pmtct in zimbabwe
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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
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
Simulation of cumulative LTFU of exposed infants - SSA
HIV positive women at ANC registration
Infants delivered at facility
Infants tested for HIV (EID)
Infants remaining in follow-up after HIV
testing
10
20
30
40
50
60
70
80
90
100
Impact Evaluation
• Impact evaluation of Zimbabwe MoHCW’s accelerated PMTCT program (WHO Option A)
• External evaluators: University of California Berkeley, CeSHHAR Zimbabwe and University College London
• Funding: Children’s Investment Fund Foundation
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
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).
1 2
3
4
5
Survey SampleRandom sample of women living in catchment areas of 157 randomly selected health facilities offering PMTCT services in:
1. Mashonaland West2. Mashonaland Central3. Harare4. Matabeleland South5. Manicaland
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
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]
Results: Maternal PMTCT Cascade:
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
0
200
400
600
800
1000
1200100% 94% 92% 92%
77%
100%
All women (n=8662)HIV-positive women (n=997)
Step in the PMTCT Cascade
No.
wom
en
No.
HIV
pos
itive
wom
en
12%
67%
Results: Uptake of postnatal services
Attended postnatal visit Immunization visit0
102030405060708090
100
66
80
94 9896 98
Not testedNegativePositive
Results: Uptake of Infant PMTCT Services (997 biological mothers who self-reported HIV positive status)
683 [66%]
[62%]*610
[58%]516
[52% (85%)]
33[3.3% (6.4%)]
28[2.8%(86%)]
* Among mothers who delivered at health facilities
Which infants received ARV prophylaxis?
Note: Poisson regression (n=981), outcome: infant ARV prophylaxis; controlling for education and marital status; PR=prevalence ratio
Maternal characteristics
PR 95% CI p value
Mother found out she is HIV+…
Before pregnancy 1.00 During pregnancy 1.16 1.07 1.26 <0.001
Mother received ARV prophylaxis 4.29 2.99 6.15 <0.001Infant delivered at home 0.52 0.42 0.64 <0.001Mother visited health facility for herself (last year) 1.17 1.06 1.30 0.003
Which infants were HIV tested?Maternal & infant characteristics PR 95% CI p
value
Mother/ infant on ARV prophylaxis
No ARVs 1.00 <0.001Maternal ARVs only 5.86 3.80 9.02 Infant ARVs only 6.29 3.93 10.06 Both maternal & infant ARVs 7.11 4.54 11.14
Mother visited health facility for herself (last year) 1.17 1.05 1.30 0.006Infant was hospitalized 1.13 1.02 1.26 0.024
Note: Poisson regression (n=995), outcome: infant HIV testing; controlling for age and whether living with mother in law; PR=prevalence ratio
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.
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
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
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