"CIDRZ created one of the earliest successful prevention of mother to child transmission programs in sub-Saharan Africa...Coupling the research and provision of services is unique and has placed CIDRZ in an appropriate respected leadership position." -- Catherine M. Wilfert, MD, Scientific Director, Elizabeth Glaser Pediatric AIDS Foundation
Scope of the Problem
Approximately one in five pregnant women in Zambia is infected with HIV. Not all babies born to infected mothers become infected themselves, but many do. In the absence of intervention, over 30,000 babies would contract HIV from their mothers each year. This risk can be reduced with relatively simple interventions.
Background of Prevention of Mother-to-Child Transmission of HIV
HIV can be transmitted from mother to baby during pregnancy (~5%-10%), during labor and delivery (~10 -20%), or during breastfeeding (~15%). About 40% of HIV-infected mothers in Zambia will transmit the virus to their babies if no intervention is available. This transmission risk can be reduced substantially with antiretroviral drugs. The simplest intervention used in Zambia is single dose nevirapine (SDNVP), a regimen of one tablet of the antiretroviral drug nevirapine to the mother at the time of labor onset and one dose to the baby after delivery. Use of SDNVP can reduce mother-to-child transmission by nearly half. Use of more efficacious regimens during pregnancy including Zidovudine (AZT) and triple-drug combination therapy, also known as highly active antiretroviral therapy (HAART), can reduce transmission rates to two percent or less. Recent studies have also shown the benefits of starting antiretroviral (ARV) prophylaxis for PMTCT earlier during pregnancy and the effectiveness of extending ARV prophylaxis to mothers or infants during the breastfeeding period in reducing risk for MTCT.
The Ministry of Health in Zambia to has adopted option A of the 2010 WHO PMTCT recommendations. These recommendations include:
HIV uninfected women will be tested every 3 months for the duration of pregnancy through the breastfeeding period.
HIV infected women with CD4>350 begin AZT prophylaxis at 14 weeks gestational age.
HIV-infected pregnant women with CD4 ≤ 350 or WHO Stage III/IV begin HAART as soon as possible, regardless of gestational age.
All HIV-infected pregnant women will receive cotrimoxazole prophylaxis after the first trimester through 6 weeks post-delivery regardless of CD4 count.
HIV exposed infants whose mothers are on HAART receive NVP prophylaxis daily from birth until 6 weeks of age.
HIV exposed infants whose mothers are not on HAART and
Breastfeeding: will receive NVP prophylaxis daily from birth until one week after cessation of breastfeeding.
Non-breastfeeding: will receive NVP prophylaxis daily from birth until 6 weeks of age.
CIDRZ supports the Zambian Ministry of Health PMTCT programs
Since 2001, CIDRZ has scaled up its technical and financial support to over 330 sites in the Eastern, Lusaka, and Western Provinces of Zambia. We have helped to train over 2000 healthcare providers on the PMTCT minimum package of care developed by the World Health Organization. The PMTCT program supports the Ministry of Health to provide a comprehensive package of services within the context of robust maternal and child health services. This includes:
Improving uptake of ANC services by demand creation throughout the community
Providing testing and counseling services for pregnant women and follow up antenatal, labor & delivery and postnatal visits
Providing testing and counseling for partners
Providing ARVs for PMTCT
Providing or referring for HAART including reflex CD4 count assessment for women testing HIV-positive
Supporting optimum infant feeding practice through initial and ongoing infant feeding counseling
Providing ARVs and cotrimoxazole to HIV exposed infants
Offering early infant diagnosis for HIV as early as six weeks and at 6 months, 12 months, and 18 months
Referral for treatment for infected infants.
CIDRZ has supported the Zambian Government in delivering PMTCT services to more than 1,081,137 women in Zambia as of February 2011.
Testing babies for HIV
Studies have shown that the earlier a baby can be diagnosed with HIV, the better he or she does. CIDRZ is supporting testing of infants as early as six weeks of age for HIV using polymerase chain reaction (PCR). Those babies born to HIV infected mothers are also given cotrimoxazole, beginning at 6 weeks of age to prevent serious lung infections associated with HIV. This is given for the first year of life to all babies whose mothers were HIV infected whether the babies are HIV infected or not.
CIDRZ supports quality assured service delivery with a component of strong community engagement. Awareness of what is being offered at the nearest health clinic is very important for community uptake. Since many clinics or small health posts in rural areas don’t have ways of broadcasting their services, we support community awareness through drama, door to door education, community leaders’ awareness meetings, and church meetings.
To cushion the limited number of health staff in government clinics, CIDRZ has engaged and supported peer educators, lay counselors, and traditional birth attendants (TBAs). Peer educators are patients or community workers who have either gone through the PMTCT program or have indepth knowledge of the program and live in the communities which are supported by the health centres. CIDRZ supports the use of peer educators because there are very few trained staff and little assistance in counseling in many of the health facilities in which we work. In sites where trained peer educators, lay counselors, and TBAs are actively involved, program coverage and performance have improved compared to sites without these support staff.
CIDRZ supported PMTCT programs have had many famous visitors. Some of our visitors include:
- Stephen Lewis
- Graca Machel
- Oprah Winfrey
- Matt Damon
- Bill Clinton
- Naomi Watts