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Country Profiles |
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Caring for Pregnant Women with HIVFHI-supported community health facilities in Zambia now provide safer and more effective ARV regimens for HIV+ expectant mothers
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OCTOBER 2008 — In February 2006, FHI's Zambia Prevention, Care and Treatment Partnership (ZPCT) embarked on a groundbreaking effort to test CD4 counts1 and provide complex antiretroviral regimens for pregnant women seeking prevention of mother-to-child transmission services (PMTCT) at their community health centers. "This approach was not without challenges," says Kwasi Torpey, MD, MPH, director, technical support, ZPCT. "We knew that if we wanted our PMTCT programs to have impact, we had to offer these expectant mothers the most effective ARV regimens. However, we also knew that to reach the maximum number of women, we had to go to primary health centers where most pregnant women go for antenatal care. These facilities are at the community level, where there are very limited resources. So, the question was: Can we provide a complex ARV regimen like highly active antiretroviral therapy (HAART) to pregnant women at the lowest level facilities?"
After one year, ZPCT, which is supported by the US President's Emergency Plan for AIDS Relief, has proven that it can be done. More HIV+ expectant mothers who visit primary health centers supported by FHI are having their CD4 counts tested and more are going on lifesaving HAART as a result. The Importance of CD4 Testing In the past, pregnant HIV+ women visiting primary health centers in Zambia were not given the opportunity to have their CD4 count checked, most likely because health center staff were not trained to interpret the CD4 test or to initiate HAART for those who needed it. There was also a lack of CD4 count machines in some facilities, and there often was not a referral mechanism available for transporting blood samples to the lab. Instead, most HIV+ pregnant women were given Nevirapine, a drug that helps prevent transmission of HIV to the fetus (although to a lesser extent than HAART), and does not address the mother's HIV infection. Being on Nevirapine also exposes the pregnant woman to the risk of developing resistance to ARV drugs. ZPCT's Major PMTCT Innovations After four quarters of collecting data (April 2007 to March 2008), FHI found that the number of HIV+ pregnant women who had their CD4 count checked at FHI-supported primary health centers increased each quarter, from 12.2 percent tested in the first quarter to 24.5 percent tested in the fourth. The number who then began HAART increased from 571 in the first quarter to 871 in the fourth. "The number beginning HAART is not as dramatic as the resultant CD4 testing," says Justin Mandala, MD, MPH, a senior technical officer at FHI who has been involved in the project, "but it still shows improvement. Between April 2007 and March 2008, in 60 primary health centers supported by FHI, 2,528 HIV+ pregnant women began full HAART. Three years ago, very few thought that would be feasible." Data also reveal that women who had blood drawn at their first appointment were more likely to have their CD4 count checked than those who had it drawn at their follow-up appointment (18 percent vs. 15 percent). Finally, women who were able to begin HAART at the PMTCT site in the community were more likely to begin treatment than those who had to go somewhere else to start treatment (38.6 percent vs. 15.4 percent of those checked for CD4). "Our findings show that, with training, supportive supervision, and a system for sending samples to a lab and transmitting results back, a complex, more effective, and safer regimen for PMTCT is feasible at primary health centers," Mandala says. "You just need to start the process and, over time and with steady effort, it will improve." _______________________ PHOTO: ZPCT has supplied motorbikes and fuel allowances to transport blood samples from PMTCT centers for testing. (FHI/Zambia) —Mary Dallao |
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In this PMTCT project, ZPCT's major innovations at the primary health center level have included procurement of CD4 count machines and creation of a blood sample referral system. ZPCT has supplied motorbikes and fuel allowances to transport specimens from PMTCT centers for testing. ZPCT has also trained health care workers, laboratory staff, and pharmacists in such areas as counseling and testing and commodity management.