Low uptake of prevention of mother-to-child transmission of HIV (PMTCT) services in resource-limited settings requires new approaches to prevent missed opportunities. Routine HIV testing ("opt-out" testing) in antenatal care (ANC) should be considered. An exploratory cross-sectional survey was conducted in 6 PMTCT sites in rural Zimbabwe. Women who had attended ANC in health centers where PMTCT was provided were surveyed in postnatal services. Of 520 women sampled, 285 (55%) had been HIV tested during their last pregnancy. Primary education or no education (P = 0.02), reporting receiving neither group education in the ANC clinic (P < 0.001) nor individual pretest counseling (P < 0.001), and having attended <6 ANC visits (P < 0.03) were associated with not having been HIV tested. Among the 235 women not HIV tested in ANC, 79% would accept HIV testing if opt-out testing was introduced. Factors associated with accepting the opt-out approach were being <20 years old (P = 0.005), having secondary education or more (P = 0.03), living with a partner (P = 0.001), and the existence of a PMTCT service where the untested women delivered. Thirty-seven women of 235 (16%) would decline routine HIV testing, mainly because of their fear of knowing their HIV status and the need to have their partner's consent. Among the women already tested in ANC (n = 285), 97% would accept the opt-out approach. In Zimbabwe, where 25% of pregnant women are HIV infected, introducing the opt-out strategy for HIV testing may have a far-reaching public health impact on PMTCT. Issues regarding, stigma, quality of post-testing counseling and staffing must be considered, however.

Background Vitamin A supplementation (VAS) has been implemented in over 82 countries globally, primarily because of its beneficial effect in preventing child mortality. Secular reductions in child mortality and the implementation of alternative programs to promote Vitamin A intake have led to questions on the need of national VAS programs. Objectives This study aimed to estimate child mortality changes related to VAS using current, scale-back, and scale-up coverage scenarios. Methods Data related to demographic characteristics, fertility, intervention coverage, anthropometry, child mortality and cause-of-death structure was integrated into the Lives Saved Tool (LiST). We estimated the cause-specific (LiST model) and all-cause mortality reductions related to VAS based on evidence from recent meta-analyses. Results Between 2008 and 2018, VAS coverage declined in most sub-Saharan African (SSA) countries. In 2019 alone, a 12% and 24% reduction in all-cause mortality related to VAS is expected to avert from 105,332 to 234,704 child deaths in SSA, respectively; whereas the cause-specific mortality model (LiST) estimated that 141,670 child deaths were averted in 2019. Estimates of VAS related child mortality reductions were highly variable among countries. Our scaling-back scenario led to highly variable country-level results, with expected increases in mortality rate from a low of 0.04 to as high as 49.3/1000 live births, suggesting that some countries could start considering scaling-back, while others need to scale-up. Conclusion Excess child mortality preventable by VAS has declined, but is still significant in many SSA countries. While scale-up of VAS is needed for most of the countries, scaling-back can also start to be considered in some countries. Policy decisions, however, should be guided by more recent data on food consumption, vitamin A status, child health, and vitamin A fortification coverage data.