Reaching More in Need: PMTCT Enhancement through Expanded Implementation and Operations Research (The Bill and Melinda Gates Foundation)

Overview

The Bill and Melinda Gates Foundation funded this project, which was designed to expand access to PMTCT services in 10 countries including Zambia, which allowed EGPAF to fill critical gaps, ensure continued service delivery in resource-limited countries, and leverage other donor resources to increase access to PMTCT services. Under this project, EGPAF:

•  Provided support and technical assistance to host country governments to strengthen commitment to scale up PMTCT service;
• Trained thousands of government personnel at the site, district, and provincial levels to build health care worker capacity to provide HIV services;
• Strengthened integration with other essential services;
• Improved linkages to care and treatment

In terms of operational research, several studies were conducted in Zambia, including a multi-country evaluation of PMTCT effectiveness. For the overall study, cord blood samples were analyzed from 27,893 mother-infant pairs treated at 43 separate clinics. HIV seropositive cord blood samples were then analyzed for the presence of nevirapine for 3,196 mother-infant pairs, with the major finding that 51 percent of HIV-exposed infants received the minimal regimen of nevirapine to protect them. The study also found that many HIV-positive women who were prescribed nevirapine before giving birth had no sign of the drug in samples of their umbilical cord blood. Reasons associated with these results include fewer antenatal visits and younger maternal age, although there was significant variation between sites and country programs. These results have mobilized EGPAF and other partners to develop strategies to improve and monitor adherence to ARV prophylaxis and the entire PMTCT cascade for mothers and infants.