title: Targeting elimination of mother-to-child HIV transmission efforts using geospatial analysis of mother-to-child HIV transmission in Zimbabwe.
abstract: We assessed Zimbabwe's progress toward elimination of mother-to-child HIV transmission (MTCT) under Option A.
  
  
  
  We analyzed 2012 and 2014 cross-sectional serosurvey data from mother-infant pairs residing in the same 157 health facility catchment areas randomly sampled from five provinces. Eligible women were at least 16 years and mothers/caregivers of infants born 9-18 months prior. We aggregated individual-level questionnaire and HIV serostatus within catchment areas or district to estimate MTCT and the number of HIV-infected infants; these data were mapped using facility global positioning system coordinates.
  
  
  
  A weighted population of 8800 and 10 404 mother-infant pairs was included from 2012 and 2014, respectively. In 2014, MTCT among HIV-exposed infants was 6.7% (95% confidence interval: 5.2, 8.6), not significantly different from 2012 (8.8%, 95% confidence interval: 6.9, 11.1, P = 0.13). From 2012 to 2014, self-reported antiretroviral therapy or prophylaxis among HIV-infected women increased from 59 to 65% (P = 0.05), as did self-reported infant antiretroviral prophylaxis (63 vs. 67%, P = 0.08). In 2014, 65 (41%), 55 (35%), and 37 (24%) catchment areas had the same, lower, and higher MTCT rate as in 2012, respectively. MTCT in 2014 varied by catchment areas (median = 0%, mean = 4.9%, interquartile range = 0-10%) as did the estimated number of HIV-infected infants (median = 0, mean = 1.1, interquartile range = 0-1.0). Also in 2014, 106 (68%) catchment areas had MTCT = 0%. Geovisualization revealed clustering of catchment areas where both MTCT and the estimated number of HIV-infected infants were relatively high.
  
  
  
  Although MTCT is declining in Zimbabwe, geospatial analysis indicates facility-level variability. Catchment areas with high MTCT rates and a high burden of HIV-infected infants should be the highest priority for service intensification.
authors.affiliation: aDivision of Epidemiology, School of Public Health, University of California, Berkeley, California, USA bMinistry of Health and Child Welfare cElizabeth Glaser Pediatric AIDS Foundation dCentre for Sexual Health and HIV Research, Harare, Zimbabwe eUniversity College London, London, UK.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fahey
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008875:Middle Aged; D062206:Spatial Analysis; D019371:Topography, Medical; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology