S . Okawa, M. Chirwa , N. Ishikawa, F. Pande,

1. Operational challenge: Linkages from prevention of mother-to-child transmission services to care and treatment services in Zambia S. Okawa, M. Chirwa, N. Ishikawa, F. Pande, H. Kapyata, C. Msiska, K. Komada, H. Miyamoto, A. Mwango ChongweDistrict Community Health Office Ministry of Health Zambia - Japan International Cooperation Agency SHIMA project, Lusaka, Zambia

2. Background • Great success in scale-up of the PMTCT program in Zambia • PMTCT ARV coverage: 97% (UNAIDS, 2012) • There is a need to take advantage by referring all HIV-positive women from PMTCT to HIV care/treatment • Few studies on linkages between PMTCT and HIV care/treatment in Zambia

3. Study design • Design: Prospective cohort study • Period: • Enrolment: June 2011 – May 2012 • Follow up: June 2011 – January 2014 • Site:Chongwe district, Lusaka province • Referral health center • 5 rural health centers (RHCs) with ART services • 5 RHCs without ART services • WHO 2010 guidelines Option A • Participants: 195 mothers newly diagnosed as HIV-positive in PMTCT program

4. Data Collection • Face-to-face interview • Basic characteristicsof mothers • Review of clinical record and electronic database of clients on HIV care/treatment • Date of enrolment in HIV care/treatment • Date of ART initiation • Date of the last visit to the services

5. Analysis • Probability of enrolment in HIV care/treatment • Kaplan-Meier survivor function • Predictors of enrolment in HIV care/treatment • Cox proportional hazards model • Observation time: • Entry point: from HIV diagnosis at antenatal clinic • End point: enrolment in HIV care/treatment • Censored point: 20 January 2014

6. Results

7. Participants Characteristics

8. Participants Characteristics cont.

9. Linkage from PMTCT to HIV care/treatment As of 20 January, 2014

10. Probability of enrolment in HIV care/treatment

11. From HIV Diagnosis to ART initiation As of 20 January 2014 *21/48 (43.8%) *108/195 (55.4%)

12. Predictors for enrolment in HIV care/treatment

13. Predictors for enrolment in HIV care/treatment (cont.)

14. Summary

15. Poor linkage from PMTCT to HIV care/treatment • 53% of new HIV-positive mothers have not enrolled in HIV care/treatment • 55% of new HIV-positive mothers were not tested CD4 count after diagnosis of HIV • 44% of mothers with CD4<350 have not started ART

16. Risk factors for not enrolled in HIV care/treatment • Younger maternal age • Attending rural health centers not providing HIV care/treatment

17. Conclusion Strengthening linkage between PMTCT and HIV care and treatment services needed - Option B+ implementation (Apr 2014-) - Treatment is offered to HIV + partners regardless of CD4 count - Future evaluation of Option B+ implementation needed

18. Acknowledgements • Study participants • Ministry of Health, Zambia • Ministry of Community Development, Mother and Child Health, Zambia • Japan International Cooperation Agency (JICA) • National Center for Global Health and Medicine, Japan (NCGM) • The University of Tokyo • Midwives and community-based volunteers at study sites

19. Thank you very much for your attention For further information: shimaproject@gmail.com