A MISSED OPPORTUNITY FOR PMTCT SERVICES: SUCCESSFUL ANTENATAL HIV SCREENING AND POOR LINKAGES TO HIV CARE AND TREATMENT Changala Mable, Sikazwe Izukanji, Okawa Sumiyo, Muvuma Samba, Siachiwena Cecillia, Kapyata Henry, Kahula Mary, Nyirenda Mastard, Paul Kalichini, Seishi Kobayashi, Msiska Charles, Miyano Shinsuke, Jere Lazarus, Moyo Crispin, Ishikawa Naoko, Jimba Masamine, Syakantu Gardner. Chongwe District Medical Office, MoH-JICA SHIMA project, National Center for Global Health and Medicine 1

BACKGROUND Scale-up of PMTCT in Zambia HIV testReceiving ARV Number of pregnant women 91.6%61% Among HIV+ Pregnant women HIV exposed infants 30%36% 2 Zambia Country Progress Report 2010

PROBLEM STATEMENT PMTCT service is one of the most effective entry points to access HIV care and treatment However there is little information available on the linkage between PMTCT and HIV care and treatment services in Zambia 3

Study objectives 1.To evaluate the linkages between PMTCT and HIV care and treatment. 2.To assess maternal characteristics associated with enrollment to HIV care and treatment. 4

Background of the study site 5 Zambia Chongwe District Distance from Lusaka : 45km Population : 197,984 (2010)

METHODS 6

Study Protocol Study design : Retrospective cohort Study Study site : Chongwe referral health centre Study period : January to October, 2011 Participants : All HIV positive pregnant women who were enrolled in PMTCT services from January to December

Data collection & analysis Data source: – PMTCT registers – Electronic database (Smartcare) Variables: – Maternal characteristics – PMTCT services provided – Maternal enrollment to HIV care/treatment – HIV test and enrollment to HIV care/treatment for infants Statistics analysis: Stata SE 9.2 (Stata Corp., Texas) 8

RESULTS 9

Basic characteristics of mothers 10 CharacteristicsNo. or Median% or IQR Total pregnant women964 HIV positive pregnant women217/ % Age Married198/ % Newly diagnosed HIV176/ % Parity2I - 3 Gestation at first ANC (in week) ANC visits : Only once89/ % Partner tested at ANC31/ % Partner tested positive at ANC17/3154.8%

Implementation of PMTCT services PMTCT services No.% Women newly diagnosed HIV 176 / % CD4 count assessed100/ % CD4 < 35051/ % AZT prophylaxis provided134/ % Referred to ART clinic135/ % Infants attended postnatal clinic 115/ (217)(53.0%) Facility delivery91/ % NVP prophylaxis given infants100/ % DBS HIV test102/ % HIV positive infants13/ % 11

Linkage to HIV care/treatment New HIV+ women=176 Referred=135Enrolled=40 Not enrolled=95 Not Referred=41 Enrolled=10 Not enrolled=31 12 PMTCTHIV care/treatment 28.4% 71.6%

Linkage to Pediatric HIV care/treatment HIV tested infants=102 HIV positive=13 Enrolled=7 Not enrolled=6 HIV negative=89 HIV transmission :12.7% 13 PMTCT HIV care/treatment

Factors associated with enrollment to HIV care/treatment 14 FactorsAdjusted OR95% CI Age : > 25years Marital status : Married – 4.8 Access : > 12km – 6.9 Parity : > 3 times – 7.8 First ANC visit : > 21 wks – 1.9 Total ANC visit : > once – 4.8 Partner tested for HIV – 4.1

DISCUSSION Linkage of PMTCT & HIV care/treatment -Limited number of new HIV positive women were actually enrolled in care/treatment -Women with more than 3 times of parity were more likely to be enrolled Follow-up of infants -Limited number of exposed infants were followed up -Few HIV positive infants were enrolled in pediatric HIV care and treatment 15

Conclusion Poor linkages and lost opportunities between PMTCT services and HIV care and treatment. 16

Recommendations 1.Linkage between PMTCT service and HIV care and treatment should be strengthened by providing ART services at antenatal and postnatal clinic 2.To sensitize mothers to start antenatal as early as 14 weeks. 3.To intensify counseling on importance of ART especially for prime para 4.Follow up exposed infants using tTBAs 17

ACKNOWLEDGEMENT 1.MINISTRY OF HEALTH-ZAMBIA 2.JICA SHIMA PROJECT 3.CDC 4. CIRDZ 5.STAFFS AND THE COMMUNITY 18

19 Thank you