PMTCT /Paediatric AIDS Program: Karamoja Experience

Achievements and Challenges

Presentation during Children and AIDS Retreat

Mountain of the Moon Hotel

Fortportal September 2009

Background

• Projected population = 1,060,900.

• Estimated pregnant women = 41,713.

• HIV prevalence 3.7% (MoH; 2005, Sero behavioural survey).

• Number of pregnant women expected to be HIV+ = 1,543 (at 3.7% prevalence).

Background cont..

• Number of ANC sites = 37

• Number of PMTCT sites = 34 (90% ANC coverage)

• Implementing partners• CESVI (Abim and Kaabong district)• IRC (Kotido, Moroto and Nakapiripirit district)• CUAM (all the 5 districts).

2009 AWP Inputs (Cash and supplies)

• Total direct disbursement to the district stands at 124,642,650 (32%); Planned amount in AWP 396,922,200.

• 3 district have submitted their second funding request.

• Supplies that included drugs for prophylaxis (ARVs, Cotrimoxazole), HIV test kits, Mama kits, gloves, cotton wool, Vacutainer tube needles and holders etc).

• Received 2 vehicles and 8 motor cycles to support programme implementation.

Out puts (Jan – July 2009)

• 131 health workers skills in Paediatric HIV testing and DBS collection enhanced through training.

• 160 HIV exposed babies tested through PCR and 32 (20%) tested positive.

Out puts (Jan – July 2009) cont.

• 58 Health Workers (Nakapiripirit 14, Kotido 10, Moroto 21 and Kaabong 13) trained and their skills on PMTCT HIV counseling and testing improved.

Out puts (Jan – July 2009) cont.

• Counseled and tested 16,235 pregnant women through static and outreaches in hard to reach areas.

• Enrolled 239 out of 333 HIV positive women into the PMTCT.

Out puts (Jan – July 2009) cont.

• 900 members of the VHTs (Abim and Kaabong) have been oriented on PMTCT.

• VHTs participating in raising awareness on PMTCT among communities and mobilising pregnant women to attend static and outreach ANC clinics.

• Scale up to other districts (Moroto, Kotido and Nakapiripirit)

Out puts (Jan – July 2009) cont..

• Community mobilized through MDD to influence and change their behaviour and attitude towards safer sexual behaviours and HIV testing with emphasis on pregnant women and their partners

Out puts (Jan – July 2009) cont.

• Following up HIV positive mothers and their babies through home visiting .

• Challenged by high mobility pattern in search of food.

Out puts (Jan – July 2009) cont

• Improved data reporting from the health units. Utilization and validation remains a challenge with discrepancies seen between PMTCT and HMIS reports.

• Minimal stock outs of supplies reported. This is attributed to buffer stocks supplied by UNICEF.

• Streamline the reporting, requisitions and delivery from NMS which remains challenging.

Regional Performance (Jan – July 2009)

Indicator Karamoja

ANC sites 37

PMTCT sites 34

Estimated pregnant mothers 41,713

Pregnant mothers tested 16,235

Mothers tested +ve 333

Mothers given ARVs 239

Babies given ARVS 135

District performance (Jan – July 2009)

Indicator Abim Kaabong Kotido Moroto Nakap

PMTCT sites 5 3 6 11 8

Estimated pregnant mothers

2,675 15,830 9,408 13,800 11,335

Pregnant mothers tested

2,64698%

2,72317%

3,77840%

4,21831%

2,87025%

Mothers tested + ve 86 25 78 96 48

Mothers given ARVs

61 12 49 82 35

Babies given ARVS

33 7 33 48 14

Challenges

• Low ANC attendance and institutional deliveries; difficulty in dispensing ARVs to new born babies? Role of VHTs/TBAs.

• Understaffing vs competing priorities.

• Lack of Psychosocial Support. (no NGOs supporting PHA networks especially livelihood for women and OVCs).

• Lack of EID and CD4 testing facility in the region resulting in long results turnaround time.

• Mixed feeding among HIV positive mothers compounded by poor follow up.

Lessons learnt

• Increasing incidences of GBV emerging from disclosure of HIV status. Need for mitigation measures.

• Involvement of PHAs have not been exploited in sensitization of communities and fighting stigma.

• VHTs is a critical structure in communities mobilization and awareness raising.

• Family centred approach to clients enhance disclosure, initiation on ART and adherence.

Priority areas up to Dec 2009

• Counseling and testing, provision of ARVs to +ve mothers, EID. (static and outreaches including home based counseling and testing).

• Community mobilization to raise awareness and increase service utilization by use of VHTs, drama, radio programs etc. special emphasis on Male participation.

• Follow up and referral of HIV positive pregnant women and their children for both PMTCT and comprehensive ART services.

• Supply chain (timely requisition to NMS of ART drugs to avoid stock out).

• Programme monitoring, supervision and evaluation through field monitoring visit, review meeting, data validation.

PMTCT sites by district

Moroto district1. Moroto hospital2. Kidepo HC III3. Lotome HC III4. Lokope HC III5. Iriiri HC III6. Matany Hospital7. Nadunget HC III8. Tapac HC III9. Lopei HC III10. Kangole HC III11. Moroto Army HC III

Kotido district1. Kanawat HC III2. Kotido HC IV3. Kacheri HC III4. Kotido CoU HC III5. Rengen HC III6. Nakaperimoru HC IIIAbim district1. Abim hospital2. Rwamuge HC III3. Morulem HC III4. Nyakwai HC III5. Alerek HC III

PMTCT sites

Nakapiripirit district

1. Tokora HC IV

2. Nabilatuku HC IV

3. Amaler HC III

4. Namalu HC III

5. Nakapiripirit HC III

6. Lolachat HC III

7. Lorengedwat HC III

8. Amudata Hospital

Kaabong district1. Kaabong hospital2. Karenga HC IV3. Kalapata HC III

Welcome to a Manyata

Thanks

Alakara Noi