Agnes Mahomva

Elizabeth Glaser Pediatric AIDS Foundation, Washington, Washington, D.C., United States

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Publications (27)80.25 Total impact

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    ABSTRACT: Background: In developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe. Methods: We analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing. Results: Overall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100 %). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95 % confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95 % CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69 %). Overall, however 77 % of home deliveries occurred among women who had accessed antenatal care and were HIV-tested. Conclusions: Uptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.
    Preview · Article · Dec 2015 · BMC Pregnancy and Childbirth
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    ABSTRACT: We estimated HIV-free infant survival and mother-to-child HIV transmission (MTCT) rates in Zimbabwe, some of the first community-based estimates from a UNAIDS priority country. In 2012 we surveyed mother-infant pairs residing in the catchment areas of 157 health facilities randomly selected from 5 of 10 provinces in Zimbabwe. Enrolled infants were born 9-18 months before the survey. We collected questionnaires, blood samples for HIV testing, and verbal autopsies for deceased mothers/infants. Estimates were assessed among i) all HIV-exposed infants, as part of an impact evaluation of Option A of the 2010 WHO guidelines (rolled out in Zimbabwe in 2011), and ii) the subgroup of infants unexposed to Option A. We compared province-level MTCT rates measured among women in the community with MTCT rates measured using program monitoring data from facilities serving those communities. Among 8568 women with known HIV serostatus, 1107 (12.9%) were HIV-infected. Among all HIV-exposed infants, HIV-free infant survival was 90.9% (95% confidence interval (CI): 88.7-92.7) and MTCT was 8.8% (95% CI: 6.9-11.1). Sixty-six percent of HIV-exposed infants were still breastfeeding. Among the 762 infants born before Option A was implemented, 90.5% (95% CI: 88.1-92.5) were alive and HIV-uninfected at 9-18 months of age, and 9.1% (95%CI: 7.1-11.7) were HIV-infected. In four provinces, the community-based MTCT rate was higher than the facility-based MTCT rate. In Harare, the community and facility-based rates were 6.0% and 9.1%, respectively. By 2012 Zimbabwe had made substantial progress towards the elimination of MTCT. Our HIV-free infant survival and MTCT estimates capture HIV transmissions during pregnancy, delivery and breastfeeding regardless of whether or not mothers accessed health services. These estimates also provide a baseline against which to measure the impact of Option A guidelines (and subsequently Option B+).
    Full-text · Article · Aug 2015 · PLoS ONE

  • No preview · Article · Jul 2015 · Journal of the International AIDS Society

  • No preview · Article · Jul 2015 · Journal of the International AIDS Society
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    ABSTRACT: To examine the uptake of services and behaviors in the prevention of mother-to-child HIV transmission (PMTCT) cascade in Zimbabwe and to determine factors associated with MTCT and maternal antiretroviral therapy (ART) or antiretroviral (ARV) prophylaxis. Analysis of cross-sectional data from mother-infant pairs. We analyzed baseline data collected in 2012 as part of the impact evaluation of Zimbabwe's Accelerated National PMTCT Program. Using multistage cluster sampling, eligible mother-infant pairs were randomly sampled from the catchment areas of 157 facilities in 5 provinces, tested for HIV infection, and interviewed about PMTCT service utilization. Of 8800 women, 94% attended ≥1 antenatal care visit, 92% knew their HIV serostatus during pregnancy, 77% delivered in a health facility, and 92% attended the 6-8 week postnatal visit. Among 1075 (12%) HIV-infected women, 59% reported ART/ARV prophylaxis and 63% of their HIV-exposed infants received ARV prophylaxis. Among HIV-exposed infants, maternal receipt of ART/ARV prophylaxis was protective against MTCT [adjusted prevalence ratio (PRa): 0.41, 95% confidence interval (CI): 0.23 to 0.74]. Factors associated with receipt of maternal ART/ARV prophylaxis included ≥4 antenatal care visits (PRa: 1.18, 95% CI: 1.01 to 1.38), institutional delivery (PRa: 1.31, 95% CI: 1.13 to 1.52), and disclosure of serostatus (PRa: 1.30, 95% CI: 1.12 to 1.49). These data from women in the community indicate gaps in the PMTCT cascade before the accelerated program, which may have been missed by examination of health facility data alone. These gaps were especially noteworthy for services targeted specifically to HIV-infected women and their infants, such as maternal and infant ART/ARV prophylaxis.
