This study evaluates the impact of Zimbabwe's program for the prevention of mother-to-child HIV transmission (PMTCT) on vertical transmission of HIV infection and HIV-free survival among infants exposed to HIV. The study will test the hypothesis that the accelerated PMTCT program in Zimbabwe will result in fewer new HIV infections in infants and will increase infant survival.
The World Health Organization (WHO) recommends that all pregnant women receive antiretroviral therapy (ART) during pregnancy and breastfeeding ("Option B") or ideally throughout their lives regardless of clinical stage ("Option B+"). In February 2013, Zimbabwe's Ministry of Health and Child Welfare (MoHCW) declared that Zimbabwe would begin implementing Option B+ in October of 2013. This impact evaluation utilizes serial population-based, community-level surveys to comprehensively assess the prevention of mother-to-child HIV transmission strategy (PMTCT) 'Option B+' among mother-infant pairs in Zimbabwe. The investigators will assess the population-level impact of Option B+ in Zimbabwe using serial community-based cross-sectional serosurveys with data from three time points: 2012 (pre-Option A standard of care), 2014 (post-Option A / pre-Option B+), and 2017 (post Option B+ implementation) in order to monitor population-level trends in MTCT and HIV-free infant survival. The investigators will compare outcomes among infants from 2017 to outcomes among mother-infant pairs who participated in similar surveys conducted in 2012 and 2014. These community-level data, along with in-depth facility survey data, will also allow the investigators to examine impact heterogeneity by the extent of integration of PMTCT and ART services at the facility. Together with effectiveness data from the serosurveys, facility-level resource utilization and cost data will allow assessment of Option B+ cost-effectiveness. In addition, this study will also include a population-based, community-level survey conducted in 2017 to assess retention of mothers in ART services after weaning (19-36 months postpartum). These data will allow the investigators to assess HIV-infected mothers' retention in care at the time of the survey, when most mothers will have stopped breastfeeding
Study Type
OBSERVATIONAL
Enrollment
30,642
Vertical transmission of HIV infection
Proportion of infants born to HIV-infected mothers who were HIV-infected
Time frame: 9-18 months after birth
HIV-free survival among infants exposed to HIV
Proportion of infants born to HIV-infected mothers who were alive and HIV-uninfected
Time frame: 9-18 months after birth
Retention of mothers in antiretroviral therapy services (ART) services after weaning
The proportion of HIV-infected mothers who were initiated on ART and who continued ART after weaning
Time frame: 19-36 months postpartum
Time between weaning and discontinuation of antiretroviral therapy services (ART) among mothers who did not continue ART after weaning
Average time between delivery and discontinuation of ART among those mothers who did not continue ART
Time frame: 19-36 months postpartum
Heterogeneity of the impact of Option B+ on HIV-free survival among infants 9-18 months of age by the extent of integration of PMTCT and anti-retroviral therapy (ART) services at health facilities
HIV-free survival in health facility catchment areas stratified by the extent of integration of PMTCT and ART services at the health facility
Time frame: Baseline
Heterogeneity of the impact of Option B+ on mother-to-child transmission of HIV (MTCT) among infants 9-18 months of age by the extent of integration of PMTCT and anti-retroviral therapy (ART) services at health facilities
MTCT in health facility catchment areas stratified by the extent of integration of PMTCT and ART services at the health facility
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Time frame: Baseline
Cost-effectiveness of Option B+ compared to the standard of care before Option A
Facility costing data and HIV-free survival and MTCT in health facility catchment areas in 2012 compared to 2017
Time frame: Baseline
Cost-effectiveness of Option B+ compared to Option A
Facility costing data and HIV-free survival and MTCT in health facility catchment areas in 2012 compared to 2014
Time frame: Baseline
Variability in health facility accesibility
Accessibility of health facilities assessed using exit interviews with patients receiving care at health facilities
Time frame: Baseline
Variability in health facility quality of available services
Quality of available services at health facilities assessed using exit interviews with patients receiving care at health facilities, and clinical vignettes and time and motion studies with healthcare providers at health facilities
Time frame: Baseline
Variability in health facility appropriateness of available services
Appropriateness of available HIV testing and counseling (HTC), prevention of mother-to-child transmission of HIV (PMTCT) and male circumcision (MC) services assessed using clinical vignettes with healthcare providers at health facilities
Time frame: Baseline