1. Evaluating the effect of point-of-care CD4 testing on access to eligibility screening and ART initiation among HIV- positive pregnant women in Zimbabwe: Towards elimination of new pediatric HIV infections by 2015 A. Muchedzi, A. Chadambuka, B. Chikwinya, A. Mahomva, A Mushavi Abstract Number: TUPDE0204

2. BACKGROUND Treatment-eligible HIV-positive pregnant women have the highest risk of vertical transmission In 2010, 11% of 41,042 HIV-positive pregnant women initiated on ART in ANC. Low proportion was partially due to limited access to CD4 testing CD4 machines in Zimbabwe were mainly laboratory based and highly centralized

3. Use of CD4 POC technology in Zimbabwe To increase access to ART eligibility: In 2009, Pima TM point-of-care evaluated and endorsed in Zimbabwe portable, battery powered produce a CD4 count in 20min can be used by non- lab staff EGPAF supported by partners to procure 50 POC CD 4 machines

4. Background Handover of the 50 POC CD4 machines

5. Background: Trainings Health worker trainings on use of POC CD4 machine and data collection tools

6. METHODS A quasi-experimental before-and-after study was conducted, at 43 high-volume PMTCT sites Deployment of the POC CD4 machines was the intervention Data were collected before (Oct 2010 -June 2011) and after (Jul 2011- Mar 2012) Data were analyzed using SPSS v15.0. Statistical differences were tested

7. RESULTS Before POC CD4 (Oct 2010 – Jun 2011) After POC CD4 (Jul 2011 – Mar 2012) Wilcoxon signrank test p-value Total number of HIV positive pregnant women 12101100 HIV Positive pregnant women CD4 Tested n(%) 6178900.023 HIV Positive pregnant women initiated on ART n(%) 1042760.001 Before POC CD4 Oct 2010 – Jun 2011 n=4988 After POC CD4 Jul 2011 – Mar 2012 n=5156 P Value HIV+ pregnant women CD4 Tested n(%) 2544 (51%)4176 (81%)0. 023 HIV+ pregnant women initiated ART n(%) 449 (9%)1289 (25%)0.001 Table 1: CD4 Testing and ART initiation among HIV+ pregnant women before and after deployment of POC CD4 machine

8. RESULTS Table 2: CD4 Testing among clients seen in MCH after deployment of POC CD4 machine at the 43 sites: Jul 2011- March 2012 ANCPNCMale Total CD 4 tested41761861723 CD4 <350cells/mm32016 (48%)738 (40%)311 (43%) ART-eligible initiated on ART in ANC – 1289 (64%)

9. Conclusion Deployment of POC CD4 analyzers was associated with significant increases in CD4 testing and ART initiation among HIV-positive pregnant women at the 43 intervention sites. Based on these early findings, expansion of POC CD4 machines to all high-volume PMTCT sites in Zimbabwe is recommended to increase access to ART for eligible pregnant women towards elimination of new HIV infections in children by 2015.

10. Acknowledgements Zimbabwe Ministry of Health and Child Welfare U.S. Presidents Emergency Plan for AIDS Relief through USAID UK Department for International Development The Childrens Investment Fund Foundation EGPAF-FAI partners Kapnek, OPHID ZAPP-UZ 10

11. THE TIME TO ELIMINATE PEDIATRIC HIV AND AIDS IS NOW - THANK YOU -