Community interventions and PMTCT: the other “p” B. Ryan Phelps Office of HIV/AIDS, USAID.
Preventing Mother to Child Transmission (PMTCT) of HIV Programme Presentation to MinMEC, July 2001.
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Transcript of Preventing Mother to Child Transmission (PMTCT) of HIV Programme Presentation to MinMEC, July 2001.
Preventing Mother to Child Preventing Mother to Child Transmission (PMTCT) of HIV Transmission (PMTCT) of HIV
ProgrammeProgramme
Presentation to MinMEC, July 2001
Overall Objectives of the Overall Objectives of the ProgrammeProgramme
Feasibility of integrating PMTCT programme into existing routine MCH services
Ability of PMTCT to avert vertical transmission and reduce childhood mortality rates
Specific ObjectivesSpecific Objectives
Feasibility of providing VCT in clinics offering routine ANC services
Acceptability of VCT in the context of PMTCT
Acceptability of ARV therapy for PMTCTFeasibility of providing counselling on safe
infant feeding practices for HIV+ womenImpact of infant feeding counselling
Specific ObjectivesSpecific Objectives
Costs of establishing and running a PMTCT programme
Feasibility of integrating follow-up of infants born to HIV+ women
Mechanisms of improving follow-up care for HIV+ women post delivery
Impact of PMTCT interventions on other PHC and HIV/AIDS programmes
Status quo of Preparations Status quo of Preparations for PMTCTfor PMTCT
Protocol has been developed Procurement and distribution system in place Training manual printed and distributed Financial resources made available Additional human resources made available Nevirapine (NVP) been registered Sites selected and provinces are in various states
of readiness Ordering of provincial supplies intiated
Research FrameworkResearch Framework
Routine data collection: Collected at 18 sites
- Uptake of the PMTCT interventions
Local operational research:
- Provincial research
Specialised research:
- e.g. Resistance studies
Research FrameworkResearch Framework
9 research areas:A: Demographic, socio-economic and health status characteristics of catchment populationB: General and healthcare infrastructure of catchment areaC: Organisation of healthcare system and health service accessibility/utilisationD: Uptake and quality of PMTCT service
Research FrameworkResearch Framework
E: Cohort follow-up of children and mothersF: Effect of PMTCT programme on the rest of the healthcare systemG: CostH: The community and community responseI: Clinical research
–Nevirapine resistance–Cotrimaxazole
ChallengesChallenges
Do women want to enrol ? Can the system cope with the demand for VCT
with the assistance of lay counsellors? Will there be an influx from non-PMTCT areas
and how to handle this? Is formula feeding going to increase the incidence
of diarrhoeal diseases in areas with poor water supply?
ChallengesChallenges
Will the system be able to adequately follow the mother and infant pair after delivery - in particular monitoring the growth of the infants?
How can inter-departmental collaboration at community level for the follow-up of HIV positive women and their infants effectively be established?
Will routine data collection/analysis be done correctly and without posing too much of a burden?
ChallengesChallenges: DOH national: DOH national
Transferring funds to the provinces for implementation
Delays in ordering of suppliesNew appointee – little time to get up to
speed
Provincial ProgressProvincial Progress: Eastern Cape: Eastern Cape
Sites: Cecilia Makiwane, Frere, Rietvlei (UNITRA providing support to Rietvlei)– Training conducted– Lay counsellors to provide VCT– Follow-up in well baby clinics– Use NGOs for community mobilisation– Cecilia Makiwane: educated 366 pregnant women,
44 agreed to voluntary counselling, 25 (57%) agreed to voluntary testing, 15 tested positive (60%)
– Since March 15 babies delivered
Provincial ProgressProvincial Progress: Eastern Cape: Eastern Cape
Challenges– Access to NVP for baby in case of home delivery– Exclusive breastfeeding – what to do if woman has
to leave infant behind– Availability of safe drinking water for bottle-feeding
Provincial ProgressProvincial Progress: Free State: Free StateSites: Frankfort, Virginia
