Quality Improvement Reports

Prevention of mother to child transmission of HIV: evaluation of a pilot programme in a district hospital in rural Zimbabwe

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7475.1147 (Published 11 November 2004) Cite this as: BMJ 2004;329:1147
  1. Freddy Perez (Freddy.Perez{at}isped.u-bordeaux2.fr), senior public health programme officer1,
  2. Joanna Orne-Gliemann, country programme officer1,
  3. Tarisai Mukotekwa, district programme officer2,
  4. Anna Miller, Zimbabwe technical adviser3,
  5. Monica Glenshaw, district medical officer, Buhera District Health Executive4,
  6. Agnes Mahomva, head of PMTCT Unit, AIDS and TB programme4,
  7. François Dabis, professor of public health1
  1. 1 Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2, 146 rue Léo-Saignat, 33076 Bordeaux, France
  2. 2 ISPED-Zimbabwe Programme
  3. 3 Elizabeth Glaser Paediatric AIDS Foundation, Zimbabwe
  4. 4 Ministry of Health and Child Welfare of Zimbabwe
  1. Correspondence to: F Perez

    Abstract

    Problem Zimbabwe has one of the highest rates of HIV seroprevalence in the world. In 2001 only 4% of women and children in need of services for prevention of mother to child transmission of HIV were receiving them.

    Design Pilot implementation of the first programme for prevention of mother to child transmission of HIV in rural Zimbabwe.

    Setting 120 bed district hospital in Buhera district (285 000 inhabitants), Manicaland, Zimbabwe.

    Key measures for improvement Programme uptake indicators monitored for 18 months; impact of policy evaluated by assessing up-scaling of programme.

    Strategies for change Voluntary counselling and testing services for HIV were provided in the hospital antenatal clinic. Women identified as HIV positive and informed of their serostatus and their newborn were offered a single dose antiretroviral treatment of nevirapine; mother-child pairs were followed up through routine health services. Nursing staff and social workers were trained, and community mobilisation was conducted.

    Effects of change No services for prevention of mother to child transmission of HIV were available at baseline. Within 18 months, 2298 pregnant women had received pretest counselling, and the acceptance of HIV testing reached 93.0%. Of all 2137 women who had an HIV test, 1588 (74.3%) returned to collect their result; 326 of the 437 HIV positive women diagnosed had post-test counselling, and 104 (24%) mother-child pairs received nevirapine prophylaxis.

    Lessons learnt Minimum staffing, an enhanced training programme, and involvement of district health authorities are needed for the implementation and successful integration of services for prevention of mother to child transmission of HIV. Voluntary counselling and testing services are important entry points for HIV prevention and care and for referral to community networks and medical HIV care services. A district approach is critical to extend programmes for prevention of mother to child transmission of HIV in rural settings. The lessons learnt from this pilot programme have contributed to the design of the national expansion strategy for prevention of mother to child transmission of HIV in Zimbabwe.

    Footnotes

    • We thank the Zimbabwean National AIDS and Tuberculosis Unit of the Ministry of Health and Child Welfare of Zimbabwe (Inam Chitsike in particular) for supporting the project, the project team members for their continuous dedication, all the staff from Murambinda Mission Hospital and Buhera district health centres who participated in the quality improvement process, and Mathilde Touron for data analysis. Special thanks go to all the mothers and children of Buhera district. We particularly appreciate the assistance of Catherine Wilfert, Dirk Buyse, and Chuck Hoblitzelle at EGPAF offices. Nevirapine was provided through a donation from Boehringer Ingelheim.

    • Contributors FP designed the project, coordinated programme implementation, and wrote the paper. JO-G and AMiller wrote the project proposal, collaborated in programme implementation, and contributed to writing the manuscript. TM coordinated local project management. MG and AMahomva provided technical input to programme implementation and suggestions for the manuscript. FD participated in the design of the proposal, coordinated programme implementation, and edited the manuscript. FP is the guarantor.

    • Funding Elizabeth Glaser Pediatric AIDS Foundation, Call to Action project No CTA#26-01.

    • Competing interests None declared.

    • Ethical approval The Ministry of Health of Zimbabwe ethics committee approved the study in 2001.

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