title: Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: first 18 months of experience.
abstract: OBJECTIVE
  To report on activities and lessons learned during the first 18 months of a rural programme of prevention of mother-to-child transmission of HIV (PMTCT) in Zimbabwe.
  
  
  METHODS
  The PMTCT services were introduced in Murambinda Mission Hospital (120 beds), Buhera, in 2001. Programme strategies consisted in recruiting counselling staff, training health professionals, improving mother-child health (MCH) facilities and conducting information, education and communication activities within the community to address HIV/AIDS awareness and stigma. The following components were implemented within MCH services: voluntary counselling and testing of HIV using rapid testing, nevirapine short regimen proposed to all HIV-infected mothers identified and their newborns, support to exclusive breastfeeding for 6- and 18-month mother-child follow-up. Routine monitoring data collected from August 2001 to February 2003 were used to estimate programme uptake.
  
  
  RESULTS
  Of 2471 pregnant women using antenatal services, 2298 were pre-test counselled, the acceptance of HIV testing reached 92.9%. Of the women who decided to take an HIV test, 1588 (74.3%) returned to collect their result. Overall HIV prevalence was 20.4% (n = 437); 326 of the HIV-positive women were counselled and 104 (24%) received complete mother-child antiretroviral prophylaxis.
  
  
  CONCLUSIONS
  Acceptability of HIV testing after counselling has remained above 90% since the onset of the programme. Collection of test results and mother-child follow-up are among the most challenging activities of the programme. A district approach and community participation are critical to develop PMTCT programmes in rural settings, even with reasonably good MCH services.
authors.affiliation: Institut de Santé Publique, d'Epidemiologie et de Développement (ISPED), Université Victor Segalen, Bordeaux, France. freddy.perez@isped.u-bordeaux2.fr
authors.forename: Freddy
authors.initials: F
authors.lastname: Perez
authors.forename: Tarisai
authors.initials: T
authors.lastname: Mukotekwa
authors.forename: Anna
authors.initials: A
authors.lastname: Miller
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.forename: Monica
authors.initials: M
authors.lastname: Glenshaw
authors.forename: Inam
authors.initials: I
authors.lastname: Chitsike
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000627:therapeutic use; D011247:Pregnancy; D015995:Prevalence; D015397:Program Evaluation / Q000379:methods; D012424:Rural Population; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine