Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

Abstract

Background We assessed Zimbabwe’s progress towards elimination of mother-to-child HIV transmission (eMTCT) under Option A. Methods We analyzed 2012 and 2014 cross-sectional serosurvey data from mother-infant pairs residing in the same 157 health facility catchment areas (CA) randomly sampled from 5 provinces. Eligible women were ≥16 years and mothers/caregivers of infants born 9–18 months prior. We aggregated individual-level questionnaire and HIV serostatus within CA or district to estimate MTCT and the number of HIV-infected infants; these data were mapped using facility GPS coordinates. Findings A weighted population of 8,800 and 10,404 mother-infant pairs was included from 2012 and 2014, respectively. In 2014, MTCT among HIV-exposed infants was 6.7% (95% confidence interval (CI): 5.2,8.6), not significantly different from 2012 (8.8%, 95%CI: 6.9,11.1, p=0.13). From 2012–2014, self-reported antiretroviral therapy or prophylaxis among HIV-infected women increased from 59% to 65% (p=0.05), as did self-reported infant antiretroviral prophylaxis (63% vs. 67%, p=0.08). In 2014, 65 (41%), 55 (35%), and 37 (24%) CAs had the same, lower, and higher MTCT rate as in 2012, respectively. MTCT in 2014 varied by CA (median=0%, mean=4.9%, interquartile range (IQR)=0–10%) as did the estimated number of HIV-infected infants (median=0, mean=1.1, IQR=0–1.0). Also in 2014, 106 (68%) CAs had MTCT=0%. Geovisualization revealed clustering of CAs where both MTCT and the estimated number of HIV-infected infants were relatively high. Interpretation Although MTCT is declining in Zimbabwe, geospatial analysis indicates facility-level variability. CAs with high MTCT rates and a high burden of HIV-infected infants should be the highest priority for service intensification.

Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda

“…Over 90% coverage of recommended antiretroviral treatment/prophylaxis during pregnancy is also consistent with UNAIDS targets for global elimination of MTCT, however the drop to 85.6% at 6–10 weeks is a concern as it is below the UNAIDS target for ART during breastfeeding of 90%. [ 10 ] The coverage figures for mothers and babies combined compare favorably to other studies, such as 65% in Zimbabwe, [ 13 ] 26% in rural Kenya, [ 11 ]. These figures also suggest approximately 10% missed opportunities for antiretroviral therapy/prophylaxis per Rwandan protocol in mother-baby pairs.…”

“…[ 9 ] Compared to regional studies of Option B or B+, this rate compares favorably to 10% MTCT found in Kenya and 6.7% in Zimbabwe. [ 12 , 13 ] The Rwanda national target is 2% at 18 months.…”

“…Other published early effectiveness studies of Option B or B+ have been only regional, not national studies with 10% MTCT found in Kenya [ 11 ] and 6.7% in Zimbabwe. [ 12 , 13 ] Finally, one paper has been published on the national 18-month effectiveness of the Zimbabwe EMTCT program during the transition from Option A to Option B. [ 14 ] Therefore, this study adds substantially to the current available literature on national effectiveness of Option B or B+ at 6–10 postnatal weeks.…”

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

“…While Southern and Eastern African countries such as Comoros, Malawi, Rwanda, South Africa, Burundi, and Uganda have seen a remarkable decline in MTCT transmission of HIV, many countries in West and Central Africa like Angola, Equatorial Guinea, the Gambia, Mali, and Niger have experienced an increase in transmission rate [2]. The intensification of the existing PMTCT program and scaling up of a nationwide program to accelerate MTCT elimination in Malawi, Zimbabwe, and South Africa have resulted in MTCT at 6-12weeks postpartum rate comparable to the 'global north' [3][4][5][6][7].…”

Evaluating the effectiveness of a multi-component intervention on early childhood development in paediatric HIV care and treatment programmes: a randomised controlled trial

“…The current prevalence of HIV is estimated to be 14.6% among 15–64 year olds in Zimbabwe [ 24 ]. Despite notable reductions in the mother-to-child transmission rates, to 6.7%, at the population level [ 25 ], UNAIDS estimated that mother-to-child transmission is 6.39% [ 26 ]. The number of children orphaned due to AIDS is estimated as 524,581 [ 26 ].…”