The development of harmonized minimum standards for guidance on HIV testing and counselling and Prevention of Mother-to-Child Transmission of HIV in the SADC region: PMTCT country report: Zambia

MarchZambia is one of the sub-Saharan African countries worst affected by HIV/AIDS pandemic. Estimates of HIV prevalence in 2007 for people aged 15 to 49 are 15.2% (UNICEF) and 14.3% (ZHDS). Estimates from sentinel surveillance data for 15-24 year olds are 6.5% (ZDHS, 2007) and 12.5% (SADC, 20081). Ninety-three percent of the population has access to antenatal care (UNICEF, 2008). HIV transmission in Zambia is mainly through heterosexual contact, exacerbated by high-risk sexual practices, gender inequality, poverty, stigma discrimination, and high prevalence of sexually transmitted infections (STIs) and TB. The remaining transmission is predominantly mother-to-child transmission (MTCT) during pregnancy, at birth, or through breast-feeding. High prevalence of HIV-related illness has overburdened Zambian health care system at all levels (Current Guidelines, 2008). Uptake of PMTCT increased from about 5% in 2003 to just over 30% in 2007 (SADC, 2008 ). However, PMTCT coverage varies considerably between rural and urban areas, as well as between different areas in each district. Rural districts, disadvantaged and hard-to-reach areas within districts are generally poorly covered with PMTCT services. There are now 935 health facilities providing PMTCT services from a total of 1,320 public facilities in the country; a coverage rate of 71%