IntRoductIon In 2018, an estimated 1.7 million children were living with human immunodeficiency v... more IntRoductIon In 2018, an estimated 1.7 million children were living with human immunodeficiency virus (HIV) globally, of whom 180,000 were newly infected. [1] At least 90% of children with HIV acquire the infection through vertical transmission. Prevention of mother-to-child transmission (PMTCT) of HIV intends to reduce the incidence of HIV infection among exposed infants and improve the overall health of these children. For instance, between 2010 and 2017, PMTCT contributed to a 35% reduction in new pediatric HIV infections. [2] Consequently, PMTCT is one of the strategies being used to close the tap of new HIV infections in both adults and children. [3] PMTCT includes HIV testing and antiretroviral therapy (ART) for HIV-infected mothers, prophylaxis for all HIV-exposed infants (HEIs), HIV testing using deoxyribonucleic acid polymerase chain reaction (DNA-PCR), and initiation of ART for all HIV-positive infants. Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.
Reduction of maternal mortality is Millennium Development Goal number five. A review of maternal ... more Reduction of maternal mortality is Millennium Development Goal number five. A review of maternal mortality notification trends in Mashonaland East Province, Zimbabwe showed that maternal mortality ratio was fluctuating. Quarterly parental and maternal mortality review meetings revealed that most of the maternal deaths were avoidable. A study to evaluate maternal mortality notification trends was conducted. A study based on a secondary data analysis of maternal mortality surveillance database for 2002-2011 was conducted at Mashonaland East Provincial offices. Microsoft Excel was used to generate graphs. Epi InfoTM was used to generate frequencies and odds ratios. A total of 338 maternal mortality surveillance notification forms were enrolled into the study. Maternal mortality ratio was lowest in 2002(19 per 100 000 live births) and highest in 2008 (245 per 100 000 live births). The median age of maternal death notifications was 27 years (Q1=23, Q3=33). Haemorrhage was the commonest d...
Introduction: In Mashonaland East Province, which is home to 186 PMTCT facilities, the Elizabeth ... more Introduction: In Mashonaland East Province, which is home to 186 PMTCT facilities, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) conducted a situation analysis to assess the quality of PMTCT program implementation in the province. Methods: A descriptive quantitative cross-sectional survey was conducted in June and July 2011 among nurses working at all 186 health facilities offering PMTCT services in Mashonaland East. District focal persons (DFPs; specialized EGPAF staff that support PMTCT implementation within districts) carried out the survey, which consisted of a questionnaire on provision of HIV testing and counseling, ARV prophylaxis, ART initiation, early infant diagnosis (EID), referral systems, HIV care, and human resources for PMTCT. Results: Of all facilities surveyed, 179 (96.2%) offered antenatal care (ANC) services. More than 80% offered HIV testing and counseling, and roughly 75% of facilities offered combination maternal and infant ARV prophylaxis (rather than...
Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are nee... more Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSP... more Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSPIRE (INtegrating and Scaling up PMTCT through Implementation REsearch) initiative. E4E is a clusterrandomized trial with 2 arms; Standard of care and "POC Plus" [in which point-of-care (POC) CD4 devices and related counseling support are provided]; aimed at improving retention-in-care of HIV-infected pregnant women and mothers. In November 2013, Zimbabwe adopted Option B+ for HIV-positive pregnant women under which antiretroviral treatment eligibility is no longer based on CD4 count. However, Ministry of Health and Child Care guidelines still require baseline and 6-monthly CD4 testing for treatment monitoring, until viral load testing becomes widely available. Considering the current limited capacity for viral-load testing, the significant investments in CD4 testing already made and the historical reliance on CD4 by health care workers for determining eligibility for antiretroviral treatment, E4E seeks to compare the impact of the provision of POC CD4 technology and early knowledge of CD4 levels on retention-in-care at 12 months, with the current standard of routine, laboratory-based CD4 testing. The study also compares rates of initiation and time-to-initiation between the 2 arms and according to level of maternal CD4 count, the cost of retaining HIV-positive pregnant women in care and the acceptability and feasibility of POC CD4 in the context of Option B+. Outcome measures are derived from routine health systems data. E4E will provide data on POC CD4 testing and retention-in-care associated with Option B+ and serve as an early learning platform to inform implementation of Option B+ in Zimbabwe.
