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

Evaluation of the National PMTCT Programme – in collaboration with UC Berkeley

We conducted three serial population representative cross sectional surveys to evaluate Zimbabwe’s PMTCT program, with each survey evaluating a di?erent WHO-recommended PMTCT approach: pre-Option A (baseline), option A, and Option B+ in 2012, 2014 and 2018 respectively

PMTCT =Prevention of mother to child transmission of HIV MTCT=Mother to child transmission of HIV

 

Zimbabwe has made remarkable progress increasing coverage of PMTCT services and reducing MTCT. MTCT decreased across the survey rounds as shown in Fig 1. These data were useful for informing practice; an example of this is shown below.

 

Data integration exercise

In 2019 we conducted a data integration exercise where we integrated our survey data with program data from OPHID and Ministry of Health, and modelling data from National AIDS Council in order to derive lessons for strengthening implementation and documentation of the national PMTCT program.

 

We found that i) data integration is feasible; ii) there is facility-level variability in implementation of services and, iii) there are gaps in post-delivery cascades for mothers and babies. We prosed a data strengthening exercise as detailed in the ?gure*.

*Sibanda et al, JIAS 2020