This study will provide essential data to better understand the population-level impact and cost effectiveness of Option B+ and mothers’ retention in care after weaning, while leveraging our data and experience from Zimbabwe.
The project specific aims are to:
Aim 1a, 1b: Compare the population-level impact of Option B+ on HIV-free survival and MTCT among infants 9-18 months of age to: a) standard of care before Option A; and b) Option A in Zimbabwe.
We hypothesize that HIV-free survival at 9-18 months will be greater and MTCT will be reduced under Option B+ compared to the standard of care before implementation of Option A (comparing the 2017 survey to the existing 2012 survey) and when compared to Option A (2017 survey compared to 2014 survey). By focusing on 9-18 months old infants, we capture transmissions occurring during pregnancy, labor and breastfeeding.
Aim 2: Assess heterogeneity of the impact of Option B+ on HIV-free survival and MTCT among infants 9-18 months of age by the extent of integration of PMTCT and ART services at health facilities. We hypothesize that communities that have health facilities with higher levels of integration of PMTCT and ART services will have higher HIV-free survival and lower MTCT than communities with poorly integrated facilities.
Aim 3: Assess retention of mothers in ART services after weaning (19-36 months postpartum).
The 2017 survey assesses engagement in HIV care after weaning. In particular, we will examine retention in care among asymptomatic HIV-infected mothers who began treatment during pregnancy.
Aim 4a, 4b: Determine the cost-effectiveness of Option B+ compared to: a) the standard of care before Option A; and b) Option A.
A comprehensive facility-based survey in study areas will collect resource utilization and unit cost data to assess the incremental cost-effectiveness ratio of Option B+ compared to the standard of care before Option A and compared to Option A.