Background: The first coverage target required for validation of “virtual elimination” of mother-to-child HIV transmission is ≥95% antenatal care (ANC) attendance. Achievement of this target will require strategic allocation of limited resources. We identified subgroups most at need for intervention for the final push toward elimination of PMTCT in Zimbabwe.
Methods: We analyzed data from a 2014 evaluation of the National PMTCT Program that collected population representative data. Eligible women were ≥16 years and had infants born 9-18 months before the interview. Participants were tested for HIV and interviewed about service utilization during pregnancy. We examined the proportion of mothers who would be targeted by various strategies, the number of outreached mothers needed in each strategy to reach one mother without ANC, and the impact on population ANC attendance if 50% of those mothers without ANC were successfully engaged in ANC. We also looked at uptake of other services among women who did not attend ANC.
Results: Two of the five provinces surveyed failed to meet ANC the target, with 6.2% of mothers in Harare and Manicaland reporting no ANC visits. The targeting strategy with the highest impact on overall ANC attendance in these provinces was outreach to mothers of Apostolic religion (reduction from 6.2% to 4.1%). However, 37% of mothers were Apostolic. An alternate strategy, also allowing these provinces to reach the target (reduction from 6.2% to 4.5%), was to target mothers in those provinces with 3 or more previous pregnancies or a previous non-institutional delivery. This group targets only 18% of mothers. Mothers with no ANC were also more likely to have missed other services including; institutional delivery (62.6% vs 11.9%, p< 0.0001), immunization (33.5% vs 0.1%, p< 0.0001), and EID (48.6% vs 28.8%, p=0.003).
Conclusions: Reaching the last group of women who do not attend ANC will require a significant effort. Women in this group are also less likely to uptake other health services, and targeted outreach to these mothers may have additional benefits if they are engaged in healthcare. These findings demonstrate a data driven approach to optimizing resources to target populations outreach for ANC services.