IntRoductIon In 2018, an estimated 1.7 million children were living with human immunodeficiency v... more IntRoductIon In 2018, an estimated 1.7 million children were living with human immunodeficiency virus (HIV) globally, of whom 180,000 were newly infected. [1] At least 90% of children with HIV acquire the infection through vertical transmission. Prevention of mother-to-child transmission (PMTCT) of HIV intends to reduce the incidence of HIV infection among exposed infants and improve the overall health of these children. For instance, between 2010 and 2017, PMTCT contributed to a 35% reduction in new pediatric HIV infections. [2] Consequently, PMTCT is one of the strategies being used to close the tap of new HIV infections in both adults and children. [3] PMTCT includes HIV testing and antiretroviral therapy (ART) for HIV-infected mothers, prophylaxis for all HIV-exposed infants (HEIs), HIV testing using deoxyribonucleic acid polymerase chain reaction (DNA-PCR), and initiation of ART for all HIV-positive infants. Introduction: Prevention of mother-to-child transmission (PMTCT) is a key strategy for ending the human immunodeficiency virus (HIV) pandemic. Most studies have focused on the mothers' side of the PMTCT cascade or the rate of vertical HIV transmission. Information on child-focused cascade is limited. We aimed to evaluate HIV testing, antiretroviral therapy (ART), and cotrimoxazole prophylaxis uptake and associated factors among HIV-exposed infants (HEIs) born in 2017. Methods: This was a record-based descriptive study in Mashonaland East Province, Zimbabwe. We analyzed routinely collected program data abstracted from electronic and paper-based HEI registers. Uptakes were calculated as proportions while associations were measured using adjusted risk ratios (log-binomial regression). Results: Of 1028 HEIs, 1015 (98.7%) were commenced on nevirapine prophylaxis, while 915 (89.0%) were commenced on cotrimoxazole prophylaxis. A total of 880 (85.0%) HEIs were tested for HIV by 6 weeks and 445 (44.4%) by 9 months. Overall, 40 (3.9%) were found to be HIV positive, and of them, 34 (85.0%) commenced on ART. Secondary and tertiary health facilities, being born through nonvaginal delivery, and certain districts were significantly associated with not commencing cotrimoxazole prophylaxis or getting tested for HIV. One district was associated with less risk of not having an HIV test by 9 months. Conclusions: While nevirapine, cotrimoxazole, and ART uptake were high among the HEIs, HIV testing by 9 months was suboptimal. The vertical HIV transmission rate was 3.9%. There is a need to strengthen HIV testing and antiretroviral and cotrimoxazole prophylaxes, especially at high-level facilities and certain districts.
Reduction of maternal mortality is Millennium Development Goal number five. A review of maternal ... more Reduction of maternal mortality is Millennium Development Goal number five. A review of maternal mortality notification trends in Mashonaland East Province, Zimbabwe showed that maternal mortality ratio was fluctuating. Quarterly parental and maternal mortality review meetings revealed that most of the maternal deaths were avoidable. A study to evaluate maternal mortality notification trends was conducted. A study based on a secondary data analysis of maternal mortality surveillance database for 2002-2011 was conducted at Mashonaland East Provincial offices. Microsoft Excel was used to generate graphs. Epi InfoTM was used to generate frequencies and odds ratios. A total of 338 maternal mortality surveillance notification forms were enrolled into the study. Maternal mortality ratio was lowest in 2002(19 per 100 000 live births) and highest in 2008 (245 per 100 000 live births). The median age of maternal death notifications was 27 years (Q1=23, Q3=33). Haemorrhage was the commonest d...
Introduction: In Mashonaland East Province, which is home to 186 PMTCT facilities, the Elizabeth ... more Introduction: In Mashonaland East Province, which is home to 186 PMTCT facilities, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) conducted a situation analysis to assess the quality of PMTCT program implementation in the province. Methods: A descriptive quantitative cross-sectional survey was conducted in June and July 2011 among nurses working at all 186 health facilities offering PMTCT services in Mashonaland East. District focal persons (DFPs; specialized EGPAF staff that support PMTCT implementation within districts) carried out the survey, which consisted of a questionnaire on provision of HIV testing and counseling, ARV prophylaxis, ART initiation, early infant diagnosis (EID), referral systems, HIV care, and human resources for PMTCT. Results: Of all facilities surveyed, 179 (96.2%) offered antenatal care (ANC) services. More than 80% offered HIV testing and counseling, and roughly 75% of facilities offered combination maternal and infant ARV prophylaxis (rather than...
Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are nee... more Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSP... more Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSPIRE (INtegrating and Scaling up PMTCT through Implementation REsearch) initiative. E4E is a clusterrandomized trial with 2 arms; Standard of care and "POC Plus" [in which point-of-care (POC) CD4 devices and related counseling support are provided]; aimed at improving retention-in-care of HIV-infected pregnant women and mothers. In November 2013, Zimbabwe adopted Option B+ for HIV-positive pregnant women under which antiretroviral treatment eligibility is no longer based on CD4 count. However, Ministry of Health and Child Care guidelines still require baseline and 6-monthly CD4 testing for treatment monitoring, until viral load testing becomes widely available. Considering the current limited capacity for viral-load testing, the significant investments in CD4 testing already made and the historical reliance on CD4 by health care workers for determining eligibility for antiretroviral treatment, E4E seeks to compare the impact of the provision of POC CD4 technology and early knowledge of CD4 levels on retention-in-care at 12 months, with the current standard of routine, laboratory-based CD4 testing. The study also compares rates of initiation and time-to-initiation between the 2 arms and according to level of maternal CD4 count, the cost of retaining HIV-positive pregnant women in care and the acceptability and feasibility of POC CD4 in the context of Option B+. Outcome measures are derived from routine health systems data. E4E will provide data on POC CD4 testing and retention-in-care associated with Option B+ and serve as an early learning platform to inform implementation of Option B+ in Zimbabwe.
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