Prevention of Mother-to-Child Transmission
Since 2006, with CDC support, the Boston University/ZCAHRD has provided extensive technical assistance to the Zambian Ministry of Health (MOH) for prevention of mother-to-child transmission (PMTCT) of HIV in 8 of 11 Districts in Zambia’s Southern Province through two CDC-funded mechanisms (1U2GPS001418-0 and 55U62PS622410). BU/ZCAHRD directly supports 203 (90%) of the 222 health centers implementing the MOH expansion of PMTCT, providing the health sector with technical, procurement, and infrastructure refurbishment assistance. Over the last seven years, BU/ZCAHRD’s successes have included: establishing a pilot program at 10 antenatal clinics providing antiretroviral therapy (ART) to pregnant women with CD4 counts below 350 cells/ml during antenatal visits and providing ART to the uninfected partner in discordant couples; increasing counseling and HIV testing to >90% of pregnant women attending antenatal clinics (ANC) across Southern Province; achieving >50% couples HIV testing and counseling; establishing a community register for mother-baby follow up; extensive integration into the community by closely working with tribal leaders; refurbishment of 5 mothers shelters, 4 clinics and 7 staff houses, antenatal clinic areas; and developing an SMS messaging system to hasten early delivery of early infant diagnosis (EID) PCR results.
BU/ZCAHRD directly supports 203 of the 222 health centers (90% total) in 8 of the 11 Southern Province Districts in the implementation of the MOH’s expansion of the four-prong PMTCT package and EID program. BU/ZCAHRD has provided PMTCT technical and other assistance to facilities, which, since 2006, have received over 325,000 first ANC visits. Through our efforts to train providers and promote adoption of universal opt-out HIV testing, these health centers have achieved an HIV testing and counseling uptake of 97% among first ANC visitors, and 73% of HIV-uninfected women have been tested twice during pregnancy. Testing of women with their spouses has improved from 37% to over 50%, and over 39,000 infants have had follow up HIV testing prior to 18 months of age.
Embedded within this PMTCT effort are several subprojects that BU/ZCAHRD has implemented in an attempt to find innovative improvements to the delivery of PMTCT in Southern Province. Among them are:
- Boston University Prevention of Mother-to-Child Transmission Integration Project (BUPIP): Mother-to-child transmission of HIV is the leading cause of HIV infection in children under 15 in Zambia. The CGHD works closely with the Government of Zambia in the Southern Province to provide technical assistance to the health system to support prevention of mother-to-child transmission (PMTCT) of HIV.
- Early Infant Diagnosis of HIV Infection (EID): Project Mwana is a mHealth platform designed to help diminish the lengthy turn-around times early infant diagnosis of HIV infection. Prior to the pilot, the average time from sample collection to results returning to the facilities in Southern Province was approximately 60 days (BUPIP data). Project Mwana has significantly decreased the time interval for EID, which is critical for early intervention.
- mUbumi: Reduction of maternal morbidity and mortality in low and middle-income countries is achievable if health facilities have the capacity to provide quality MCH care and basic EmONC and if there is adequate demand for services amongst women. In order to continue to reduce maternal mortality, the mHealth team has piloted a customized mobile health (mHealth) platform, Project mUbumi, designed to assist CSVs in the follow-up of pregnant women at the community level.
- Protocol for Program Evaluation of the Antiretroviral – Antenatal Care Integration Project in Southern Zambia: This project is an evaluation of one of the projects implemented by Zambia’s Southern Province Ministry of Health in several health centers to address the gap between services offered and services received by pregnant women in antenatal clinics.
- Protocol for Program Evaluation of the Rapid Syphilis Test Implementation Project in Southern Zambia: With implementation of new a new test, the Government of Zambia needs to evaluate the impact of adding another point-of-care test to the antenatal care package. This project will evaluate the implementation of the RST in antenatal clinics.
- Saving Mothers Giving Life (SMGL): Initiated by the United States Government (USG) in 2011, the global partnership for Saving Mothers, Giving Life (SMGL) is a public-private partnership with the aim of reducing maternal mortality by 50% during the first phase of implementation (June 1, 2012 – May 31, 2013) in four districts in Zambia. To achieve this goal, the partnership has focused its efforts on: (1) increasing demand for maternal and newborn health services and (2) improving the quality of care in public health facilities, with particular attention to emergency obstetric and newborn care (EmONC).
- Costs and Outcomes of HIV Treatment: When CGHD began its work on the economics of HIV in sub-Saharan Africa, few estimates were available of simple parameters such as the average cost of ART per patient treated. CGHD developed a methodology and model for using retrospective cohort data from local clinics and hospitals to estimate costs. When information about the outcomes of treatment was combined with these cost estimates, theresults indicated the cost per patient retained in care and responding successfully to treatment—a “production cost” for HIV treatment. This approach has been applied to estimate treatment costs in South Africa, Zambia, Kenya, and Uganda, and for both adults and children. It has also been expanded to allow cost-effectiveness comparisons among different models of service delivery—such as ART managed by doctors at hospitals v. nurses at clinics—and between different antiretroviral drugs, such as tenofovir and stavudine.
- Costs of HIV Prevention: Although HIV prevention has not been a major area of research for CGHD’s health economics team, studies have been undertaken to estimate the costs of prevention of mother to child transmission (PMTCT) in Zambia and Kenya and of delivery of safe male circumcision in Uganda.
|Principal Investigator||Donald M. Thea|
|Boston University Co-Investigators||Godfrey Biemba, Leoda Hamomba, Arthur Mazimba, Irene Miti Singog, Kaluba Mataka, Julie Herlihy, Bruce Larson, Katherine Semrau, Chris Gill, David Hamer, Rachael Bonawitz, Emily Hammond, Corrie Haley, Julia Rohr|
|Dates of Activity||2006–2014|