    No preview · Article · Jun 2015 · JAIDS Journal of Acquired Immune Deficiency Syndromes
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    ABSTRACT: Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women's uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe. We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9-18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households. The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PRa) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PRa = 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PRa = 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PRa = 0.68, 95% CI: 0.43, 1.08). Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.
    Preview · Article · Apr 2015 · BMC Public Health
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    ABSTRACT: Background Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. Methods We analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Results Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Conclusions Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.
    Full-text · Article · Aug 2014 · PLoS ONE
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    ABSTRACT: Background: According to Zimbabwe Demographic Health Survey 2010/11, young and single pregnant adolescents are unlikely to utilize ANC services at all throughout their pregnancy, and are highly unlikely to have access to PMTCT in their pregnancy. Targeted education is needed to support young, at-risk women through their pregnancy and to inform them of and enroll them in PMTCT services in Zimbabwe. Description: Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) technical and communications staff designed a radio program to target adolescents. The program aired for thirteen weeks from July 2013 to September 2013. The program was interactive, allowing real-time feedback via live call-in, instant messaging and social media. The program was hosted by male and female adolescents, recruited by EGPAF, affiliated with various youth groups on sexual and reproductive health throughout the country. The radio program enabled large-scale, peer-to-peer mentoring. It included segments on personal experiences (e.g. one teen mother spoke of her perspective in disclosing her pregnancy, accessing ANC services and “youth-friendly corners” which were established by the Ministry of Health and Child Care for at-risk youths and are found in most health facilities, and re-integrating into school). The broadcast was conducted in the local language. Lessons learned: The radio program was broadcast country-wide and reached an estimated 2.7 million people in both rural and urban settings. Within an hour after airing the first broadcast, EGPAF communications staff handling the interactive feedback, received 136 instant messages - indicating that Zimbabweans were listening to and engaging in the program. Questions included how to access ANC and sexual and reproductive health services. One pregnant adolescent, in her second trimester, who had not disclosed pregnancy to her family called into the program and received guidance and mentoring from the panel. Conclusions/Next steps: Routine PMTCT program implementation should embrace mass communications to reach vulnerable groups who are often not easy to reach due to various socio-cultural barriers. This program allowed for a large group of people to discreetly acquire information on pregnancy support and PMTCT
    Full-text · Conference Paper · Jul 2014
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    ABSTRACT: Background: Access to HIV prophylaxis early in pregnancy is associated with better health outcomes among HIV-exposed infants. According to the Zimbabwe Ministry of Health and Child Care (MOHCC), in 2011, only 19% of pregnant women nationally accessed antenatal care (ANC) services in their first trimester. In Zimbabwe, traditional beliefs and lack of universal health education are barriers to early ANC attendance. To heighten national awareness and education on PMTCT and importance of early ANC visits, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the MOHCC co-hosted a 13-week radio program between July and September 2012. Methods: The program was aired on a local radio station with nationwide coverage in the Shona language. The program, which ran from July to September 2013, consisted of 13, 30-minute shows created by MOHCC and EGPAF. Each 30-minute segment had a theme (e.g., importance of ANC attendance early in pregnancy and institutional deliveries, information on infant and child feeding, male involvement in ANC, retention in care and personal experiences engaging in PMTCT featuring clients in care) and was followed by a call-in segment allowing listeners to ask questions, which the host addressed on air. In one segment, a traditional chief participated live on-air addressing cultural barriers to PMTCT attendance. At the end of each show, the host would asked listeners one question and would request a texted response; this allowed EGPAF to ascertain if people were tuning in and listening to content. Incorrect/correct answers were discussed on-air at each following show. Results: The program was well received by listeners throughout the country. After a session on importance of early ANC booking, listeners were asked, “When is a woman expected to book her pregnancy?” 1,227 listeners from a wide geographical area responded; 907 responses, were valid, 893 (73%) answered correctly. Of the 907 listeners, 900 (99.2%) indicated they got information for the first time during the show, while 7 (0.8%) confirmed having prior knowledge about early ANC attendance before the show. Conclusions: Radio is a powerful tool to engage and inform even the most remote communities to provide PMTCT information. EGPAF-Zimbabwe plans to continue this activity while strengthening monitoring and evaluation to assess contribution of the radio program on early ANC booking.
    Full-text · Conference Paper · Jul 2014
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    ABSTRACT: Introduction: In Mashonaland East Province, which is home to 186 PMTCT facilities, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) conducted a situation analysis to assess the quality of PMTCT program implementation in the province. Methods: A descriptive quantitative cross-sectional survey was conducted in June and July 2011 among nurses working at all 186 health facilities offering PMTCT services in Mashonaland East. District focal persons (DFPs; specialized EGPAF staff that support PMTCT implementation within districts) carried out the survey, which consisted of a questionnaire on provision of HIV testing and counseling, ARV prophylaxis, ART initiation, early infant diagnosis (EID), referral systems, HIV care, and human resources for PMTCT. Results: Of all facilities surveyed, 179 (96.2%) offered antenatal care (ANC) services. More than 80% offered HIV testing and counseling, and roughly 75% of facilities offered combination maternal and infant ARV prophylaxis (rather than single-dose nevirapine). The province has 14 ART initiation sites and 76 follow-up sites. Availability of on-site ART eligibility assessment (i.e., clinical staging and CD4 testing) was minimal, with most facilities referring women elsewhere (Table 1). EID services were offered at 121 (65%) facilities but transportation of blood samples was a major challenge, with an average turnaround time for dried-blood spot (DBS) samples of 60 days between submission of samples and results returned to the site. Tracking mechanisms for CD4, EID and ART initiation referrals were present in less than 15% of facilities. The proportions of nurses trained in the various PMTCT components were below 40%. Conclusion: This analysis provided a critical overview of the status of PMTCT program implementation in the province that helped identify key PMTCT program gaps (e.g., limited capacity of staff to provide PMTCT services and initiate women on ART). Further efforts are needed to improve access to combination ARV prophylaxis for adults and infants, as well as on-site CD4 testing and EID services, and to reduce EID result turnaround times. Based on these findings, the province with EGPAF support will work closely with its district teams to improve each of these components in order to achieve elimination of new pediatric HIV infections by 2015.
    Full-text · Conference Paper · Jul 2012
  • A. Muchedzi · A. Chadambuka · B. Chikwinya · A. Mahomva
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    ABSTRACT: Introduction: Treatment-eligible HIV-positive pregnant women have the highest risk (>75%) of transmitting HIV to their infants, but only a small proportion of women are being initiated on antiretroviral therapy (ART) during pregnancy in Zimbabwe, partially due to limited access to CD4 testing to determine treatment eligibility. We assessed whether introducing point-of-care (POC) CD4 machines at 43 high-volume, Elizabeth Glaser Pediatric AIDS Foundation supported, PMTCT sites in Zimbabwe increased the proportion of HIV-positive pregnant women assessed for ART eligibility and subsequently initiated on ART. Methods: A quasi-experimental before and after study design was conducted, with 43 high-volume PMTCT sites selected based on number of HIV-positive pregnant women seen. POC CD4 machines were deployed to all 43 sites in June 2011 following health worker trainings on usage of machines and tools (registers, summary sheets). Data were collected before (April-June 2011) and after (July-September 2011) deployment of POC CD4 machines (intervention). Data were analyzed using SPSS v15.0. Differences between proportions were tested using Wilcoxon signed rank test. Results: Before introduction of the POC machines, 617 (51%) of 1,210 HIV-positive pregnant women received a CD4 test at the 43 sites. After the machines were introduced, 890 (81%) of 1,100 women received a CD4 test. There was a significance difference between the proportion of women tested for CD4 count before and after the intervention (P=0.023) and between the proportion initiated on ART before and after the introduction of the CD4 machines (9% [104] before versus 25% [276] after; (P=0.001). Conclusion: Deployment of POC CD4 machines was associated with increased CD4 testing and ART initiation for HIV-positive pregnant women at the 43 intervention sites. Based on these early results, expansion of POC CD4 machines to all high volume PMTCT sites in Zimbabwe is recommended to increase access to ART eligibility towards elimination of new HIV infections in children by 2015.
