Community-based prevention of mother-to-child HIV transmission is perceived as effective and trusted in rural Zambia: qualitative results from the SMACHT project


BACKGROUND: While Zambia has made significant progress towards prevention of mother to child transmission (PMTCT) of HIV, gaps remain. Novel differentiated service delivery (DSD) interventions are required to close the gaps in PMTCT as well as testing and linkage to care for HIV-exposed infants (HEIs) along the early infant diagnosis (EID) cascade. We report promising qualitative results from a University of Maryland Baltimore community-based PMTCT program: the Stop Mother And Child HIV Transmission (SMACHT) project.
DESCRIPTION: Project: SMACHT implemented the Community HIV Epidemic Control (CHEC) DSD model in the Southern Province of Zambia from 2015-2020. Under CHEC, SMACHT recruited, trained, deployed and mentored community health workers (CHWs) to conduct community-based PMTCT services. Each CHW was tasked with identifying pregnant and breastfeeding women (PBFW) and ensured they receive antenatal care and HIV testing. The CHWs followed up HIV-infected PBFW to ensure antiretroviral adherence as well as HEI prophylaxis, immunizations, and EID testing.
Study Design: Nine healthcare facilities and corresponding catchment areas spanning three districts were purposively sampled for a qualitative study to examine implementation and perceived feasibility, acceptability and effectiveness of the CHEC model for PMTCT and related services. Methods included in-depth interviews with government and community officials (n=11), program implementers (n=24), and beneficiaries (mothers engaged in PMTCT and/or HEI care) (n=36), as well as focus-group discussions with CHWs and community members (n=14).
LESSONS LEARNED: We found facility-based healthcare workers and beneficiaries benefitted from the CHEC model with respect to decongestion of services and increased uptake and retention in HIV care. Community members trusted CHWs to provide confidential HIV-related services; health facility workers observed higher retention in care across HIV treatment cascades; and relations between CHWs and healthcare workers were positive. Both healthcare workers and CHWs perceived increases in the uptake of ANC and facility-based delivery, and retention in care for the HIV exposed infant. Challenges included project sustainability, and shifting guidelines for identifying HIV+ cases.
CONCLUSIONS: Use of the CHEC model for PMTCT was perceived as effective at increasing community understanding of HIV and influencing reductions in PMTCT. Trusted DSD models like CHEC are needed to achieve elimination of MTCT in Zambia.