1 Innovative rapid scale-up of effective PMTCT services to achieve virtual elimination of new pediatric HIV infections: A Zimbabwe experience Dr. Agnes Mahomva (MBChB, MPH) Country Director XIX International AIDS Conference Washington DC 22/07/2012

Background Population of 12 million Health system challenged by – Depressed economy – HIV prevalence 14.3% in adults – HIV prevalence 16.1% in Pregnant women attending antenatal care (ANC) clinics 2

National Roll-Out of Effective PMTCT Services Roll-out of PMTCT services for elimination of new pediatric HIV infections is underway supported by: – Strong political commitment (3% AIDS levy) – Existing health infrastructure - a total of 1,560 health facilities provide ANC – All ANC facilities providing PMTCT services but mainly single-dose nevirapine by the end of

Roll-Out of the 2010 PMTCT Guidelines In 2011, EGPAF with USAID and CIFF funding collaborated with MOHCW to roll- out revised national PMTCT guidelines through – Stakeholder consultations on WHO PMTCT option selection (Option A chosen) – Integrated national PMTCT training curriculum and M&E tools – Health care worker training – Strategies and innovations for rapid scale-up 4

Launch of the Zimbabwe national program on elimination of new HIV infections in children, January Minister of Health and Child Welfare speaking

Innovative Strategies Introduction of PMTCT District Focal Persons – Coordination of all district PMTCT activities Deployment of point-of-care CD4 machines – Support early CD4 testing and ART for pregnant women in ANC Targeted advocacy and community engagement – Promote early ANC and minimize mother-baby loss to follow-up Coordination of three sub-grantees – Rapid roll-out of health care worker trainings nation wide 6

All EGPAF-Supported Districts Implementing 2010 PMTCT Guidelines by End of 2011

PMTCT Results (1) (by end of December 2011) 1,344 (86%) of 1,560 MOHCW ANC facilities implementing WHO 2010 PMTCT guidelines – Up from 134 (9%) in ,890 (37%) identified ART-eligible pregnant women received ART in ANC – Up from 2,498 (17%) in

Proportion of ANC facilities (N=1,560) implementing the 2010 versus the 2006 PMTCT guidelines

PMTCT Results (2) (by end of December 2011) A total of 367,498 pregnant women enrolled in 1,344 EGPAF supported sites – 96% (351,867) tested for HIV and received results – 12% (43,758) HIV-positive – 84% (36,760) of HIV-positive women received ARV prophylaxis (not including ART) – 56% (24,696) of HIV-exposed infants received ARV prophylaxis per 2010 guidelines (extended NVP) 10

Conclusions Rapid scale-up of effective national PMTCT services require: MOHCW leadership for coordination and national program strategic direction Meaningful collaboration with partners and donors as an essential component Use of innovative approaches and strategies 11

Acknowledgements Zimbabwe Ministry of Health and Child Welfare U.S. President’s Emergency Plan for AIDS Relief through USAID UK Department for International Development The Children’s Investment Fund Foundation EGPAF-FAI partners – J.F. Kapnek Trust, – OPHID Trust – ZAPP-UZ 12