    No preview · Conference Paper · Jul 2012
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    ABSTRACT: Background: Treatment-eligible HIV-positive pregnant women have the highest risk (>75%) of transmitting HIV to their infants, but only a small proportion of women are being initiated on antiretroviral therapy (ART) during pregnancy in Zimbabwe, partially due to limited access to CD4 testing to determine treatment eligibility. We assessed whether introducing point-of-care (POC) CD4 machines at 43 high-volume, Elizabeth Glaser Pediatric AIDS Foundation supported, PMTCT sites in Zimbabwe increased the proportion of HIV-positive pregnant women assessed for ART eligibility and subsequently initiated on ART. Methods: A quasi-experimental before and after study design was conducted, with 43 high-volume PMTCT sites selected based on number of HIV-positive pregnant women seen. POC CD4 machines were deployed to all 43 sites in June 2011 following health worker trainings on usage of machines and tools (registers, summary sheets). Data were collected before (April-June 2011) and after (July-September 2011) deployment of POC CD4 machines (intervention). Data were analyzed using SPSS v15.0. Differences between proportions were tested using Wilcoxon signed rank test. Results: Before introduction of the POC machines, 617 (51%) of 1,210 HIV-positive pregnant women received a CD4 test at the 43 sites. After the machines were introduced, 890 (81%) of 1,100 women received a CD4 test. There was a significance difference between the proportion of women tested for CD4 count before and after the intervention (P=0.023) and between the proportion initiated on ART before and after the introduction of the CD4 machines (9% [104] before versus 25% [276] after; (P=0.001). Conclusions: Deployment of POC CD4 machines was associated with increased CD4 testing and ART initiation for HIV-positive pregnant women at the 43 intervention sites. Based on these early results, expansion of POC CD4 machines to all high volume PMTCT sites in Zimbabwe is recommended to increase access to ART eligibility towards elimination of new HIV infections in children by 2015.
    Full-text · Conference Paper · Jul 2012
  • A. Muchedzi · A. Chadambuka · B. Chikwinya · A. Mahomva
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    ABSTRACT: Introduction: Treatment-eligible HIV-positive pregnant women have the highest risk (>75%) of transmitting HIV to their infants, but only a small proportion of women are being initiated on antiretroviral therapy (ART) during pregnancy in Zimbabwe, partially due to limited access to CD4 testing to determine treatment eligibility. We assessed whether introducing point-of-care (POC) CD4 machines at 43 high-volume, Elizabeth Glaser Pediatric AIDS Foundation supported, PMTCT sites in Zimbabwe increased the proportion of HIV-positive pregnant women assessed for ART eligibility and subsequently initiated on ART. Methods: A quasi-experimental before and after study design was conducted, with 43 high-volume PMTCT sites selected based on number of HIV-positive pregnant women seen. POC CD4 machines were deployed to all 43 sites in June 2011 following health worker trainings on usage of machines and tools (registers, summary sheets). Data were collected before (April-June 2011) and after (July-September 2011) deployment of POC CD4 machines (intervention). Data were analyzed using SPSS v15.0. Differences between proportions were tested using Wilcoxon signed rank test. Results: Before introduction of the POC machines, 617 (51%) of 1,210 HIV-positive pregnant women received a CD4 test at the 43 sites. After the machines were introduced, 890 (81%) of 1,100 women received a CD4 test. There was a significance difference between the proportion of women tested for CD4 count before and after the intervention (P=0.023) and between the proportion initiated on ART before and after the introduction of the CD4 machines (9% [104] before versus 25% [276] after; (P=0.001). Conclusion: Deployment of POC CD4 machines was associated with increased CD4 testing and ART initiation for HIV-positive pregnant women at the 43 intervention sites. Based on these early results, expansion of POC CD4 machines to all high volume PMTCT sites in Zimbabwe is recommended to increase access to ART eligibility towards elimination of new HIV infections in children by 2015.
