title: Implementation and Operational Research: Uptake of Services and Behaviors in the Prevention of Mother-to-Child HIV Transmission Cascade in Zimbabwe.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Analysis of cross-sectional data from mother-infant pairs.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (PR(a)): 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 (PR(a): 1.18, 95% CI: 1.01 to 1.38), institutional delivery (PR(a): 1.31, 95% CI: 1.13 to 1.52), and disclosure of serostatus (PRa: 1.30, 95% CI: 1.12 to 1.49).
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Division of Epidemiology, School of Public Health, University of California, Berkeley, CA; †Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe; ‡Organisation for Public Health Interventions and Development (OPHID) Trust, Harare, Zimbabwe; §Ministry of Health and Child Care, Harare, Zimbabwe; ‖Centre for Sexual Health and HIV Research, Zimbabwe; ¶University College London, London, United Kingdom.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
authors.forename: Reuben
authors.initials: R
authors.lastname: Musarandega
authors.forename: Barbara
authors.initials: B
authors.lastname: Engelsmann
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Martz
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011635:Public Health Administration / Q000379:methods*; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D044966:Anti-Retroviral Agents