Community Based HIV Screening in Pregnant Women and Provision of Prevention of Mother to Child Transmission Care in Rural Zambia

Abstract

Background: Providing care for pregnancy is compounded by high HIV prevalence in Zambia. Approximately 10% of new HIV infections in children 0-14 years old occur as mother to child transmission (MTCT). Objective: To establish the capacity of the community to screen for HIV in pregnant women with saliva test and provide PMTCT, in a continuum of care. Methods: This study is a sub-set of a community based prospective cluster randomized controlled trial, (RCT) conducted 2008 to 2013. Oraquick, an FDA approved technology uses saliva to screen for HIV1 and HIV2. CBAs were trained, supervised and provided with job aids. Results: From 3846 pregnant women in the RCT, 2018 were screened. Among the 2018, 1089 (45.8%) were screened using Oraquick saliva test. Of the total tested for HIV, 23.8% had Oraquick only testing, 46% routine tests only and 30.2% had both tests done. Of the 1089, 608 participants (55.85%) screened using Oraquick, also had their test results confirmed with routine antibody tests at nearby health centers. The community based agents counselled, screened, dispensed nevirapine and referred appropriately. Eighty two (4%) out of the 2018 women were recorded as HIV positive. These include 47 (5.93%) women tested with Oraquick and 35 who were tested at the health centres using routine HIV testing. Conclusion: CBAs demonstrated that when trained, equipped and supported with incentives, they are able to screen the community for HIV utilizing Oraquick saliva testing and provide PMTCT.They provided increased access to HIV screening and PMTCT services.