An Assessment of the Prevention of Mother to Child Transmission (PMTCT) Programme Challenges at Harare Hospital, Zimbabwe

Abstract

Despite various efforts in place to lower vertical transmission of HIV, the goal of eliminating vertical transmission in Zimbabwe remains far off. There has been notable decline in vertical HIV transmission rates from 33% in 1999 to 7.5% in 2018. Despite the decline, strategic interventions are needed to further reduce the transmission rates to levels below 5% as recommended by World Health Organisation. The main objective of the study was to assess challenges faced by the PMTCT programme at Harare Hospital. A mixed method approach comprising quantitative review of records in the Early Infant Diagnosis database between January and December 2018 as well as qualitative interviews with key informants was used. The study was also based on a tool adapted from the HIV exposed infants register. The database gave insight to the risk factors of mother to child transmission while qualitative interviews highlighted the challenges faced by the programme. A total of 250 exposed infants records were reviewed. One infant (0.4%) was infected at one week, 92 (37%) were infected at 8 weeks of age while 97 (39%) were infected at 9 months. Of the 100 women who transmitted HIV, 5 women (5%) were never on ART and 32 women (32%) were initiated before pregnancy. Twelve (12%) transmitted the virus after late initiation during the pregnancy. Only 7 (7%) transmitted the HIV virus after they were initiated early in the pregnancy. Of those who transmitted, 30 women (30%) were initiated post-delivery. Receiving an HIV test during ANC reduced transmission by 6% from 48 619 in 2014 to 45814 in 2018. All six health workers interviewed revealed that they were short-staffed and were overwhelmed with work. Two out of six participants also highlighted that stock outs for reagents and consumables for viral load and early infant diagnosis (EID) testing affected service delivery and hence programme performance. The study showed that transmission rates are declining, however more resources and staff are needed for uninterrupted HIV testing.