Abstract
BackgroundWe assessed the integration of PMTCT services during the postpartum period including early infant diagnosis of HIV (EID) and adult and pediatric antiretroviral therapy (ART) in maternal and child health (MCH) facilities in ZimbabweMethods and FindingsFrom August to December 2012 we conducted a cross-sectional survey of a nationally representative sample of 151 MCH facilities. A questionnaire was used to survey each site about staff training, dried blood spot sample (DBS) collection, turnaround time (TAT) for test results, PMTCT services, and HIV care and treatment linkages for HIV-infected mothers and children and HIV-exposed infants. Descriptive analyses were used.Of the facilities surveyed, all facilities were trained on DBS collection and 92% responded. Approximately, 99% of responding facilities reported providing DBS collection and a basic HIV-exposed infant service package including EID, extended nevirapine prophylaxis, and use of cotrimoxazole. DBS collection was integrated with immunisations at 83% of facilities, CD4 testing with point-of-care machines was available at 37% of facilities, and ART for both mothers and children was provided at 27% of facilities. More than 80% of facilities reported that DBS test results take >4 weeks to return; TAT did not have a direct association with any specific type of transport, distance to the lab, or intermediate stops for data to travel.ConclusionsZimbabwe has successfully scaled up and integrated the national EID and PMTCT programs into the existing MCH setting. The long TAT of infant DBS test results and the lack of integrated ART programs in the MCH setting could reduce effectiveness of the national PMTCT and ART programs. Addressing these important gaps will support successful implementation of the 2014 Zimbabwe's PMTCT guidelines under which all HIV-infected pregnant and breastfeeding women will be offered life-long ART and decentralized ART care.
Highlights
HIV infections continue to be a source of significant mortality in the pediatric population
Of 139 responding facilities, 100% reported having at least one staff member trained in collecting dried blood spot sample (DBS) samples for HIV deoxyribonucleic acid (DNA) testing (Table 1), and 98% (n = 136) reported providing postnatal care services
DBS collection scheduled at 6 weeks postpartum was reportedly provided in 99% (n = 138) of the facilities, the National Microbiology Reference Laboratory (NMRL) report indicated that DBS was submitted from all selected facilities in 2012
Summary
HIV infections continue to be a source of significant mortality in the pediatric population. Mortality is high among HIV-infected infants in their first year of life; approximately 30% of HIV-positive children do not survive to their first birthday, and half die before the age of two years [2]. Mother-to-child transmission of HIV (MTCT) is by far the most common source of pediatric HIV infection, responsible for greater than 90% of new HIV infections among infants [3]. In an effort to reduce mortality of children less than five years of age, the World. Prevention of mother-to-child-transmission (PMTCT) interventions can reduce MTCT to less than 5% [4]. We assessed the integration of PMTCT services during the postpartum period including early infant diagnosis of HIV (EID) and adult and pediatric antiretroviral therapy (ART) in maternal and child health (MCH) facilities in Zimbabwe
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