title: Facility-based delivery in the context of Zimbabwe's HIV epidemic--missed opportunities for improving engagement with care: a community-based serosurvey.
abstract: BACKGROUND
  In developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe.
  
  
  METHODS
  We analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing.
  
  
  RESULTS
  Overall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested.
  
  
  CONCLUSIONS
  Uptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.
authors.affiliation: University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. rbuzdugan@berkeley.edu.
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.affiliation: University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. smccoy@berkeley.edu.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.affiliation: University College London, London, United Kingdom. kwebb@ophid.co.zw.|Organisation for Public Health Interventions and Development Trust, 20 Cork Road, Belgravia, Harare, Zimbabwe. kwebb@ophid.co.zw.
authors.forename: Karen
authors.initials: K
authors.lastname: Webb
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe. mushavia@yahoo.co.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe. amahomva@pedaids.org.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.affiliation: University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. nancy.padian@gmail.com.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
authors.affiliation: University College London, London, United Kingdom. f.cowan@ucl.ac.uk.|Centre for Sexual Health and HIV/AIDS Research Zimbabwe, 9 Monmouth Road, Avondale West, Harare, Zimbabwe. f.cowan@ucl.ac.uk.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe