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Toward elimination of mother-to-child HIV transmission in Zambia: Early infant diagnosis specimen referral system

November 17, 2012

This piece originally appeared on FHI 360's Degrees Blog. For the complete text, please visit: http://degrees.fhi360.org/toward-elimination-of-mother-to-child-hiv-transmission-in-zambia-early-infant-diagnosis-specimen-referral-system/.

By Michael Welsh, Ph.D., M.A. FHI 360 Country Director in Zambia, and Prisca Kasonde, MD, MPH, Director, Technical Services, ZPCT II

Great progress is being made toward eliminating mother-to-child transmission of HIV in Zambia. Counseling and testing of pregnant women is routine and serves as an entry point to prevention services. Increased access to antiretroviral drugs for pregnant women with HIV and their potentially exposed babies are in place throughout the country. Tracking transmission prevention success — a mother with HIV bears a child who is uninfected at birth and remains uninfected through the first year of life — is key to eliminating transmission. In Zambia, antenatal (prenatal) care and prevention of mother-to-child transmission (PMTCT) services are decentralized to the primary health facilities, but the successful tracking of this key indicator requires access to one of the three polymerase chain reaction (PCR) laboratories in the country. These PCR laboratories analyze blood samples to determine if an infant has HIV. With a country as large as Zambia (roughly the size of France), linking PMTCT services to a PCR laboratory requires a referral system that can both perform early infant diagnosis and expeditiously transmit the findings back to the facility for appropriate care, regardless of distance.

In Zambia, with resources provided by the U.S. Agency for International Development and the President’s Emergency Plan For AIDS Relief, the Zambia Prevention Care and Treatment partnership (ZPCT II) project has supported the Ministry of Health in establishing both a PCR laboratory (in Arthur Davison Children’s Hospital in Ndola) and a functioning specimen referral system. The system consists of several components. Blood from a baby exposed to HIV is blotted on a special filter paper and dried, and the dried blood spot is transferred to the laboratory in Ndola via a central hub using motorcycles managed by the rural health facilities themselves. The laboratory then sends the test results back to the health facilities through the same mechanism. ZPCT II has incorporated the use of a short messaging service (SMS) to expedite the communication process, in which the laboratory sends results to facilities or to a provider. The specimen referral system for early infant diagnosis is now operating in over 298 ZPCT II-supported facilities in Zambia.