Evaluating the effect of point-of-care CD4 testing on access to eligibility

screening and ART initiation among HIV-positive pregnant women in Zimbabwe:

Towards elimination of new pediatric HIV infections by 2015

A. Muchedzi, A. Chadambuka, B. Chikwinya, A. Mahomva, A Mushavi

Abstract Number: TUPDE0204

BACKGROUND

• Treatment-eligible HIV-positive pregnant women have the highest risk of vertical transmission

• In 2010, 11% of 41,042 HIV-positive pregnant women initiated on ART in ANC.

• Low proportion was partially due to limited access to CD4 testing

• CD4 machines in Zimbabwe were mainly laboratory based and highly centralized

Use of CD4 POC technology in Zimbabwe

• To increase access to ART eligibility:

• In 2009, Pima TM point-of-care evaluated and endorsed in Zimbabwe

• portable, battery poweredproduce a CD4 count in 20mincan be used by non- lab staff

• EGPAF supported bypartners to procure50 POC CD 4 machines

Background

• Handover of the 50 POC CD4 machines

Background: TrainingsHealth worker trainings on use of POC CD4 machine and data collection tools

METHODS

A quasi-experimental before-and-after study was conducted, at 43 high-volume PMTCT sites

Deployment of the POC CD4 machines was the intervention

Data were collected before (Oct 2010 -June 2011) and after (Jul 2011- Mar 2012)

Data were analyzed using SPSS v15.0.

Statistical differences were tested

RESULTS

Before POC CD4 Oct 2010 – Jun 2011

n=4988

After POC CD4Jul 2011 – Mar 2012

n=5156 P Value

HIV+ pregnant women CD4 Testedn(%)

2544 (51%) 4176 (81%) 0. 023

HIV+ pregnant women initiated ART n(%)

449 (9%) 1289 (25%) 0.001

Table 1: CD4 Testing and ART initiation among HIV+ pregnant women before and after deployment of POC CD4 machine

RESULTS

Table 2: CD4 Testing among clients seen in MCH after deployment of POC CD4 machine at the 43 sites: Jul 2011- March 2012

ANC PNC Male

Total CD 4 tested 4176 1861 723

CD4 <350cells/mm3 2016 (48%) 738 (40%) 311 (43%)

• ART-eligible initiated on ART in ANC – 1289 (64%)

Conclusion Deployment of POC CD4 analyzers was

associated with significant increases in CD4 testing and ART initiation among HIV-positive pregnant women at the 43 intervention sites.

Based on these early findings, expansion of POC CD4 machines to all high-volume PMTCT sites in Zimbabwe is recommended to increase access to ART for eligible pregnant women towards elimination of new HIV infections in children by 2015.

AcknowledgementsZimbabwe Ministry of Health and Child Welfare

U.S. President’s Emergency Plan for AIDS Relief through USAID

UK Department for International Development

The Children’s Investment Fund Foundation

EGPAF-FAI partners Kapnek,

OPHID

ZAPP-UZ

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