Community-based prevention of mother-to-child HIV transmission increases engagement in antenatal care for women and infants in Zambia: results from the SMACHT project


BACKGROUND: While Zambia has made significant progress towards prevention of mother to child transmission (PMTCT) of HIV, gaps remain in uptake of antenatal care (ANC), HIV testing of pregnant women, and linkage to ART. Effective differentiated service delivery interventions are needed to test and link to treatment pregnant women living with HIV (PWLHIV) and ensure follow up of HIV-exposed infants (HEIs) along the early infant diagnosis (EID) cascade. We report quantitative results from the University of Maryland Baltimore Stop Mother And Child HIV Transmission (SMACHT) project, a community-based PMTCT program implemented in Southern Province of Zambia.
DESCRIPTION: As part of the SMACHT program, community health workers (CHWs) identified pregnant women in the community, provided health education, and escorted them to ANC clinic for continuity of care and HIV testing. CHWs followed pregnant and breastfeeding women (PBFW) to ensure adherence to HIV prevention and treatment. To assess program impact, we conducted a before and after evaluation using routine aggregate programmatic data from the pre-intervention (April 2014 to March 2015), implementation phase (April 2015 to March 2016), and post-intervention period (April 2016 to December 2017) across 41 facilities.
LESSONS LEARNED: The number of pregnant women attending ANC increased in the post-intervention period more than six-fold, from 4,799 to 31,503. Early ANC attendance (before 20 weeks) increased from 45% to 48%. Positivity yield among pregnant women increased from 10% to 13%. The total number of PWLHIV in ANC on ART increased from 777 to 9,731. Total number of HEIs identified increased over two-fold, from 2,537 to 5,446 due to an increase in PWLHIV attending ANC. HEIs tested at 6 weeks increased from 1,515 to 2,760. However, there was a decrease in EID coverage at six weeks (60 to 51%) and for 6 and 12 month EID testing.
CONCLUSIONS: The SMACHT project greatly increased absolute numbers of PBFW attending ANC, as well as HIV-positive women in ANC and HEIs in care. Community PMTCT programs are effective at reaching PWLHIV and their infants, however; additional strategies, including ensuring sufficient test kits, must be deployed to optimize EID coverage and monitor closely baby-mother pairs.