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Preventing mother-to-child transmission of HIV in urban Zimbabwe

Journal of Perinatology volume 30, page 763 (2010)Cite this article

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We read with great interest a recent article by Gumbo et al.1 describing risk factors of perinatal HIV transmission in an observational cohort study conducted between 2002 and 2003 at three urban antenatal clinics in Zimbabwe. During the above-referenced study period, pregnant women were tested for HIV by an ‘opt-in’ approach or client-initiated testing, wherein antenatal HIV testing was conducted after individual pretest counseling by trained peer counselors, with clients actively choosing whether to be tested.2 In recent years, with funding from the Elizabeth Glaser Pediatric AIDS Foundation and US Agency for International Development, considerable progress has occurred in the prevention of mother-to-child transmission of HIV program (PMTCT) in Zimbabwe due to successful collaboration between the Ministry of Health and Child Welfare and national and international partners in urban and rural settings. First, routine antenatal HIV testing (‘opt-out’ approach) is now the standard of care for all pregnant women presenting for antenatal care in urban and rural Zimbabwe after pilot studies evaluating opt-out HIV testing found it feasible and acceptable with significant number of pregnant women accepting HIV testing with no adverse social consequences.3, 4 Second, more efficacious PMTCT regimens are currently being implemented in urban and rural antenatal clinics to enhance PMTCT effectiveness. Third, due to severe attrition of health-care workers and limited resources, implementation of PMTCT program using peer counselors and community mobilizers has proven very effective and similar strategies are currently implemented across other PMTCT programs in Zimbabwe.2 However, many challenges remain at these sites including lack of widespread access to highly active antiretroviral therapy for mother's own health, limited facilities offering early infant diagnosis, poor follow-up of HIV-exposed infants and ineffective integration into family-health units, limited access to pediatric antiretroviral therapy, lack of male participation in PMTCT programs and continued increase in unintended pregnancies among HIV-infected women. Finally, preventing postnatal transmission during breastfeeding remains a major public health priority for PMTCT programs in resource-limited countries including Zimbabwe where more than 99% of women breastfeed and formula feeding is not affordable, sustainable or culturally acceptable.

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References

  1. Gumbo FZ, Duri K, Kandawasvika GQ, Kurewa NE, Mapingure MP, Munjoma MW et al. Risk factors of HIV vertical transmission in a cohort of women under a PMTCT program at three peri-urban clinics in a resource-poor setting. J Perinatol 2010; 30: 717–723.

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  2. Shetty AK, Marangwanda C, Stranix-Chibanda L, Chandisarewa W, Chirapa E, Mahomva A et al. The feasibility of preventing mother-to-child transmission of HIV using peer counselors in Zimbabwe. AIDS Res Ther 2008; 5: 17.

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  3. Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A et al. Routine offer of antenatal HIV testing (‘opt-out’ approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ 2007; 85 (11): 843–850.

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  4. Perez F, Zvandaziva C, Engelsmann B, Dabis F . Acceptability of routine HIV testing (‘opt-out’) in antenatal services in two rural districts of Zimbabwe. J Acquir Immune Defic Syndr 2006; 41 (4): 514–520.

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Authors and Affiliations

  1. Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC, USA

    A K Shetty

  2. Zimbabwe AIDS Prevention Project, University of Zimbabwe, Harare, Zimbabwe

    W Chandisarewa

  3. Elizabeth Glaser Pediatric AIDS Foundation, Zimbabwe Country Office, Harare, Zimbabwe

    A Mahomva

  4. Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe

    A Mushavi

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  1. A K Shetty
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  2. W Chandisarewa
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Correspondence to A K Shetty.

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Shetty, A., Chandisarewa, W., Mahomva, A. et al. Preventing mother-to-child transmission of HIV in urban Zimbabwe. J Perinatol 30, 763 (2010). https://doi.org/10.1038/jp.2010.104

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