African Journal of Public Health and Health Systems | 07 July 2016
Assessing the Impact of Dolutegravir-Based Regimens on Mother-to-Child HIV Transmission in Manicaland Province, Zimbabwe: A Mixed Methods Study, 2016
T, a, r, i, r, o, M, o, y, o, ,, F, a, r, a, i, C, h, i, g, u, d, u, ,, R, u, t, e, n, d, o, M, a, k, o, n, i
Abstract
The introduction of dolutegravir-based antiretroviral therapy for pregnant and breastfeeding women in Zimbabwe was a major policy change to improve viral suppression and reduce mother-to-child transmission of HIV. Evidence of its real-world effectiveness within routine antenatal services in Zimbabwean provinces was limited prior to implementation. This study assessed the impact of the dolutegravir-based regimen rollout on mother-to-child transmission rates in Manicaland Province. Its objectives were to quantify changes in early infant diagnosis positivity and to explore healthcare worker and patient experiences of the new regimen’s implementation. A convergent parallel mixed methods design was used. The quantitative component was a retrospective cohort analysis of routine programme data from antenatal clinics, comparing early infant diagnosis outcomes before and after the dolutegravir rollout. The qualitative component involved semi-structured interviews with healthcare workers and focus group discussions with HIV-positive mothers receiving antenatal care. Quantitative analysis showed a statistically significant reduction in the mother-to-child transmission rate at six weeks postpartum following the rollout. Qualitative data revealed three key themes: improved patient-reported side-effect profiles leading to better adherence; initial healthcare worker anxieties about drug safety that were later alleviated; and persistent systemic challenges, including occasional drug stock-outs. The rollout of dolutegravir-based regimens in Manicaland Province was associated with a substantial reduction in mother-to-child transmission of HIV, meeting the programme target. The regimen was well-accepted by patients and providers, though operational barriers remained. Sustain and expand access to dolutegravir for all eligible pregnant and breastfeeding women. Strengthen drug supply chain management to prevent stock-outs. Incorporate focused dolutegravir counselling training for antenatal care providers. Dolutegravir, mother-to-child transmission, HIV, antenatal care, mixed methods, Zimbabwe, implementation. This study provides evidence of the real-world effectiveness of dolutegravir-based regimens in reducing perinatal HIV transmission within a routine public health programme, highlighting both clinical benefits and operational challenges for policymakers and programme managers.