Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe

Abstract

Background: We assessed Zimbabwe's progress toward elimination of mother-to-child HIV transmission (MTCT) under Option A.

Methods: We analyzed 2012 and 2014 cross-sectional serosurvey data from mother-infant pairs residing in the same 157 health facility catchment areas randomly sampled from five provinces. Eligible women were at least 16 years and mothers/caregivers of infants born 9-18 months prior. We aggregated individual-level questionnaire and HIV serostatus within catchment areas or district to estimate MTCT and the number of HIV-infected infants; these data were mapped using facility global positioning system coordinates.

Results: A weighted population of 8800 and 10 404 mother-infant pairs was included from 2012 and 2014, respectively. In 2014, MTCT among HIV-exposed infants was 6.7% (95% confidence interval: 5.2, 8.6), not significantly different from 2012 (8.8%, 95% confidence interval: 6.9, 11.1, P = 0.13). From 2012 to 2014, self-reported antiretroviral therapy or prophylaxis among HIV-infected women increased from 59 to 65% (P = 0.05), as did self-reported infant antiretroviral prophylaxis (63 vs. 67%, P = 0.08). In 2014, 65 (41%), 55 (35%), and 37 (24%) catchment areas had the same, lower, and higher MTCT rate as in 2012, respectively. MTCT in 2014 varied by catchment areas (median = 0%, mean = 4.9%, interquartile range = 0-10%) as did the estimated number of HIV-infected infants (median = 0, mean = 1.1, interquartile range = 0-1.0). Also in 2014, 106 (68%) catchment areas had MTCT = 0%. Geovisualization revealed clustering of catchment areas where both MTCT and the estimated number of HIV-infected infants were relatively high.

Conclusion: Although MTCT is declining in Zimbabwe, geospatial analysis indicates facility-level variability. Catchment areas with high MTCT rates and a high burden of HIV-infected infants should be the highest priority for service intensification.

Figures

FIGURE 1

The PMTCT cascade in Zimbabwe, 2012–2014. The percentages for each step are the weighted proportion of the total number of all women with a recent birth (Panel A) or HIV-infected women and their HIV-exposed infants (Panel B) in the survey receiving each service. Asterisks (*) indicate statistically significant differences at the alpha=0.05 level. Analysis restricted to biological mothers and their eligible infants.

FIGURE 1

The PMTCT cascade in Zimbabwe, 2012–2014. The percentages for each step are the weighted proportion of the total number of all women with a recent birth (Panel A) or HIV-infected women and their HIV-exposed infants (Panel B) in the survey receiving each service. Asterisks (*) indicate statistically significant differences at the alpha=0.05 level. Analysis restricted to biological mothers and their eligible infants.

FIGURE 2

Estimated number of HIV-infected infants and MTCT rate in 156 selected health facility catchment areas in five provinces in Zimbabwe, 2012 (Panel A) and 2014 (Panel B). Data from pregnant women and their infants were linked to health facility catchment area; their inclusion in a particular area does not necessarily imply that the mother-infant pair received care at that facility, or received care at all.

FIGURE 3

Estimated number of HIV-infected infants and MTCT rate in 156 selected health facility catchment areas in five provinces in Zimbabwe, 2014. High priority catchment areas (as determined with our algorithm) are labeled with a star. Panel A displays HIV prevalence in the background, Panel B displays maternal ART/ARV coverage in the background.

FIGURE 3

Estimated number of HIV-infected infants and MTCT rate in 156 selected health facility catchment areas in five provinces in Zimbabwe, 2014. High priority catchment areas (as determined with our algorithm) are labeled with a star. Panel A displays HIV prevalence in the background, Panel B displays maternal ART/ARV coverage in the background.