Zambia
Country Situation
Adult HIV prevalence (ages 15-49) in Zambia, estimated at 13.5%, has remained relatively stable over the last decade. HIV prevalence is higher among females (16.1%) than males (13.9%)[7]; in urban areas (19.7%) than rural areas (10.3%) and among those in the richest wealth quintiles (17.8%) than the poorest quintiles (7.8%)[8]. HIV prevalence among pregnant women (13.9%) is comparable to that of the general population. Between 2009 and 2011, Zambia has had a 55% decline in the number of new paediatric HIV infections – from 21,000 to 9,500[3].
By 2010, Zambia had expanded its PMTCT service coverage to 81% of ANC clinics[9], resulting in an increase in HIV testing among pregnant women, from 14% in 2005 to 94% in 2010[10]. Eighty six percent of pregnant women living with HIV received efficacious ARVs for PMTCT in 2011, up from 58% in 2009[3].
Zambia has adopted WHO Option A regimen for PMTCT prophylaxis and has developed a national MTCT elimination plan (2011-2015)[11]. Zambia has markedly increased PMTCT service access and is well placed to achieve Global Plan targets by 2015.
Zambia Policy Guidelines for eMTCT Option B+
In May 2012 Zambia re-affirmed its commitments at the first annual face-to-face gathering of Ministers of Health and representatives from the 22 focus countries since the launch of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive in 2011.
All positive pregnant women will receive treatment immediately and for life regardless of CD4 count and infants will be provided with ARVs from birth through to six weeks regardless of feeding method. Government has taken this policy decision in order to make the implementation of eMTCT much simpler and more effective.
In addition to the operational benefits, this new policy provides additional health benefits of lower HIV transmission to infants, improved maternal health and lower transmission to HIV-negative male sexual partners.
Business Case for an Improved eMTCT Protocol in Zambia
Overall, Option B+ is likely to have a greater impact in reducing infant HIV infections, increasing maternal survival and reducing transmission to HIV negative male sexual partners than the current eMTCT program (Option A) and Option B. These benefits will have a continuing positive impact in the future, both during future pregnancies and in protecting HIV-negative male partners. Option B+ is therefore considered the best available method to eliminate MTCT.
Link to Zambia Ministry of Health.