    No preview · Conference Paper · Jul 2012
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    ABSTRACT: In several recent papers it has been suggested that HIV prevalence and incidence are declining in Zimbabwe as a result of changing sexual behavior. We provide further support for these suggestions, based on an analysis of more extensive, age-stratified, HIV prevalence data from 1990 to 2009 for perinatal women in Harare, as well as data on incidence and mortality. Pooled prevalence, incidence and mortality were fitted using a simple susceptible-infected (SI) model of HIV transmission; age-stratified prevalence data were fitted using double-logistic functions. We estimate that incidence peaked at 5.5% per year in 1991 declining to 1% per year in 2010. Prevalence peaked in 1998/9 [35.9% (CI95: 31.3-40.7)] and decreased by 67% to 11.9% (CI95: 10.1-13.8) in 2009. For women <20y, 20-24y, 25-29y, 30-34y and ≥35y, prevalence peaked at 25.4%, 34.2%, 47.1%, 44.0% and 33.5% in 1993, 1996, 1997, 1998 and 1999, respectively, declining thereafter in every age group. Among women <25y, prevalence peaked in 1994 at 28.8% declining thereafter by 69% to 8.9% (CI95: 6.8-11.5) in 2009. HIV prevalence declined substantially among perinatal women in Harare after 1998 consequent upon a decline in incidence starting in the early 1990s. Our model suggests that this was primarily a result of changes in behavior which we attribute to a general increase in awareness of the dangers of AIDS and the ever more apparent increases in mortality.
    Full-text · Article · Jun 2011
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    A K Shetty · W Chandisarewa · A Mahomva · A Mushavi
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    Preview · Article · Nov 2010 · Journal of perinatology: official journal of the California Perinatal Association
  • S Mtombeni · A Mahomva · S Siziya · C Sanyika · R Doolabh · K J Nathoo
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    ABSTRACT: To determine the prevalence and risk factors for transmission of tuberculosis in children under five years of age who are household contact of sputum smear positive tuberculosis adults in Harare, Zimbabwe. Cross sectional study. City Health Infectious Diseases Hospital Outpatient Department. 174 children in contact with 102 index cases. TB infection status in children according to modified WHO classification of tuberculosis. Under five year old contacts of sputum smear positive TB adults were recruited over a three month period. A coded questionnaire was used to document the following: socio-demographic profile of caregivers, duration of stay with the index case and presenting complaints. Contacts were evaluated by clinical examination, Mantoux testing, HIV antibody testing and chest radiographs. Of the 174 children in contact with 102 index cases evaluated, 109 (62.6%) were Mantoux positive (> or = 10 mm), 42% had abnormal chest X-ray, with hilar lymphadenopathy being the commonest abnormality. Forty nine percent of the children evaluated had probable TB, 28% had suspected TB and 23% had no TB. High alcohol acid fast load (AAFB) in the index case was independently associated with probable and suspected TB (OR 2.27 95% CI (1.05 to 4.87). The documented high transmission rate among under five years contacts in the study justifies the need for strengthening contact tracing and appropriate therapeutic management of identified children.
    No preview · Article · Feb 2010 · The Central African journal of medicine
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    ABSTRACT: HIV Testing and Counselling (TC) programmes are being scaled-up as part of efforts to provide universal access to antiretroviral treatment (ART). Mathematical modelling of TC in Zimbabwe shows that if universal access is to be sustained, TC must include prevention counselling that enables behaviour change among infected and uninfected individuals. The predicted impact TC is modest, but improved programmes could generate substantial reductions in incidence, reducing need for ART in the long-term. TC programmes that focus only on identifying those in need of treatment will not be sufficient to bring the epidemic under control.
