Routine off of antenatal HIV testing (“opt-out” approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe

Department of Pediatrics , Stanford University, Stanford, California, United States
Bulletin of the World Health Organisation (Impact Factor: 5.09). 11/2007; 85(11):843-50. DOI: 10.1590/S0042-96862007001100010
Source: PubMed


To assess the impact of routine antenatal HIV testing for preventing mother-to-child transmission of HIV (PMTCT) in urban Zimbabwe.
Community counsellors were trained in routine HIV testing policy using a specific training module from June 2005 through November 2005. Key outcomes during the first 6 months of routine testing were compared with the prior 6-month "opt-in" period, and clients were interviewed.
Of the 4551 women presenting for antenatal care during the first 6 months of routine HIV testing, 4547 (99.9%) were tested for HIV compared with 3058 (65%) of 4700 women during the last 6 months of the opt-in testing (P < 0.001), with a corresponding increase in the numbers of HIV-infected women identified antenatally (926 compared with 513, P < 0.001). During routine testing, more HIV-infected women collected results compared to the opt-in testing (908 compared with 487, P < 0.001) resulting in a significant increase in deliveries by HIV-infected women (256 compared with 186, P = 0.001); more mother/infant pairs received antiretroviral prophylaxis (n = 256) compared to the opt-in testing (n = 185); and more mother/infant pairs followed up at clinics (105 compared with 49, P = 0.002). Women were satisfied with counselling services and most (89%) stated that offering routine testing is helpful. HIV-infected women reported low levels of spousal abuse and other adverse social consequences.
Routine antenatal HIV testing should be implemented at all sites in Zimbabwe to maximize the public health impact of PMTCT.

Download full-text


Available from: Yvonne Maldonado
  • Source
    • "Despite the potential of increased HIV testing among males who accompany their pregnant spouses to ANC, much more remains to be achieved as our results show that only 55% of men with partners who visited ANC in the past 2 years reported being HIV-tested. In one Zimbabwean study,[26]encouragement of women receiving HIV testing in ANC to bring their male partners, showed that only 7% of men attended ANC and likewise in a Malawi study[30], 8% of HIV-infected partners undertook HIV testing. This low proportion of HIV testing among male partners may be linked to ANC settings being female centred environments and therefore alternative arrangements such as provision of places for men to congregate while their partners are giving birth or extending opening hours for clinics to allow men to attend after work may be innovative strategies to lure more men into getting tested. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Zimbabwe has a high human immunodeficiency virus (HIV) burden. It is therefore important to scale up HIV-testing and counseling (HTC) as a gateway to HIV prevention, treatment and care. To determine factors associated with being HIV-tested among adult men and women in Zimbabwe. Secondary analysis was done using data from 7,313 women and 6,584 men who completed interviewer-administered questionnaires and provided blood specimens for HIV testing during the Zimbabwe Demographic and Health Survey (ZDHS) 2010-11. Factors associated with ever being HIV-tested were determined using multivariate logistic regression. HIV-testing was higher among women compared to men (61% versus 39%). HIV-infected respondents were more likely to be tested compared to those who were HIV-negative for both men [adjusted odds ratio (AOR) = 1.53; 95% confidence interval (CI) (1.27-1.84)] and women [AOR = 1.42; 95% CI (1.20-1.69)]. However, only 55% and 74% of these HIV-infected men and women respectively had ever been tested. Among women, visiting antenatal care (ANC) [AOR = 5.48, 95% CI (4.08-7.36)] was the most significant predictor of being tested whilst a novel finding for men was higher odds of testing among those reporting a sexually transmitted infection (STI) in the past 12 months [AOR = 1.86, 95%CI (1.26-2.74)]. Among men, the odds of ever being tested increased with age ≥20 years, particularly those 45-49 years [AOR = 4.21; 95% CI (2.74-6.48)] whilst for women testing was highest among those aged 25-29 years [AOR = 2.01; 95% CI (1.63-2.48)]. Other significant factors for both sexes were increasing education level, higher wealth status and currently/formerly being in union. There remains a high proportion of undiagnosed HIV-infected persons and hence there is a need for innovative strategies aimed at increasing HIV-testing, particularly for men and in lower-income and lower-educated populations. Promotion of STI services can be an important gateway for testing more men whilst ANC still remains an important option for HIV-testing among pregnant women.
    Full-text · Article · Jan 2016 · PLoS ONE
  • Source
    • "Few studies have pointed to a positive impact of PITC on linkage to care as compared to standard opt-in approaches. A Zimbabwe study in 2005 compared mother-to-child transmission (PMTCT) service indicators during a 6 month routine HIV testing period with the prior opt-in testing period and found significantly more women in the routine testing period received their test results and were post-test counselled and more mother-infant pairs were seen at their 6 week follow-up visits [16]. Stronger evidence emerged from a South African retrospective review that found a statistically significant temporal association between the introduction of PITC for patients with TB in 2005, and subsequent increased referrals to ART (from 16% in the period 2002–2005 to 34.7% in 2007–2008) [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundWe examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care.MethodsIn a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms.ResultsThere was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007).ConclusionThe PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies.Trial registrationCurrent Controlled Trials ISRCTN93692532Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-350) contains supplementary material, which is available to authorized users.
    Full-text · Article · Aug 2014 · BMC Health Services Research
  • Source
    • "The reporting of implementation information is highly variable both within and across articles, with some articles reporting a great deal of information about some criteria and almost nothing about others, and likewise some articles report almost nothing about most criteria while others report a great deal about most criteria. For example, the articles by Chandisarewa [19], Kumar [23], and Marsh [28] are examples of good reporting on most criteria. In total, eight articles had ‘good’ or ‘fair’ documentation for greater than 75% of criteria, while five articles had ‘poor or none’ documentation for 50% or more criteria. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background There is an increasing push for ‘evidence-based’ decision making in global health policy circles. However, at present there are no agreed upon standards or guidelines for how to evaluate evidence in global health. Recent evaluations of existing evidence frameworks that could serve such a purpose have identified details of program context and project implementation as missing components needed to inform policy. We performed a pilot study to assess the current state of reporting of context and implementation in studies of global health interventions. Methods We identified three existing criteria sets for implementation reporting and selected from them 10 criteria potentially relevant to the needs of policy makers in global health contexts. We applied these 10 criteria to 15 articles included in the evidence base for three global health interventions chosen to represent a diverse set of advocated global health programs or interventions: household water chlorination, prevention of mother-to-child transmission of HIV, and lay community health workers to reduce child mortality. We used a good-fair-poor/none scale for the ratings. Results The proportion of criteria for which reporting was poor/none ranged from 11% to 54% with an average of 30%. Eight articles had ‘good’ or ‘fair’ documentation for greater than 75% of criteria, while five articles had ‘poor or none’ documentation for 50% of criteria or more. Examples of good reporting were identified. Conclusions Reporting of context and implementation information in studies of global health interventions is mostly fair or poor, and highly variable. The idiosyncratic variability in reporting indicates that global health investigators need more guidance about what aspects of context and implementation to measure and how to report them. This lack of context and implementation information is a major gap in the evidence needed by global health policy makers to reach decisions.
    Full-text · Article · May 2014 · Implementation Science
Show more