status were more likely (OR 5.0, 95% CI 4.2-6.1) not to come for a follow-up visit after starting ART, followed by those who started while breast feeding (OR 2.2, 95% CI 1.8-2.8). Loss to follow up was therefore found to be highest among pregnant women who started ART on the same day they were diagnosed HIV positive and those treated in large clinics. A second analysis was based on the antenatal clinic (ANC) data. The analysis aimed at assessing HIV status ascertainment and its predictors during pregnancy. In this analysis he found that there was suboptimal HIV testing levels in the country at 82.3% (95% CI 80.2-85.9%) compared to the elimination of mother to child transmission (EMTCT) goal of 90%. He further found that HIV ascertainment was independently associated with higher age and attending an ANC more than once. He further observed high variability of HIV ascertainment between sites ranging from 50.6-97.7% and over time suggesting that HIV test kits shortages and insufficient numbers of staff were the major barriers to reducing MTCT. Currently Lyson is coordinating the Umoyo+ Project, a research collaboration between the ISPM and the HIV and AIDS Department of the MoH in Malawi.