Follow up and retention for Treatment and PMTCT

Members• Angela Mushavi-Zimbabwe• Martin Sirengo-Kenya• Bernard Dornoo-Ghana• Micheal Eliya-Malawi

• Godfrey Esiru-Uganda• Vuyelwa Chitimbire-Zim• Claudia Kazadi-USA

Background

• Retention important especially for life long ART

• In the past PMTCT programs were not keen on retention because of single pills-sdNVP

• With emergence of more efficacious regimens including Option B plus, there is now need for adherence and retention

Strategies-GOK

1. Scheduled counselling sessions2. Rx supporters3. Peer support groups4. Community response

CHWs –Primary health care initially but now role expanding to take care of HIV aspects

5. mHealth initiatives-Use of cell phones

Strategies-FBOs

1. Implement Govt initiatives on top of own parallel initiatives

2. Collaborations Use govt protocols and training curricula Focus on holistic approaches for all the health

needs of clients Outreach work Mentor patients to boost adherence

Strategies-FBOs

Decentralized commodity supply HBC initiatives Capacity building-MCH counsellors Infrastructure development Equipment for MCNH School programs

Challenges in Govt-FBO partnerships

• Attitudes about mandates of each• Weak involvement of FBO leadership in planning

for HIV activities• Parallel programming• Lack of equity in programming leaving out some

areas e.g. hard to reach places• Weak logistics management for supplies and

commodities• Distance to access Health facilities an

impediment to access

Challenges in Govt-FBO partnerships

• Culture and traditional beliefs limiting access• Stigma and discrimination• Poverty

DiscussionStrategies that may address retention-

Complementary to each other1. Interventions at health facilities to – Improve quality of service– Improve attitudes of health care providers– Treatment supporters– Reduce waiting time– Reinforced counselling for women to understand

why its important to remain in care and adhere to medication

Strategies that may address retention-cont..

2. Mother baby booklets/cards and other tools for tracking clients

3. Actual follow up– Use of mobile phones– Use of peer supporters/– Support groups

4. Community response– Support groups at community level– CSOs– CHWs– Referral system between Community and facilities

Use of church structures for retention

• Break the religious beliefs that stop people form going to health facilities of taking prescribed medications

• Use the church teachings to break retrogressive traditional beliefs and traditions

Key recommendations for Govts and FBOS1. Improve quality of service at health facility to

improve client satisfaction-HCWs attitudes, train HCWs, Infrastructure improvement, fast and timely services, avail commodities and supplies, integrate services (One stop shop), POC solutions e.g. CD4, EID etc

2. Client education and counselling: Reinforced counselling for women to understand why its important to remain in care and adhere to medication including community structure support and response. Respond and accommodate cultural beliefs that keep women away from hospitals

Key recommendations for Govts and FBOS

3. Strengthen peer support and defaulter tracing tools and mechanisms: Standard M&E system-Cards/registers, EMR,

mHealth initiatives, Smart cards, appointment books and other referral and linkages tools.

Peer support initiatives:- Mentor mothers, support groups, CHWs etc