HIV Care And Prevention Programs For Mothers And Children In Zimbabwe
ZVITAMBO is an interdisciplinary Zimbabwe-based organization that provides technical support for, and conducts operational and clinical research relevant to HIV care and prevention for women and young children. ZVITAMBO is a project of The Johns Hopkins Bloomberg School of Public Health (Baltimore, MD, USA), The University of Zimbabwe, and the Research Institute of the McGill University Health Centre (Montreal, Quebec Canada). ZVITAMBO operates under a Memorandum of Understanding with the Ministry of Higher Education of Zimbabwe.
ZVITAMBO was initially formed in 1996 to carry out a clinical trial among 14,110 mother-infant pairs to test the impact of single dose postpartum maternal and neonatal vitamin A supplementation on a number of maternal and infant outcomes including infant health and survival, maternal HIV incidence, and postnatal mother to child transmission of HIV. In 1999, when international policy and practice changed regarding infant feeding in the context of HIV, an additional objective was added to the trial: an education and counselling intervention to inform and support women about infant feeding in the context of HIV was developed, implemented within the trial, and its impact on feeding and sexual practices and infant infection and survival was evaluated. Mother-infant pairs were followed clinically for up to two years, resulting in a large database and biological sample archive of ~400,000 specimens (breast milk, maternal and infant plasma, serum, and cells). To date, 37 publications have resulted from this work.
In 2001, ZVITAMBO also began providing technical support to the National Prevention of Mother to Child HIV Transmission (PMTCT) program of the Ministry of Health and Child Welfare of Zimbabwe (MOHCW-Z). This program-support work built on the expertise and experience acquired during the clinical trial, and the relationships and partnerships the team developed over the years with national and district levels of the health system, policymakers within the AIDS&TB and Nutrition Units of the MOHCW, and international and local partners. Initially, ZVITAMBO raised two grants locally to start PMTCT work in 4 hospitals. Subsequently, the Canadian International Development Agency (CIDA) provided a substantial 3-year grant in 2003 for ZVITAMBO to expand this work. Currently, ZVITAMBO is assisting 14 rural mission hospitals to integrate PMTCT interventions (e.g., HIV testing and counselling, provision of short-course antiretroviral prophylaxis to HIV-positive mothers and HIV-exposed neonates and cotrimoxazole prophylaxis to HIV-exposed infants, infant HIV diagnosis by PCR, and infant feeding counselling and support) into their health services. Finally, ZVITAMBO staff provide technical assistance to the national PMTCT program by participating in the PMTCT Partnership Forum and co-authoring and co-implementing national policy and training curricula on infant feeding in the context of HIV, HIV counselling, laboratory quality control and monitoring & evaluation. Currently, we are negotiating a new 3-year grant with CIDA (2006- 2009) to continue support of the 14 hospitals and extend to a geographic district (Chirumanzi in Midlands Province). We will establish a satellite office in Chirumanzi and, in addition to strengthening PMTCT services throughout the district, conduct operational research to identify how PMTCT can be more effectively linked with other HIV care and prevention services. The site will also provide opportunities to conduct programmatically relevant research (e.g., identifying optimal replacement feeding options for HIV-positive mothers who chose to cease breastfeeding early).
ZVITAMBO is unique in that we concomitantly conduct research and support public health programming. We believe that doing both within the same organization creates a synergy between health research and programming: research findings can be more speedily integrated into programming, and program experience informs and maintains the relevance of research.
Since 1998, we have offered internships and attachments within research projects and the PMTCT program to students at Johns Hopkins Bloomberg School of Public Health (JHBSPH) and to students from several disciplines at the University of Zimbabwe (UZ). Our setting has been particularly well-suited to meeting the academic requirement for a 4-6 month attachment of the JHBSPH Masters of Health Science (MHS) program. In most cases, JHBSPH students worked jointed with UZ students to enhance cross-cultural learning, share experiences, and take advantage of complementary skills.
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