Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew...
-
Upload
amelia-mcnamara -
Category
Documents
-
view
217 -
download
2
Transcript of Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew...
Re-testing & Seroconversion - ZPCT II experience
TC for PMTCT meetingMay 17th, 2010
Andrew Kumwenda, MD, MPhilFHI/ZPCT II
Outline: ZPCT II background
Efforts made to cope with seroconversion
Policy on re-testing
Status in ZPCT II supported sites
Trainings & promotion of re-testing
Achievements & challenges
Possible beneficial TA
ZPCT II background:
ZPCT II is a follow on to ZPCT (2004-2009); funded by USAID/PEPFAR (June 2009 – May 2014)
Supports the MOH to strengthen and expand HIV/AIDS services in five provinces ((T&C, PMTCT and CC/ART) :Central, Copperbelt, Luapula, Northern, North Western
ZPCT currently supports 262 PMTCT facilities in 39 of Zambia’s 72 districts
Why the need for re-testing in PMTCT?
Acute maternal HIV infection during pregnancy & BF is associated with very high rates of MTCT
It is known that high maternal viral load increases the likelihood of perinatal transmission of HIV in women
without AIDS and advanced immunosuppression.
Women with newly acquired HIV infection are not usually identified by PMTCT programs
Data is needed to estimate the contribution of acute HIV infection in women to nationwide MTCT in the ZPCT II program
Process to operationalize re-testing
Field staff re-oriented on importance of re-testing after 3 months for those that test negative in accordance with national CT guidelines
Orientation on documentation process for those that are re-tested (how, where to document within existing data collection tools)
ZPCT II has started collecting monthly data on retesting & strengthening its documentation
Re-testing study planned for June / July 2010
Trainings & promotion of re-testing
Six day PMTCT trainings using approved national PMTCT training packages for:
HCWs Community volunteers
Emphasis is made to PMTCT providers during trainings
Capacity building through onsite mentorship of providers
No media or mass campaigns done on re-testing – only through technical assistance.
Achievements in implementing re-testing Re-testing has been operationalized in most FHI supported PMTCT sites
Providers oriented and receiving ongoing mentorship
Re-testing being documented and some program indicators developed
Seroconversion in ZPCT II supported sites
491
1,145
5,524
26 35 32 43 136
1,842 2,046
5.3%
2.5%
2.1%1.7%
3.1%
0
1000
2000
3000
4000
5000
6000
2010 Jan 2010 Feb 2010 Mar 2010 Apr Total
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
Pregnant women re-tested for HIV and received their results Pregnant women re-tested for HIV and tested positive Percent Serro-conversion
Status of seroconversion in ZPCT II supported facilities Vs other countries In the ZPCT II supported facilities, January to April
2010: 5,524 HIV negative women pregnant women were
retested. 136 (2.5%) seroconverted
Recent data on seroconversion in other countries: Botswana – 2.9%; RSA – 3%; Kenya – 2.6% & Swaziland – 4.4%
Challenges Much more needs to be done to reinforce the re-testing
policy
Rate of performing retesting still infrequent
Documentation needs to be improved
Low facility delivery – reported as 48% in 2007 ZDHS
Possible beneficial technical assistance Reinforcing the re-testing policies
Strategies to enhance detection of newly acquired HIV-infection
Forecasting for commodities to include seroconverters
Mentoring providers in re-testing
Documentation of re-testing
Thank you for your attention.