Modifiable factors within the prevention of mother-to-child transmission programme associated with failure to prevent HIV transmission in the Onandjokwe district of Namibia

Background: Ending new paediatric HIV infections continues to be a global health priority. Cuba and other countries have demonstrated that elimination of mother-to-child transmission is possible through Prevention of Mother-to-Child Transmission (PMTCT) interventions. As Namibia works on improving PMTCT there is a need to identify the local modifiable factors to achieve zero new HIV infections. Aim: This study aimed to identify the modifiable factors within the PMTCT programme, which contributed to the acquisition of HIV infection among children. Setting: The study was carried out in the Onandjokwe District, Northern Namibia. Methods: A descriptive audit was undertaken of 59 medical records of mothers and their children under two years, who acquired HIV despite the PMTCT programme between 2014 and 2016. Results: The study found that overall HIV transmission was only 2%, but 80% of the paediatric HIV infections could be prevented by implementing the existing Namibian PMTCT recommendations. Overall 61% of modifiable factors were related to mothers, 30% to health workers and 10% to the health system. The top three modifiable factors were the mother defaulting on ART during pregnancy or breastfeeding, the health worker not intervening when the mother failed the first-line ART regimen, and poor coordination of care between the hospital and primary care. Conclusion: Although overall transmission is low with the PMTCT programme, the majority of remaining HIV infections among children under two years could be prevented by addressing the modifiable factors identified in this study