    No preview · Article · Jun 2009
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    ABSTRACT: The World Health Organization recommends a single-dose nevirapine (NVP) regimen for prevention of mother-to-child transmission (PMTCT) of HIV in settings without the capacity to deliver more complex regimens, but the population-level impact of this intervention has rarely been assessed. A decision analysis model was developed, parameterized, and applied using local epidemiologic and demographic data to estimate vertical transmission of HIV and the impact of the PMTCT program in Zimbabwe up to 2005. Between 1980 and 2005, of approximately 10 million children born in Zimbabwe, a cumulative 504,000 (range: 362,000 to 665,000) were vertically infected with HIV; 59% of these infections occurred in nonurban areas. Mother-to-child transmission (MTCT) of HIV decreased from 8.2% (range: 6.0% to 10.7%) in 2000 to 6.2% (range: 4.9% to 8.9%) in 2005, predominantly attributable to declining maternal HIV prevalence rather than to the PMTCT program. Between 2002 and 2005, the single-dose NVP PMTCT program may have averted 4600 (range: 3900 to 7800) infections. In 2005, 32% (range: 26% to 44%) and 4.0% (range: 2.7% to 6.2%) of infections were attributable to breast-feeding and maternal seroconversion, respectively, and the PMTCT program reduced infant infections by 8.8% (range: 5.5% to 12.1%). Twice as many infections could have been averted had a more efficacious but logistically more complex NVP + zidovudine regimen been implemented with similar coverage (50%) and acceptance (42%). The decline in MTCT from 2000 to 2005 is attributable more to the concurrent decrease in HIV prevalence in pregnant women than to PMTCT at the current level of rollout. To improve the impact of PMTCT, program coverage and acceptance must be increased, especially in rural areas, and local infrastructure must then be strengthened so that single-dose NVP can be replaced with a more efficacious regimen.
    No preview · Article · Jun 2008 · JAIDS Journal of Acquired Immune Deficiency Syndromes
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    ABSTRACT: Prevention of mother-to-child transmission of HIV (PMTCT) is a major public health challenge in Zimbabwe. Using trained peer counselors, a nevirapine (NVP)-based PMTCT program was implemented as part of routine care in urban antenatal clinics. Between October 2002 and December 2004, a total of 19,279 women presented for antenatal care. Of these, 18,817 (98%) underwent pre-test counseling; 10,513 (56%) accepted HIV testing, of whom 1986 (19%) were HIV-infected. Overall, 9696 (92%) of women collected results and received individual post-test counseling. Only 288 men opted for HIV testing. Of the 1807 HIV-infected women who received posttest counseling, 1387 (77%) collected NVP tablet and 727 (40%) delivered at the clinics. Of the 1986 HIV-infected women, 691 (35%) received NVPsd at onset of labor, and 615 (31%) infants received NVPsd. Of the 727 HIV-infected women who delivered in the clinics, only 396 women returned to the clinic with their infants for the 6-week follow-up visit; of these mothers, 258 (59%) joined support groups and 234 (53%) opted for contraception. By the end of the study period, 209 (53%) of mother-infant pairs (n = 396) came to the clinic for at least 3 follow-up visits. Despite considerable challenges and limited resources, it was feasible to implement a PMTCT program using peer counselors in urban clinics in Zimbabwe.
    Full-text · Article · Feb 2008 · AIDS Research and Therapy
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    ABSTRACT: 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.
    Full-text · Article · Nov 2007 · Bulletin of the World Health Organisation

Publication Stats

684 Citations
80.25 Total Impact Points

Institutions

  • 2007-2015
    • Elizabeth Glaser Pediatric AIDS Foundation
      Washington, Washington, D.C., United States
  • 2006-2011
    • Ministry of Health and Child Welfare, Zimbabwe
      Salisbury, Harare Province, Zimbabwe