Retention of HIV Positive Mothers and HIV Exposed Babies in the PMTCT Programme at Sites of Booking in Zimbabwe, April - Dec 2014 – A Dataset Analysis E. Muchenje, A. Chadambuka, A. Mahomva, M.Mungati, D. Bangure, N. Gombe, M. Tshimanga

Introduction Zimbabwe launched Option B+ guidelines in November 2013 HIV +ve pregnant and lactating women initiated on lifelong ART despite CD4 HIV prevalence among women years 16.7% in 2014 (HIV AIDS Estimates 2014) Mother to child transmission – 6.7% in 2014 (UCB 2014) Retention into PMTCT programme at 4 th ANC visit <50% nationally during Option A (EGPAF Annual Report 2013) Initiation on Option B+ above 90% (prog data) Need to determine retention rate for this high proportion of initiated mothers

Introduction EGPAF provides technical support to MOHCC Part of support was establishment of an Electronic database (EDB) Nationally set in 36 randomly selected sites To collect longitudinal mother and baby data from facility registers

Flow of EDB Data Health Facility Nurse ( enters data in register ) Data Entry Clerk ( compiles data ) Data Manager M&E Officer ( EGPAF ) ( MOHCC )

Broad Objective To determine retention at the selected sites of booking for a cohort of mothers and exposed babies in the PMTCT programme for the period April to December 2014

Specific Objectives Describe demographic characteristics of mothers in the EDB Assess retention of mothers at their sites of booking Assess differences in retention between mothers booked at urban and rural sites Assess retention of Exposed babies at 6 weeks.

Materials and methods Data for HIV positive mothers who booked between April and June 2014 at 36 EDB sites were reviewed Retention at 6 months was measured for mothers initiated in ANC Retention at 6 weeks was measured for infants whose mothers were initiated in ANC Data was analysed using Microsoft Excel Permission was sought from EGPAF and HSO Ethical approval obtained from MRCZ

RESULTS

Description of Mothers Booked at 36 Sites – April to June 2014 (154)

Demographic Characteristics Variablen%Median Age groupn= years years – 29 years – 39 years – 49 years42.6 Gestational age at bookingn= weeks 0 – 12 weeks weeks – 28 weeks

Retention of Mothers who Booked at Urban and Rural sites – April – June 2014 (55%)

Exposed Babies Born April to June 2014 Retained at 6 weeks (55 %)

Discussion Retention rate at 6 months 55% at the sites of booking. –Slightly above the findings of the ANC survey 2013 (48%) Urban sites retention slightly higher than rural sites by 4% –Possibly distance to and accessibility of sites Retention of exposed babies similar to that of mothers (55%) –Mothers bring their babies when coming for own pick ups

Discussions High proportion of women booking already on ART (45%) – High uptake of general ART in the community – ART initiation during subsequent pregnancies – ART encouraging HIV positive women to bear more children Mothers book pregnancies late (22 weeks) – Delayed ART initiation for those who need it – Delays attainment of elimination goal

Conclusions PMTCT programme faced with challenges around; –Retention of mothers at sites of booking –Retention of Exposed babies –Late ANC booking

Recommendations There is need to continue strengthening education to improve retention Synchronising mother and baby visits to retain babies Strengthen tracking and tracing mechanisms Encourage early ANC booking

Acknowledgements EGPAF staff HSO CDC MPH -FETP

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