Correlates of antiretroviral coverage for prevention of mother-to-child transmission of HIV in sub-Saharan Africa

Antiretroviral (ARV) drugs are effective in the prevention of mother-to-child transmission of HIV (PMTCT), however many sub-Saharan African countries are yet to achieve universal ARV coverage among pregnant women living with HIV. This study examined factors associated with ARV coverage for PMTCT in 41 sub-Saharan Africa countries. Country-level aggregated data were obtained from the Joint United Nations Programme on HIV/AIDS, World Health Organization, and United Nations Children's Fund. Using Spearman's rho and point-biserial correlation, we conducted bivariate analyses between ARV coverage for PMTCT and the following variables: stigma, antenatal care (ANC) uptake, institutional delivery, community delivery of ARV drugs, number of HIV testing and counselling (HTC) facilities, and density of skilled health workers. We also performed a multivariate median regression with the significant correlates. P<.05 was considered statistically significant for all the tests. The median ARV coverage for PMTCT was 76% (IQR: 55-85%). ARV coverage for PMTCT was significantly associated with HTC facilities (r=0.46, p=.004), institutional delivery (r=0.48, p=.002), ANC uptake: at least one visit (r=0.54, p=.001), and stigma (r=-0.52, p=.003). In the multivariate analysis, only stigma remained statistically significant (beta=-0.6, 95% CI=-1.13, -0.07, p=.03). To eliminate perinatal transmission of HIV in sub-Saharan Africa, interventions that will address stigma-related barriers to uptake of PMTCT services are needed. More research on country-specific population-level correlates of ARV coverage for PMTCT is recommended.