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Background: Research conducted before the introduction of anti-retroviral therapy (ART), showed that the majority of children living with HIV (CLHIV) would die before their second birthday. In Zambia, ART was rolled out to the public health system in 2004 with subsequent improved survival in CLHIV. However, the survival rates of CLHIV on ART in Zambia since 2004 have not been extensively documented. We assessed survival experiences and the factors associated with survival in CLHIV on ART in Zambia.Methods: We conducted a retrospective cohort analysis of CLHIV (aged up to 15 years) using routinely collected data from health facilities across Zambia, over 13 years to ascertain mortality rates. We explored survival factors using Cox regression giving adjusted hazard ratios (AHR) and 95% confidence intervals (95% CI). Nelson Aalen estimates were used to show the cumulative hazards of mortality for different levels of explanatory factors.Results: A total of 65,448 eligible children, were initiated on ART between 2005 and 2018, of which 33,483 (51%) where female. They contributed a total survival time of 275,715-person years at risk during which 3,265 children died which translated into an incidence rate of 1.1 deaths per 100 person-years during the review period. Mortality rates were highest in children in the first year of life (Mortality rate 2.24; 95% CI = 2.08–2.42) and during the first year on ART (Mortality rate 3.82 95% CI = 3.67–3.98). Over 50% of the children had been on ART for 5–10 years by 2018, and they had the lowest risk of mortality compared to children who had been on ART for

Background: Mother to child transmission of HIV (MTCT) is a global challenge affecting many countries especially in sub-Saharan Africa. In 2009 about 370,000 infants were infected with HIV mainly through MTCT and most of them in sub-Saharan Africa. We aimed to determine the effectiveness of Option B+ compared to other options in reducing rates of early MTCT of HIV infections in Zambia.Methods: This was a retrospective cohort study based on routinely collected data using SmartCare in Zambia. Survival analysis with Cox Proportional Hazard regression was used to determine association between MTCT and regimen type of mothers. Kaplan-Meier (K-M) curves were used to compare MTCT for infants born to mothers option B+ to those on other options, and Wilcoxon (Breslow) test was used to establish statistical significance.Results: Overall (n = 1,444), mother-baby pairs with complete data were included in the analysis, with the median age of mothers being 33 (28–38) years; and 57% of these women were on Option B+. MTCT rate was estimated at 5% (73/1,444) [P = 0.025]. A Kaplan-Meier estimate showed that HIV Exposed Infants (HEI) of mothers on Option B+ had lower MTCT rate than those who were on other MTCT prevention interventions [Wilcoxon test; chi2 = 4.97; P = 0.025]. Furthermore, The Nelson Aalen cumulative hazard estimates indicated similar evidence of option B+ being more effective than other options with some statistical significance [HR = 0.63, P = 0.068]. HEI of option B+ mothers had 50% reduced risk of having HIV infection compared to option A/B [adjusted HR = 0.4; 95% CI = 0.28–0.84; P = 0.010]. HEI to women who were married had an increased risk 50% of getting infected compared to those not married [adjusted HR = 1.5; 95% CI = 3.43–6.30; P < 0.001]. Exposed infants whose mothers had assisted delivery had 3 times increased risk of getting infected compared to those born through normal vaginal delivery [Adjusted HR = 3.2; 95% CI = 0.98–10.21; P = 0.050].Conclusions: The use of Option B+ as PMTCT intervention was found to be more effective in reducing MTCT of HIV compared to other options. Scaling up access to life-long ART and improving retention for women on treatment can potentially reduce further vertical transmission.

Introduction: Accurate estimates of coverage of prevention of mother-to-child (PMTCT) services among HIV-infected pregnant women are vital for monitoring progress toward HIV elimination targets. The achievement of high coverage and uptake of services along the PMTCT cascade is crucial for national and international mother-to child transmission (MTCT) elimination goals. In eastern and southern Africa, MTCT rate fell from 18% of infants born to mothers living with HIV in 2010 to 6% in 2015. This paper describes the degree to which World Health Organization (WHO) guidelines for PMTCT services were implemented in Zambia between 2010 and 2015.Method: The study used routinely collected data from all pregnant women attending antenatal clinics (ANC) in SmartCare health facilities from January 2010 to December 2015. Categorical variables were summarized using proportions while continuous variables were summarized using medians and interquartile ranges.Results: There were 104,155 pregnant women who attended ANC services in SmartCare facilities during the study period. Of these, 9% tested HIV-positive during ANC visits whilst 43% had missing HIV test result records. Almost half (47%) of pregnant women who tested HIV-positive in their ANC visit were recorded in 2010. Among HIV-positive women, there was an increase in those already on ART at first ANC visit from 9% in 2011 to 74% in 2015. The overall mean time lag between starting ANC care and ART initiation was 7 months, over the 6 year period, but there were notable variations between provinces and years.Conclusion: The implementation of the WHO post 2010 PMTCT guidelines has resulted in an increase in the proportion of HIV-infected pregnant women attending ANC who are already on ART. However, the variability in HIV infection rates, missing data, and time to initiation of ART suggests there are some underlying health service or database issues which require attention.

Background: Globally, an estimated 150,000 children were newly infected with HIV in 2015, over 90% of them in Sub-Saharan Africa. In Zambia, ~500,000 babies are born to HIV positive mothers every year, and without intervention 40,000 of them would acquire the infection. Studies have shown a strong association between education and HIV prevalence, but in Zambia, this association has not been demonstrated. There is little published information on the association between educational attainment and HIV testing uptake among pregnant women, which is fundamental in understanding the mother to child transmission of HIV. This study investigated whether educational attainment was associated with uptake of HIV testing among women of reproductive age in Zambia.Methods: Data were taken from Zambia Demographic and Health Survey in 2014 (ZDHS14). The analysis consisted of all women aged 15–49 years, who responded to the question on HIV testing in the ZDHS. Multivariable logistic regression was used to determine whether educational attainment was associated with uptake of HIV testing among women of reproductive age in Zambia.Results: Educational attainment was strongly associated with HIV testing among 15,388 women of child bearing age [AOR 3.8, 95% CI 1.7–8.2; p = 0.001]. HIV testing differed greatly by socioeconomic social status with an increased uptake among women with higher wealth index [AOR 4.4, 95% CI 1.9–9.9; p = 0.001]. Additionally, HIV testing was observed to be higher among the older women 25–34 years compared to the young women 15–19 years [AOR 2.3, 95% CI 1.3–4.3; p = 0.007].Conclusions: This study revealed educational attainment to be a strong predictor of HIV testing among women of child bearing age in this population. High HIV testing uptake among educated pregnant women indicated that low-educated women may not fully realize the benefits of testing for HIV. Therefore, strengthening HIV testing in rural health facilities and providing initiatives to overcome barriers to testing among women with no formal education may help reduce vertical transmission of HIV.