Abstract:

Background: In 2013, Zimbabwe adopted Option B+, lifelong anti-retroviral therapy (ART) for all pregnant and breastfeeding HIV positive women and Nevirapine prophylaxis for their infants as a PMTCT method. Kadoma city started implementing the same in 2014. An evaluation was done to assess progress and determine reasons for loss of follow-up to advice and improve the program.

Methods: A process-outcome program evaluation using a logical framework was conducted. Pretested interviewer administered questionnaires, checklists and monthly reports were used for data collection. Epi Info 7 was used to calculate means and frequencies. Microsoft-Excel 2013 was used to consolidate monthly reports.

Results: Thirty health workers and 43 Option B+ clients were recruited. Although resources were limited, all the 324 women who tested positive in 2014 and 2015 received ART. CD4+ monitoring increased from 54% in 2014 to 65% in 2015. All the 240 exposed infants identified within 72 hours received Nevirapine prophylaxis in 2014 and 2015. HIV positivity at six weeks in infants decreased from 4% in 2014 to 2% in 2015. Reasons given by health workers for loss to follow-up were: clients’ limited understanding (37%), poor tracking mechanisms (23%), mobility of clients (20%), religious beliefs (17%) and side effects (3%). Clients’ involvement in community support groups was poor (3%).

Conclusions: Despite limited resources, there was an improvement in Option B+ services. Reasons for loss to follow-up include poor tracking mechanisms, clients’ mobility, religious beliefs and side effects. Clients have been referred to community support groups and retention has improved.

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