Population Council Research that makes a difference

In Zimbabwe, HIV remains the leading cause of maternal and infant mortality. As recently as 2010, approximately 75 percent of HIV-positive pregnant women were still being offered less-effective prevention of mother-to-child transmission (PMTCT) prophylaxis—single-dose nevirapine.

The Council has initiated a project in Zimbabwe to implement and evaluate intensive PMTCT interventions at both the facility and community levels. This project (formally called "Enabling Access to High-quality PMTCT Services by Community and Facility Strengthening in Mashonaland Central Province") aims to increase access to and uptake of the World Health Organization's recommended and more efficacious PMTCT prophylaxis regimen. The Council will assess the effectiveness of the intervention by measuring the decrease in HIV infection among HIV-exposed infants.

Implemented by the Council in partnership with Clinton Health Access Initiative and the Zimbabwe AIDS Prevention Project, the project delivers facility-level interventions including staff training, mentoring, strengthening infrastructure, and support supervision to increase the quality and scope of PMTCT services. A complementary set of community mobilization activities include peer counseling, support groups for HIV-positive women and their male partners, home-based support for adherence to the PMTCT package and follow-up of infants, and community education activities, including efforts to promote male involvement.

The project will be implemented in 21 health facilities across the eight districts of Mashonaland Central Province. A formative assessment to inform the intervention includes an inventory of the 21 health facilities to understand the current infrastructure, staffing, training, quality issues, links to community, and availability of commodities; as well as community-level focus groups to obtain views on proposed interventions, community awareness needs, and male involvement. In addition, baseline and endline assessments will include exit interviews with women attending antenatal/PMTCT services; in-depth interviews with male partners accompanying their wife/partner to these services; and a knowledge, attitudes, and practices (KAP) survey among mothers visiting child health clinics for immunizations and other well-baby care services. Evaluation of the impact of the intervention will be determined by the results of DNA PCR tests on all infants delivered by HIV-positive mothers at six weeks and nine months.

The project is part of a broader initiative, Arise—Enhancing HIV Prevention Programs for At-Risk Populations, through financial support provided by the Canadian Government through the Canadian International Development Agency, and via financial and technical support provided by PATH. Arise implements innovative HIV prevention initiatives for vulnerable communities, with a focus on determining cost-effectiveness through rigorous evaluations.

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