Facility-Based Delivery in the Context of Zimbabwe's HIV Epidemic - Missed Opportunities for Improving Engagement with Care: A Community-Based Serosurvey
BACKGROUND:
In
developing countries, facility-based delivery is recommended for maternal and
neonatal health, and for prevention of mother-to-child HIV transmission
(PMTCT). However, little is known about whether or not learning one's HIV
status affects one's decision to deliver in a health facility. We examined this
association in Zimbabwe.
METHODS:
We
analyzed data from a 2012 cross-sectional community-based serosurvey conducted
to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women
(≥16 years old and mothers of infants born 9-18 months before the survey)
were randomly sampled from the catchment areas of 157 health facilities in five
of ten provinces. Participants were interviewed about where they delivered and provided
blood samples for HIV testing.
RESULTS:
Overall
8796 (77 %) mothers reported facility-based delivery; uptake varied by
community (30-100 %). The likelihood of facility-based delivery was not
associated with maternal HIV status. Women who self-reported being HIV-positive
before delivery were as likely to deliver in a health facility as women who
were HIV-negative, irrespective of when they learned their status - before
(adjusted prevalence ratio (PRa) = 1.04, 95 % confidence interval (CI) = 1.00-1.09)
or during pregnancy (PRa = 1.05, 95 % CI = 1.01-1.09). Mothers who had not
accessed antenatal care or tested for HIV were most likely to deliver outside a
health facility (69 %). Overall, however 77 % of home deliveries
occurred among women who had accessed antenatal care and were HIV-tested.
CONCLUSIONS:
Uptake
of facility-based delivery was similar among HIV-infected and HIV-uninfected
mothers, which was somewhat unexpected given the substantial technical and
financial investment aimed at retaining HIV-positive women in care in Zimbabwe.
- 1University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. rbuzdugan@berkeley.edu.
- 2University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. smccoy@berkeley.edu.
- 3University College London, London, United Kingdom. kwebb@ophid.co.zw.
- 4Organisation for Public Health Interventions and Development Trust, 20 Cork Road, Belgravia, Harare, Zimbabwe. kwebb@ophid.co.zw.
- 5Ministry of Health and Child Care, Harare, Zimbabwe. mushavia@yahoo.co.uk.
- 6Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe. amahomva@pedaids.org.
- 7University of California Berkeley, School of Public Health, 779 University Hall, MS 7360, Berkeley, CA, 94720, USA. nancy.padian@gmail.com.
- 8University College London, London, United Kingdom. f.cowan@ucl.ac.uk.
- 9Centre for Sexual Health and HIV/AIDS Research Zimbabwe, 9 Monmouth Road, Avondale West, Harare, Zimbabwe. f.cowan@ucl.ac.uk.
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