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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 DirectorXIX International AIDS Conference

Washington DC22/07/2012

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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

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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 2006

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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

Launch of the Zimbabwe national program on elimination of new HIV infections in children,

January 2011

Minister of Health and Child Welfare speaking

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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

All EGPAF-Supported Districts Implementing 2010 PMTCT Guidelines by

End of 2011

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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 2010

• 5,890 (37%) identified ART-eligible pregnant women received ART in ANC– Up from 2,498 (17%) in 2010

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

PMTCT guidelines

2010 20110%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%%

of A

NC

faci

lities

WHO 2006

WHO 2010

WHO 2006

WHO 2010

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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)

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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

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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