1. Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II

2. Outline: ZPCT II background Efforts made to cope with seroconversion Policy on re-testing Status in ZPCT II supported sites Trainings & promotion of re-testing Achievements & challenges Possible beneficial TA

3. ZPCT II background: ZPCT II is a follow on to ZPCT (2004-2009); funded by USAID/PEPFAR (June 2009 – May 2014) Supports the MOH to strengthen and expand HIV/AIDS services in five provinces ((T&C, PMTCT and CC/ART) :Central, Copperbelt, Luapula, Northern, North Western ZPCT currently supports 262 PMTCT facilities in 39 of Zambias 72 districts

4. Why the need for re-testing in PMTCT? Acute maternal HIV infection during pregnancy & BF is associated with very high rates of MTCT It is known that high maternal viral load increases the likelihood of perinatal transmission of HIV in women without AIDS and advanced immunosuppression. Women with newly acquired HIV infection are not usually identified by PMTCT programs Data is needed to estimate the contribution of acute HIV infection in women to nationwide MTCT in the ZPCT II program

5. Process to operationalize re-testing Field staff re-oriented on importance of re-testing after 3 months for those that test negative in accordance with national CT guidelines Orientation on documentation process for those that are re-tested (how, where to document within existing data collection tools) ZPCT II has started collecting monthly data on retesting & strengthening its documentation Re-testing study planned for June / July 2010

6. Trainings & promotion of re-testing Six day PMTCT trainings using approved national PMTCT training packages for: HCWs Community volunteers Emphasis is made to PMTCT providers during trainings Capacity building through onsite mentorship of providers No media or mass campaigns done on re-testing – only through technical assistance.

7. Achievements in implementing re-testing Re-testing has been operationalized in most FHI supported PMTCT sites Providers oriented and receiving ongoing mentorship Re-testing being documented and some program indicators developed

8. Seroconversion in ZPCT II supported sites

9. Status of seroconversion in ZPCT II supported facilities Vs other countries In the ZPCT II supported facilities, January to April 2010: 5,524 HIV negative women pregnant women were retested. 136 (2.5%) seroconverted Recent data on seroconversion in other countries: Botswana – 2.9%; RSA – 3%; Kenya – 2.6% & Swaziland – 4.4%

10. Challenges Much more needs to be done to reinforce the re-testing policy Rate of performing retesting still infrequent Documentation needs to be improved Low facility delivery – reported as 48% in 2007 ZDHS

11. Possible beneficial technical assistance Reinforcing the re-testing policies Strategies to enhance detection of newly acquired HIV- infection Forecasting for commodities to include seroconverters Mentoring providers in re-testing Documentation of re-testing

12. Thank you for your attention.