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Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th , 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II
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Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

Mar 26, 2015

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Page 1: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

Re-testing & Seroconversion - ZPCT II experience

TC for PMTCT meetingMay 17th, 2010

Andrew Kumwenda, MD, MPhilFHI/ZPCT II

Page 2: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/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

Page 3: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 4: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 5: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 6: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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.

Page 7: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 8: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 9: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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%

Page 10: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 11: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

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

Page 12: Re-testing & Seroconversion - ZPCT II experience TC for PMTCT meeting May 17 th, 2010 Andrew Kumwenda, MD, MPhil FHI/ZPCT II.

Thank you for your attention.