BACKGROUND: In 2020, Zimbabwe Mother to Child Transmission (MTCT) rate stood at 8.7% which is above the WHO target of 5% (Zimbabwe HIV Estimates Report, 2021). This is attributable to numerous factors that include manual tracking of HEI resulting in missed clinical appointment dates, poor follow-up of PMTCT mothers with high viral load, delayed final PMTCT outcome testing, and high Nucleic Acid Test (NAT) result turnaround time of more than 6 to 8 weeks. In helping bridge the gap, FACT Zimbabwe through USAID/PEPFAR funding is implementing an Orphans and Vulnerable Children (OVC) project in 9 districts in Manicaland and Masvingo.
DESCRIPTION: The project utilizes trained mentor mothers through a community case management approach to prevent HEI from seroconversion. The mentors are responsible for bi-weekly home visits to support PMTCT adherence, facilitate for EID testing, regularly check developmental milestones, and provide PMTCT sessions. In April 2023, the project adopted the DHIS2 tracker capture application with an embedded Early Infant Diagnosis (EID) module to identify HEIs due for EID testing, and record dates and results for completed tests throughout the PMTCT algorithm up to outcome. The application flags pending results while signaling to project staff and mentors the priority needs for HEIs being case managed, allowing timely follow-up on pending results with the laboratories.
LESSONS LEARNED: In 2023, 289 HEI enrolled in the project due for the final test were identified through the DHIS2 tracker capture app. 100% (289) were tested for their final PMTCT outcome by September 2023 and 281(97%) received results within two weeks reducing the turnaround time by 50%. Of those tested, 98.6% (277) were negative and 1.4% (4) were positive, achieving an MTCT rate within the national target of <5%.
CONCLUSIONS: Digital longitudinal tracking of HEI is comprehensive, timely, and reliable. Coupled with individual-level case management, these approaches have contributed to high outcome testing among HEI and a low MTC rate. The next phase of the project is scaling the strategy to future cohorts due for their PMTCT outcome test.