Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience

Gannon, Hannah; Chappell, Elizabeth; Ford, Deborah; Gibb, Diana; Chimwaza, Anesu; Manika, Ngoni; Wedderburn, Catherine J; Nenguke, Zivai Mupambireyi; Cowan, Frances M; Gibb, Tom; Phillips, Andrew; Mushavi, Angela; Fitzgerald, Felicity; Heys, Michelle; Chimhuya, Simbarashe; Bwakura‐Dangarembizi, Mutsa

doi:10.21203/rs.3.rs-2670998/v1

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…In 2013, the Zimbabwe Ministry of Health and Child Care (MoHCC) adopted the WHO guideline which recommended the provision of lifelong ART to all HIV positive pregnant and breastfeeding women (Option B+) [24,25]. With the implementation of Option B +, pregnant women are encouraged to register for ANC services in the first 12 weeks of pregnancy and have at least eight antenatal contact visits [26].…”

Section: Pmtct In Zimbabwementioning

confidence: 99%

“…The risk of vertical transmission at 18 months postnatal was estimated at 15% in 2015 and had fallen to 7.8% in 2018 [21]. During 2019, 56% of HIV-exposed infants received early infant diagnosis (EID) [25]. Although progress has been made in reducing vertical transmission of HIV and syphilis, there were some gaps in the provision of PMTCT services before the COVID-19 pandemic.…”

Section: Pmtct In Zimbabwementioning

confidence: 99%

“…Uptake of ANC in this study is defined as seeking ANC services from trained healthcare providers and remaining in care pre-and postnatally while provision of care is referring to the provision of a range of ANC services on time by trained healthcare providers. This qualitative study was embedded within a larger mixedmethods study which retrospectively looked at the effects of COVID-19 on key PMTCT indicators, using programme (District Health Information System-2) and population-level data (ZIMSTAT) [24] and analysis of the outcomes of HIV-exposed neonates using NeoTree data [25].…”

Section: Pmtct In Zimbabwementioning

confidence: 99%

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“Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

Mupambireyi,

Cowan,

Chappell

et al. 2024

PLOS Glob Public Health

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The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal health services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers. Longitudinal in-depth interviews were conducted with 20 pregnant and breastfeeding women aged 20–39 years living with HIV and 20 healthcare workers in two maternity polyclinics in low-income suburbs of Harare, Zimbabwe. Semi-structured interviews were held after the second and third waves of COVID-19 in March and November 2021, respectively. Data were analysed using a modified grounded theory approach. While eight antenatal care contacts are recommended by Zimbabwe’s Ministry of Health and Child Care, women reported only being able to access two contacts. Although HIV testing, antiretroviral therapy (ART) refills and syphilis screening services were accessible at first contact, other services such as HIV-viral load monitoring and enhanced adherence counselling were not available for those on ART. Closure of clinics and shortened operating hours during the second COVID-19 wave resulted in more antenatal bookings occurring later during pregnancy and more home deliveries. Six of the 20 (33%) interviewed women reported giving birth at home, assisted by untrained traditional midwives as clinics were closed. Babies delivered at home missed ART prophylaxis and HIV testing at birth despite being HIV-exposed. Although women faced multiple challenges, they continued to attempt to access services after delivery. These findings underline the importance of investing in robust health systems that can respond to emergency situations to ensure continuity of essential HIV prevention, treatment, and care services.

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Section: Pmtct In Zimbabwementioning

confidence: 99%

Section: Pmtct In Zimbabwementioning

confidence: 99%

Section: Pmtct In Zimbabwementioning

confidence: 99%

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“Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

Mupambireyi,

Cowan,

Chappell

et al. 2024

PLOS Glob Public Health

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“Getting pregnant during the COVID 19 was a big risk because getting the help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

Mupambireyi

Cowan

Chappell

et al. 2023

Preprint

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Background The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal healthcare services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers. Methods Longitudinal in-depth interviews were conducted with 20 pregnant and breastfeeding women aged 20-39 years living with HIV and 20 healthcare workers in two maternity polyclinics in low-income suburbs of Harare, Zimbabwe. Semi-structured interviews were held after the second and third waves of COVID-19 in March and November 2021 respectively. Data were analysed using the modified grounded theory approach. Results While eight antenatal care contacts are recommended by Zimbabwe’s Ministry of Health and Child Care, women reported only being able to access two contacts. At antenatal booking, women were told to return at onset of labour; subsequent visits were suspended. Healthcare workers reported this reduction in antenatal attendance was a result of limited availability of personal protective equipment and fear that patients and services providers would contract SARS-CoV-2. Although HIV testing, antiretroviral therapy (ART) refills and syphilis screening services were accessible at first contact, other services such as HIV-viral load monitoring and enhanced adherence counselling were not available for those on ART. Closure of clinics and shortened operating hours during the second COVID-19 wave resulted in more antenatal bookings occurring later during pregnancy and more home deliveries. Six of the 20 interviewed women reported giving birth at home assisted by untrained traditional midwives as clinics were closed. Babies delivered at home missed ART) prophylaxis and HIV testing at birth despite being HIV-exposed. Although women were faced with multiple challenges, they continued to attempt to access services after delivery. Conclusions The COVID-19 pandemic disrupted provision and uptake of PMTCT services; antenatal care contacts were significantly reduced, home deliveries increased and babies born at home missed out on the necessary ARV prophylaxis. These findings underline the importance of investing in robust health systems that are able to respond to emergency situations to ensure continuity of essential HIV prevention, treatment and care services.

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Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study

Haghparast-Bidgoli,

Hull-Bailey,

Nkhoma

et al. 2023

JMIR Mhealth Uhealth

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Background Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap. Objective We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe. Methods We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented. Results Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50). Conclusion Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed.

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Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience

Cited by 4 publications

References 13 publications

“Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

“Getting pregnant during COVID-19 was a big risk because getting help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

“Getting pregnant during the COVID 19 was a big risk because getting the help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study

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