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PMTCT in Zimbabwe

What happens to the babies? Factors associated with PMTCT outcomes among a community sample of HIV-exposed infants from Zimbabwe . Frances M Cowan, Raluca Buzdugan, Sandra I McCoy, Tyler E Martz, Constancia Watadzaushe , Jeffrey Dirawo , Angela Mushavi , Agnes Mahomva , Nancy S Padian.

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PMTCT in Zimbabwe

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  1. What happens to the babies? Factors associated with PMTCT outcomes among a community sample of HIV-exposed infants from Zimbabwe Frances M Cowan, Raluca Buzdugan, Sandra I McCoy, Tyler E Martz, ConstanciaWatadzaushe, Jeffrey Dirawo, Angela Mushavi, Agnes Mahomva, Nancy S Padian

  2. PMTCT in Zimbabwe • Overall Goal: Virtual elimination of paediatric HIV • Follow-up and care of HIV-exposed infants is critical to • prevent new HIV infection (HIV-free survival) • decrease mortality and morbidity in HIV-exposed infants IAS Poster MOPE113

  3. Simulation of cumulative LTFU of exposed infants - SSA

  4. Impact Evaluation • Impact evaluation of Zimbabwe MoHCW’saccelerated PMTCT program (WHO Option A) • External evaluators: University of California Berkeley, CeSHHAR Zimbabwe and University College London • Funding: Children’s Investment Fund Foundation

  5. Impact Evaluation Design • Serial cross-sectional community-based surveys in 157 health facilities • Pre-post design with the facility catchment area as unit of analysis • Baseline – 2012; endline – 2014/5 • Primary outcomes: MTCT rate & HIV-free infant survival at 9-18 months

  6. Methods I • Cross-sectional data from baseline survey of the impact evaluation of Zimbabwe’s accelerated implementation of the 2010 WHO PMTCT guidelines • The accelerated program was initiated in 2011 by the Zimbabwe Ministry of Health and Child Welfare (MOHCW) with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF).

  7. Survey Sample 2 1 3 5 4 Random sample of women living in catchment areas of 157 randomly selected health facilities offering PMTCT services in:1. Mashonaland West 2. Mashonaland Central 3. Harare 4. Matabeleland South 5. Manicaland

  8. Methods II • Eligible women were ≥16 years old and biological mothers of infants (alive or deceased) born 9-18 months prior. • Participants were interviewed about health service utilization during pregnancy and HIV status and had DBs taken for HIV testing. • Here we use self-reported HIV status and service uptake. • Factors associated with reported infant ARV prophylaxis and infant HIV testing respectively were examined. IAS Poster TUPE424

  9. Baseline Enrolment • 9087 mother-infant pairs (98.9% of those eligible) from 157 facility catchment areas • 9019 alive infants (99.3%) • 997 (11.5%) mothers reported positive HIV status before or during delivery • 16 HIV-exposed babies (1.6%) were deceased • Average infant age: • All infants: 412 days • HIV-exposed infants: 407 days [IAS Poster TUPE425]

  10. Results: Maternal PMTCT Cascade:

  11. Results: Uptake of postnatal services

  12. Results: Uptake of Infant PMTCT Services (997 biological mothers who self-reported HIV positive status) * Among mothers who delivered at health facilities

  13. Which infants received ARV prophylaxis? Note: Poisson regression (n=981), outcome: infant ARV prophylaxis; controlling for education and marital status; PR=prevalence ratio

  14. Which infants were HIV tested? Note: Poisson regression (n=995), outcome: infant HIV testing; controlling for age and whether living with mother in law; PR=prevalence ratio

  15. Limitations • Data are cross-sectional • Uptake of health services is based on self reports • HIV status during ANC and at delivery was based on self-report • Data are not representative of all regions in Zimbabwe.

  16. Conclusions • High rates of attrition at key stages along the cascade of services for HIV-exposed infants • Strong association between maternal & infant ARV prophylaxis • Strong association between ARV prophylaxis & infant HIV testing • Cost effective interventions to reduce LTFU required

  17. Other IAS Posters/ Presentations based on this study • Food insecurity – barrier to PMTCT service uptake • Presentation MOAD0204 • Feasibility of population-based cross-sectional surveys for estimating vertical HIV transmission: data from Zimbabwe – Poster -TUPE424 • Uptake of Prevention of Mother-to-Child HIV Transmission (PMTCT) Services Among Women With a Recent Birth in Zimbabwe – Poster TUPE425 • Role of fees in the demand for PMTCT services - Poster WEPE631

  18. Acknowledgements Ministry of Health and Child Welfare EGPAF Zimbabwe • Reuben Musarandega The Children’s Investment Fund Foundation (CIFF) funded the baseline impact evaluation survey. UC Berkeley • Maya Petersen CeSHHAR Zimbabwe • Survey team

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