Use of data from various sources to evaluate and improve the prevention of mother‐to‐child transmission of HIV programme in Zimbabwe: a data integration exercise

Abstract

IntroductionDespite improvements in prevention of mother‐to‐child transmission (PMTCT) of HIV outcomes, there remain unacceptably high numbers of mother‐to‐child transmissions (MTCT) of HIV. Programmes and research collect multiple sources of PMTCT data, yet this data is rarely integrated in a systematic way. We conducted a data integration exercise to evaluate the Zimbabwe national PMTCT programme and derive lessons for strengthening implementation and documentation.MethodsWe used data from four sources: research, Ministry of Health and Child Care (MOHCC) programme, Implementer – Organization for Public Health Interventions and Development, and modelling. Research data came from serial population representative cross‐sectional surveys that evaluated the national PMTCT programme in 2012, 2014 and 2017/2018. MOHCC and Organization for Public Health Interventions and Development collected data with similar indicators for the period 2018 to 2019. Modelling data from 2017/18 UNAIDS Spectrum was used. We systematically integrated data from the different sources to explore PMTCT programme performance at each step of the cascade. We also conducted spatial analysis to identify hotspots of MTCT.ResultsWe developed cascades for HIV‐positive and negative‐mothers, and HIV exposed and infected infants to 24 months post‐partum. Most data were available on HIV positive mothers. Few data were available 6‐8 weeks post‐delivery for HIV exposed/infected infants and none were available post‐delivery for HIV‐negative mothers. The different data sources largely concurred. Antenatal care (ANC) registration was high, although women often presented late. There was variable implementation of PMTCT services, MTCT hotspots were identified. Factors positively associated with MTCT included delayed ANC registration and mobility (use of more than one health facility) during pregnancy/breastfeeding. There was reduced MTCT among women whose partners accompanied them to ANC, and infants receiving antiretroviral prophylaxis. Notably, the largest contribution to MTCT was from postnatal women who had previously tested negative (12/25 in survey data, 17.6% estimated by Spectrum modelling). Data integration enabled formulation of interventions to improve programmes.ConclusionsData integration was feasible and identified gaps in programme implementation/documentation leading to corrective interventions. Incident infections among mothers are the largest contributors to MTCT: there is need to strengthen the prevention cascade among HIV‐negative women.

Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery

“…The trial design has been described in detail elsewhere. 34 Briefly, between March and December 2019, we conducted a three-arm cRCT comparing two models of peer delivery of HIVST (incentivised peer networks (IPN) and direct distribution by trained area-based peer navigators) with standard of care (SOC, referral by peer navigators to HIV testing, prevention and care services) for increasing the uptake of biomedical HIV prevention (PrEP) or ART among young women (18)(19)(20)(21)(22)(23)(24) and all young people (aged [18][19][20][21][22][23][24][25][26][27][28][29][30].…”

“…Peer navigators in the IPN distribution arm spent less time (5039 hours total) implementing the intervention and distributed the highest number of referral packs (1585, 38.1% of total). Peer navigators in the eight IPN clusters approached n=55 seeds (women aged [18][19][20][21][22][23][24], this resulted in n=216 incentivised respondents during 6 months and seven recruitment waves. The structure of the social networks through which distribution occurred in the IPN arm is summarised in figure 2.…”

“…7 12 17 30 31 We also hypothesised that mobilising social networks to distribute HIVST using incentivised peer-led methods (respondent-driven sampling) would extend the reach of HIVST and demand for PrEP among young people who were most at-risk compared with direct distribution. 19 32 33 The aim of this cluster-randomised controlled trial (cRCT) was to investigate whether HIVST delivered by peers, either directly or through incentivised social networks, would increase demand for PrEP/ART among adolescent girls and young women aged 18-24 years and all young people (aged [18][19][20][21][22][23][24][25][26][27][28][29][30] in a rural setting with a high burden of HIV in KZN, SA.…”

“…Outcome of the cRCT: PrEP/ART linkage rate A: Primary outcome: intention to treat analysis among women aged[18][19][20][21][22][23][24] …”

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

“…In Zimbabwe, neonatal mortality has been a particularly stubborn problem: it increased from 27/1000 to 32/1000 live births between 1990 and 2019, in part re ecting economic hardship and high HIV prevalence [22]. This increase occurred despite high coverage of prevention of mother-to-child transmission (PMTCT) interventions (> 90% in 2018) [23], antenatal care (93% with ≥ 1 visit and 74% with ≥ 4 visits), and institutional deliveries (88%) [24]. The Sanitation Hygiene Infant Nutrition E cacy (SHINE) trial was a cluster-randomized community-based trial conducted in two contiguous rural Zimbabwean districts (Chirumanzu and Shurugwi) which tested the independent and combined effects of improved infant and young child feeding (IYCF) and improved water, sanitation, and hygiene (WASH) on child health outcomes.…”