P-68 Case studies on prevention of mother-to-child transmission (PMTCT) of HIV in remote Guyanese communities: a close look at missed opportunities, social inequities, and clinical gaps in maternal HI

Methods: We conducted a retrospective case series review of 12 maternal-infant pairs from remote regions, including 1, 2, 7, 8, and 9, using national surveillance data from the Ministry of Health. Variables included ART uptake, antenatal enrollment, delivery outcomes, infant HIV status, follow-up adherence, and social determinants of health. Descriptive and thematic analyses were applied to highlight missed opportunities along the PMTCT cascade.

Results: Of the 12 cases reviewed, 83.3% of infants were diagnosed HIV-positive. Only 25% of mothers initiated ART during pregnancy, with no confirmed cases of viral suppression at delivery. Infant prophylaxis at birth was administered in just 41.7%, and only 75% were initiated on ART postnatally. Confirmatory DBS testing was completed in 83.3%, but immunization and follow-up documentation were inconsistently recorded. Contributing barriers included low ANC enrollment (≤20 weeks in 41.7% of cases), maternal non-adherence (58.3%), absence of household HIV testing (83.3%), and sociocultural challenges such as stigma, migration, and language barriers.

Conclusion: The real-life cases provided critical challenges in PMTCT implementation in low-resource settings. Gaps in partner testing, referral coordination, and postnatal care continuity contribute to preventable HIV transmission. Community-based outreach, telemedicine expansion, and stronger linkages between tertiary and regional facilities are essential to breaking the transmission chain and supporting long-term viral suppression.