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What happens to the babies? Factors associated with PMTCT outcomes among a community sample of HIV-exposed infants from Zimbabwe Frances M Cowan, Raluca.

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Presentation on theme: "What happens to the babies? Factors associated with PMTCT outcomes among a community sample of HIV-exposed infants from Zimbabwe Frances M Cowan, Raluca."— Presentation transcript:

1 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

2 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

3 Simulation of cumulative LTFU of exposed infants - SSA

4 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

5 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

6 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).

7 Survey Sample Random sample of women living in catchment areas of 157 randomly selected health facilities offering PMTCT services in: 1. Mashonaland West 2. Mashonaland Central 3. Harare 4. Matabeleland South 5. Manicaland

8 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

9 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]

10 Results: Maternal PMTCT Cascade:

11 Results: Uptake of postnatal services

12 Results: Uptake of Infant PMTCT Services (997 biological mothers who self-reported HIV positive status) * Among mothers who delivered at health facilities

13 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 PR95% CIp value Mother found out she is HIV+… Before pregnancy1.00 During pregnancy <0.001 Mother received ARV prophylaxis <0.001 Infant delivered at home <0.001 Mother visited health facility for herself (last year)

14 Which infants were HIV tested? Maternal & infant characteristicsPR95% CIp value Mother/ infant on ARV prophylaxis No ARVs1.00<0.001 Maternal ARVs only Infant ARVs only Both maternal & infant ARVs Mother visited health facility for herself (last year) Infant was hospitalized Note: Poisson regression (n=995), outcome: infant HIV testing; controlling for age and whether living with mother in law; PR=prevalence ratio

15 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.

16 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

17 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

18 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


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