title: Evaluating the Impact of Zimbabwe's Prevention of Mother-to-Child HIV Transmission Program: Population-Level Estimates of HIV-Free Infant Survival Pre-Option A.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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+).
authors.affiliation: School of Public Health, University of California, Berkeley, California, United States of America.
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.affiliation: School of Public Health, University of California, Berkeley, California, United States of America.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe.
authors.forename: Constancia
authors.initials: C
authors.lastname: Watadzaushe
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Kang Dufour
authors.affiliation: School of Public Health, University of California, Berkeley, California, United States of America.
authors.forename: Maya
authors.initials: M
authors.lastname: Petersen
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dirawo
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.affiliation: University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Hilda Angela
authors.initials: HA
authors.lastname: Mujuru
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe.
authors.forename: Reuben
authors.initials: R
authors.lastname: Musarandega
authors.affiliation: Children's Investment Fund Foundation, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Hakobyan
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe; Research Department of Infection and Population Health, University College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: School of Public Health, University of California, Berkeley, California, United States of America.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D011247:Pregnancy; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology