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National Survey of HIV and Syphilis Prevalence Among

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National Survey of HIV and Syphilis Prevalence Among AIDS & TB PROGRAMME 2013 i Contents Foreword i Acknowledgements iii Executive Summary iv Acronym v 1. INTRODUCTION 1 1.1 Country Profile 1 1.2 Background 2 2: OBJECTIVES 6 2.1 Broad Objectives 6 2.2 Specific objectives 6 3: METHOD 3.1 Survey design 6 3.2 Sampling 7 3.2.1 Sentinel population 7 3.2.2 Selection of survey population 7 3.2.3 Selection of sentinel surveillance sites 7 3.3 Sample size determination 7 3.6 Summary of Survey Operational Procedures 9 3.7 Laboratory procedures 10 3.7.1 Laboratory Methods 10 3.7.3 Quality Assurance of HIV Testing 11 3.8 Data entry and management 12 3.9 Data analysis 12 3.10 Overall quality assurance 12 4. RESULTS 13 4.1 Population characteristics 13 4.2 Distribution of HIV Prevalence in the fifty-three sentinel sites 17 4.3 Trends in HIV Prevalence 2002 -2012, For All Women 15-49 years in Nineteen Sentinel Sites 2002 -2012 29 4.4 HIV Prevalence and trends, Women age 15-24 years in Nineteen Sentinel Sites, 2002 -2012 36 4.5 Results of Syphilis 42 5. DISCUSSION AND CONCLUSIONS 44 5.1 Lessons Learnt 46 6. RECOMMENDATIONS 46 References 47 APPENDICES 48 Appendix 1: 2012 Sentinel Survey Sites Province and Sentinel Site Classification 48 Appendix 2: 2012 ANC Surveillance Form 50 Appendix 3: Laboratory HIV Parallel Testing Algorithm 53 Appendix 4: ANC Sentinel Surveillance Sites Since 2002 54 ii National Survey of HIV and Syphilis Prevalence among Women attending Antenatal Clinics in Zimbabwe 2012 List of Tables and Figures Tables Table 1: Summary of Zimbabwe Population in 2012 1 Table 2: Health and Socio-Economic Indicators 1 Table 3: Distribution of clients by residential classification 13 Table 4: Distribution of client characteristics 16 Table 5: HIV Prevalence by Sentinel Site,2012 18 Table 6: Distribution of HIV prevalence by exposure to PMTCT services 26 Table 7: Overall HIV prevalence statistics 29 Figures Figure 1: Overall HIV pooled prevalence for women 15-49 years, 2012 17 Figure 2: HIV prevalence by sentinel site location, 2012 20 Figure 3: Median HIV prevalence by province, 2012 20 Figure 4: HIV prevalence by age-group among ANC attendees, 2012 21 Figure 5: Urban-rural comparison of HIV prevalence among ANC attendees 15-49 years, 2012 21 Figure 6: HIV prevalence by education level, 2012 22 Figure 8: HIV Prevalence by occupation, 2012 24 Figure 9: HIV Prevalence by gravidity among ANC attendees, 15-49 years 25 Figure 10: HIV Prevalence by number of abortions and still-births, 2012 25 Figure 11: Prevalence of HIV by history and presence of GUD 26 Figure 12: HIV prevalence by partner’s occupation 27 Figure 13: HIV prevalence by partner’s place of residence 28 Figure 14: HIV prevalence by partner’s level of education 28 Figure 15: Overall HIV prevalence trends 29 Figure 16: HIV prevalence trends by age-group 30 Figure 17: HIV prevalence trends by level of education 31 Figure 18 : HIV prevalence trends by occupation 32 Figure 19: Trends in HIV prevalence by sentinel site location 33 Figure 20: Trends in HIV prevalence by occupation 33 Figure 21: HIV prevalence trends by province 2012 34 Figure 22: Overall HIV prevalence trends by young women (15 -24 years) 36 Figure 23: HIV prevalence trends in young women 15-24 years by site 37 Figure 24: HIV prevalence in young women by age-group 39 Figure 25: Trends in HIV prevalence by education level in young women 15-24 years 39 Figure 26: HIV prevalence trends by sentinel location 15-24 years 40 Figure 27: HIV prevalence trends by province 15 -24 years 41 Figure 28: Percentage RPR Positive among, women, 15-49 years, and 2012 42 Figure 29: Percentage RPR Positive by Age-Group, Among ANC Attendees, 15-49 years, 2012 42 Figure 30: Prevalence of RPR positive by gravidity 43 AIDS & TB PROGRAMME 2013 iii Appendices Appendix 1: Sentinel Sites Classification 59 Appendix 2: 2012 ANC Surveillance Form 61 Appendix 3: Laboratory Testing Algorithm 63 Appendix 4: Parallel Testing Algorithm 64 Appendix 5 : Report on Evaluation of Rapid HIV test Kits using ELISA HIV test Kits 68 Appendix 6: Comparison of 2008 PMTCT data and 2009 ANC Site Prevalence data 75 Appendix 7: Trends in HIV Prevalence all women 15-49 years, Genescreen HIV Test 76 Appendix 8: List of ANC Survey Participants 77 iv National Survey of HIV and Syphilis Prevalence among Women attending Antenatal Clinics in Zimbabwe 2012 Foreword The 2012 ANC sentinel surveillance report is a follow up on the 2009 ANC survey. HIV prevalence has declined from 16.1% in 2009 to 15.9% in 2012 among pregnant women 15-49 years old. While prevalence in most sentinel sites has continued to decline, some sentinel sites registered notable increases in HIV prevalence. High HIV infection rates were observed among women 35-39 (26.7%) and 40-44 (26.0%) years of age. HIV prevalence has remained high at sites classified as ‘Other’, (growth points, border posts, mining and resettlement farms) compared to the urban and rural areas. Although the observed decreasing trend is encouraging, overall HIV sero-prevalence among women attending ANC in Zimbabwe remains high. Although there has been a significant decrease in HIV prevalence in the 15-24 year age group (11.6% in 2009 to 9.85% in 2012), increased efforts to scale up prevention campaigns targeting youth are still needed. The positive signs in our fight against HIV and AIDS should spur every Zimbabwean to re- double their efforts and commitment to further reduce the burden of HIV and AIDS. Brigadier General (Dr.) G. Gwinji Permanent Secretary, Ministry of Health and Child Care Zimbabwe AIDS & TB PROGRAMME 2013 v This project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through Cooperative between the Centers for Disease Control and Prevention and the University of Zimbabwe Department of Community Medicine SEAM Project under the terms of Cooperative Agreement Number: 1U2GGH000315-01 vi National Survey of HIV and Syphilis Prevalence among Women attending Antenatal Clinics in Zimbabwe 2012 Acknowledgements The Ministry of Health and Child Care would like to extend its gratitude to all the onsite health care workers, including the sentinel site staff, midwives, as well as their provincial and national supervisors who participated in the Antenatal Clinic Survey for the year 2009. Their hard work and dedication ensured the success of the survey. We would also like to acknowledge the National AIDS Council (NAC) for collaborating with the AIDS and TB Unit in training and data abstraction and to the National Microbiology Reference Laboratory (NMRL) for testing and providing quality assurance for all the survey samples. We wish to express our gratitude to: Central Statistical Office (CSO), Centers for Disease Control and Prevention, Zimbabwe (CDC Zimbabwe), Imperial College London, Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Children Emergency Fund (UNICEF), United Nations Population Fund (UNFPA), World Health Organization (WHO) and Elizabeth Glazier Paediatric AIDS Foundation (EGPAF) supporting the conduct of the survey and providing assistance with data analysis and report writing. Finally, we would like to express our appreciation and gratitude to the pregnant women who participated anonymously in this study, without whom this survey would not have taken place. Dr. Owen Mugurungi Director AIDS and TB Unit AIDS & TB PROGRAMME 2013 vii Executive Summary In 2012, the Ministry of Health and Child Care (MOHCC), AIDS and TB unit conducted HIV sero-prevalence survey of women attending antenatal clinics (ANC) to monitor the level and trends in HIV prevalence. A total of 54 sentinel sites were selected to participate in the survey using probability proportional to size sampling method to represent 10 provinces in the country. A total of 18,437 ANC clients were consecutively enrolled in the survey over a period of four months. Leftover blood specimens collected from pregnant women for routine screening at their first ANC visit were used for HIV antibody testing. All personal identifiers were removed from the specimens ensuring that testing was unlinked and anonymous. The highest HIV prevalence was observed in Matabeleland South 23.8% while the lowest was in Harare 10.8%. The prevalence in the other eight provinces was; Matabeleland North 19.6%, Mashonaland East 17.6%, Midlands 17.2%, Bulawayo 17.1%, Mashonaland West 15.6% Masvingo 14.6%, Manicaland 13.9% and Mashonaland Central 12.4% .The national median HIV prevalence was 15.9%. HIV prevalence among women 15-49 years was slightly higher among women who accessed services in urban sentinel sites (16.1%) as compared to the rural sentinel sites 15.7%. There was a gradual increase in HIV prevalence with age group from 5.6% in the 15-19 years peaking to 26.7% in the 35-39 year old group followed by a decline to 23.1% in the 45-49 year old group. HIV prevalence was highest among women who had not received any form of education, those who were not married, those employed in the informal sector and those with previous history of sexual transmitted infection. The HIV prevalence among pregnant women 15-49 years has declined from 16.1 % in 2009 to 15.9% in 2012. A similar trend was observed in the 15-24 age group where HIV declined from 11.6% in 2009 to 9.85% in 2012. Significant declines were at the following provinces: Mashonaland Central (25.5% in 2002 to 12.4% in 2012), Mashonaland West (27.1% in 2002 to 15.6% in 2012) and Manicaland (25.6% in 2002 to 13.9% in 2012).
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