– Trained 60 nurses– Lay counsellors will do counselling– Follow-up of infants at well baby clinics– Monitoring tools available– Undertaken health promotion activities– IEC materials being prepared– Provincial coordinator has been appointed– Virginia started on 3 July 2001– Frankfort will start on 14 July 2001
Provincial ProgressProvincial Progress: Free State: Free StateChallenges
– Delay in availability of funds– Limited accommodation at the clinics for
counselling service
Provincial ProgressProvincial Progress: Gauteng: Gauteng
Sites: J Dumane, Natalspruit, Pretoria West, Kalafong– Training conducted– Follow-up mechanisms in place– Data collection mechanisms in place– Designing information pamphlet– Implementation started 25 May– Appointment of provincial coordinator in progress
Provincial ProgressProvincial Progress: Gauteng: Gauteng
On average women agreeing to test:– J Dumane - 55% out of which 39% test positive– N Spruit - 71% (32% test positive)
– P West - 65% (10% test positive)– Kalafong - 23% (33% test positive)
Overall 107 women were given NVP Overall, 37 children were delivered (only 1 died) All women chose to formula feed
Provincial ProgressProvincial Progress: Gauteng: Gauteng
Challenges– Counsellors not keeping records– Registers not given to coordinator– Not all patients are post counselled because some do
not want results on the same day– Not all negative results counselled– Limited accommodation at the clinics for counselling
service
Provincial ProgressProvincial Progress: KwaZulu-Natal: KwaZulu-Natal
Sites: King Edward, Prince Mshiyeni, Greys/Northdale, Edendale, Church of Scotland– Training conducted– Follow-up mechanisms in place– Data collection mechanisms in place– To date Durban sites counselled 880 women of which
89% (784) agreed to voluntary testing 30% tested positive, and 64% of them received NVP All 53 children born received NVP
Provincial ProgressProvincial Progress: KwaZulu-Natal: KwaZulu-Natal
– In Pietermaritzburg, 1078 women counselled, 88% (945) agreed to voluntary testing
29% tested positive, 67% received NVP, 9 children received NVP
Provincial ProgressProvincial Progress: KwaZulu-Natal: KwaZulu-Natal
Challenges:– Women who come from outside the province
to get access to NVP
Provincial ProgressProvincial Progress: Mpumalanga: Mpumalanga
Sites: Evander, Nkomazi sub-districtImplementation started 1 July 2001Gauteng to assist with training of trainersMTCT coordinators – interviews held 6 June
2001Will use lay counsellorsHealth promotion activities to be in phases
Provincial ProgressProvincial Progress: Mpumalanga: Mpumalanga
Challenges:– Funds not yet transferred from national– Awaiting delivery of orders
Provincial ProgressProvincial Progress: Northern Cape: Northern Cape
Sites: De Aar, GalasheweMTCT coordinator appointed May 2001Training conducted in March 2001Lay counsellors identified and trainedHealth promotion activities undertakenMonitoring and evaluation systems in place
Provincial ProgressProvincial Progress: Northern Cape: Northern Cape
Challenges– Equipment and space for the programme
Progress Report: Northern ProvinceProgress Report: Northern Province
Training has begun: 18 nurses trained and 18 more being trained
Project management structure in placeCommunity mobilisation in progressCoordinator and admin clerk employment
currently being processedLaunch scheduled for 6 August 2001
Provincial ProgressProvincial Progress: North West: North West
Sites: Tlhabane HC, Lehurutshe– Training conducted– Lay counsellors to do VCT– Follow-up mechanisms in place– Data collection mechanisms in place– Campaigns and media releases to mobilise
communities– Launched 3 July 2001
Provincial ProgressProvincial Progress: Western Cape: Western Cape
Western Cape: Paarl, Gugulethu– Nurses trained– Lay counsellors used for VCT– Follow-up mechanisms in place– Monitoring and evaluation mechanisms established– Community information session
Western Cape: PaarlWestern Cape: PaarlPaarl booked 454 women, 432 (95%)
accepted HIV test- 7% tested positive and all were counselled- 8 women delivered live babies- All mothers and babies received NVP- 7 babies started formula feed and 1 exclusive
breast-feeding- No problems
Western Cape: GugulethuWestern Cape: Gugulethu
– Started April 2001– Gugulethu counselled 437 women, 387 (89%)
accepted the HIV test and 73 (19%) tested positive and all received NVP
– 17 women delivered alive babies and all babies received NVP (14 bottle-feed, 3 exclusive breastfeed)
– No problems