UNAIDS has set the ambitious target of eliminating mother to child transmission of HIV through implementation of antiretroviral therapy based prevention of mother to child transmission (PMTCT) programmes. Although substantial progress has been made over the years, in 2018 160,000 children were estimated newly infected in the 23 countries that are part of the Start Free Stay Free AIDS Free Initiative (https://free.unaids.org/).

The World Health Organization (WHO) has regularly updated their PMTCT guidelines for developing countries, in response to new evidence about the efficacy of PMTCT regimens. In 2010, WHO recommended ‘Option A’. In 2013, WHO updated their guidelines, recommending that all pregnant women, regardless of clinical stage, receive ART at a minimum during pregnancy and breastfeeding (Option B) or ideally lifelong (Option B+).

Option A was implemented in Zimbabwe starting 2011. And Option B+ was implemented starting in 2014. CeSHHAR, in partnership with Ministry of Health and Child Care, University California Berkeley and others has been evaluating the population level impact of these programmes and working Ministry to bring about elimination of paediatric HIV in Zimbabwe

Funding Source: Children’s Investment Fund Foundation; National Institutes of Health

Funding period: February 2012 to June 2019

In 2010, the World Health Organisation (WHO) released guidelines for prevention of mother-to-child transmission (PMTCT) that recommended countries adopt one of two regimens: initiation of two antiretroviral drugs (option A) or of antiretroviral therapy (ART) (option B) to be taken for the duration of transmission risk. Option B+ is further modified such that HIV infected women are initiated on lifelong ART during pregnancy or breastfeeding irrespective of their CD4 count.

Option B+ is anticipated to address key challenges in the implementation of previous World Health Organization (WHO) guidelines for the prevention of mother-to-child transmission of HIV (PMTCT). However,key gaps remain in the evidence supporting Option B+’s impact on HIV-free survival and mother-to-child transmission of HIV (MTCT) when taken to scale.

CeSHHAR with University of California Berkeley is conducting an impact evaluation of Zimbabwe’s National eradication of mother to child transmission program (eMTCT). In 2012 our team conducted a community survey of over 9,000 mother-infant pairs that were born before the implementation of Option A; providing the first community based evidence of MTCT in Zimbabwe. Between October 2013 and September 2014, MoHCC rolled out Option B+, requiring integration of PMTCT and ART services in all 1,560 facilities.

In 2014, we conducted a post-Option A / pre-Option B+ survey of 10,000 mother-infant pairs using methodology similar to that of our 2012 survey. In 2017, we will survey 13,000 mother–infant pairs and will assess the impact of Option B+ using two strategies. First, we will compare outcomes from 2017 versus 2012, permitting a comparison of Option B+ to the standard of care prior to the implementation of Option A (Aim 1a).

Second, we will compare outcomes from 2017 to those from 2014, permitting a direct assessment of the value-added of Option B+ over Option A (Aim 1b). The surveys have already resulted in a large number of publications (http://www.ceshhar.org.zw/publications).

The results will have direct relevance for the national PMTCT programme in Zimbabwe and for other developing countries that are considering Option B+, irrespective of whether they implemented previous WHO guidelines including Option A.