Buzdugan R., McCoy S.I., Watadzaushe C., Dufour M.-S.K., Petersen M., Dirawo J., Mushavi A., Mujuru H.A., Mahomva A., Musarandega R., Hakobyan A., Mugurungi O., Cowan F.M., Padian N.S.
School of Public Health, University of California, Berkeley, CA, United States; Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe; School of Medicine, University of California San Francisco, San Francisco, CA, United States; Ministry of Health and Child Care, Harare, Zimbabwe; University of Zimbabwe, Harare, Zimbabwe; Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe; Children's Investment Fund Foundation, London, United Kingdom; Research Department of Infection and Population Health, University College London, London, United Kingdom
Buzdugan, R., School of Public Health, University of California, Berkeley, CA, United States; McCoy, S.I., School of Public Health, University of California, Berkeley, CA, United States; Watadzaushe, C., Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe; Dufour, M.-S.K., School of Medicine, University of California San Francisco, San Francisco, CA, United States; Petersen, M., School of Public Health, University of California, Berkeley, CA, United States; Dirawo, J., Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe; Mushavi, A., Ministry of Health and Child Care, Harare, Zimbabwe; Mujuru, H.A., University of Zimbabwe, Harare, Zimbabwe; Mahomva, A., Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe; Musarandega, R., Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe; Hakobyan, A., Children's Investment Fund Foundation, London, United Kingdom; Mugurungi, O., Ministry of Health and Child Care, Harare, Zimbabwe; Cowan, F.M., Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe, Research Department of Infection and Population Health, University College London, London, United Kingdom; Padian, N.S., School of Public Health, University of California, Berkeley, CA, United States
Objective: We estimated HIV-free infant survival and mother-to-child HIV transmission (MTCT) rates in Zimbabwe, some of the first community-based estimates from a UNAIDS priority country. Methods: In 2012 we surveyed mother-infant pairs residing in the catchment areas of 157 health facilities randomly selected from 5 of 10 provinces in Zimbabwe. Enrolled infants were born 9-18 months before the survey. We collected questionnaires, blood samples for HIV testing, and verbal autopsies for deceased mothers/infants. Estimates were assessed among i) all HIV-exposed infants, as part of an impact evaluation of Option A of the 2010 WHO guidelines (rolled out in Zimbabwe in 2011), and ii) the subgroup of infants unexposed to Option A. We compared province-level MTCT rates measured among women in the community with MTCT rates measured using program monitoring data from facilities serving those communities. Findings: Among 8568 women with known HIV serostatus, 1107 (12.9%) were HIV-infected. Among all HIV-exposed infants, HIV-free infant survival was 90.9% (95% confidence interval (CI): 88.7-92.7) and MTCT was 8.8% (95% CI: 6.9-11.1). Sixty-six percent of HIV-exposed infants were still breastfeeding. Among the 762 infants born before Option A was implemented, 90.5%(95% CI: 88.1-92.5) were alive and HIV-uninfected at 9-18 months of age, and 9.1% (95%CI: 7.1-11.7) were HIV-infected. In four provinces, the community-based MTCT rate was higher than the facility-based MTCT rate. In Harare, the community and facility-based rates were 6.0% and 9.1%, respectively. Conclusion: By 2012 Zimbabwe had made substantial progress towards the elimination of MTCT. Our HIV-free infant survival and MTCT estimates capture HIV transmissions during pregnancy, delivery and breastfeeding regardless of whether or not mothers accessed health services. These estimates also provide a baseline against which to measure the impact of Option A guidelines (and subsequently Option B+).