The COVID-19 pandemic and response are likely to lead to severe unintended consequences for the prevention of mother-to-child transmission (PMTCT) of HIV and syphilis. Zimbabwe has made huge progress in coverage of antenatal testing of HIV and syphilis, which reached 98% and 91% in 2019, and is aiming for dual elimination. However, there is emerging evidence of disruption to health services due to COVID-19, similar to that seen in prior epidemics, which may reverse this progress. Mathematical modelling has estimated 3 and 6 month interruptions to ART supply would lead to 1.67 and 2.07 times more babies being born with HIV in SSA over the next year respectively. This study aims to provide real-world data to understand the effects of COVID-19 on the provision and uptake of PMTCT services. Our study has five objectives. Firstly, to conduct a retrospective analysis of national data routinely collected by healthcare facilities to explore changes before, during and after the pandemic in key indicators related to antenatal testing and treatment of HIV and syphilis, and management of HIV-exposed and infected infants. Secondly, data on neonates admitted to Sally Mugabe Central Hospital, already collected for the NeoTree study, will be analysed to explore the impact of COVID-19 on the number of HIV-exposed infants hospitalised, their clinical status at presentation and outcomes. Thirdly, qualitative studies with mothers and healthcare workers will explore barriers to optimal engagement with care and provision of PMTCT services respectively. Fourthly, quantitative results on testing and ART provision will be used to model the impact of disruptions on the rate of PMTCT of HIV enabling policy makers to plan for subsequent waves of COVID-19 and future epidemics. Finally, educational materials will be developed, piloted and disseminated during the project to provide information to pregnant women on safe access to PMTCT services.
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Proportion of pregnant women seen in antenatal care who are tested for HIV and syphilis
Timeframe: Up to 6 years
Proportion of HIV-positive pregnant women seen in antenatal care who are on antiretroviral therapy
Timeframe: Up to 6 years
Proportion of HIV-exposed infants seen in antenatal care who are tested for HIV by 6 weeks of age
Timeframe: Up to 6 years
Number of HIV-exposed neonates admitted to Sally Mugabe Central Hospital
Timeframe: Up to 2 years
Among neonates admitted to Sally Mugabe Central Hospital, number receiving HIV testing and prophylaxis
Timeframe: Up to 2 years
Case fatality rate per 1,000 HIV-exposed neonates admitted to Sally Mugabe Central Hospital
Timeframe: Up to 2 years
Number of pregnant women who experienced interruptions to PMTCT service delivery
Timeframe: Up to 18 months
Qualitative evaluation of the impact of COVID-19 on provision and uptake of PMTCT services
Timeframe: Up to 18 months