Community interventions and PMTCT: the other “p”

B. Ryan Phelps

Office of HIV/AIDS, USAID

New HIV infections in children

Source: Universal Access Report, 2011

Indicators 2009 2010 2015 Target

Number of new pediatric HIV infections 430,000 390,000 <43,000

• Two literature reviews– Retention along the PMTCT continuum of care– Community-based strategies that work

Objectives

PMTCT care continuum

The PMTCT Effectiveness in Africa: Research and Linkages to Care (PEARL) Study

http://www.pepfar.gov/documents/organization/118151.pdf

SdNVP coverage in pregnancy

More PMTCT Options

Status of B+ Decision CountriesMOH-endorsed plan for national implementation of B+

MalawiRwandaHaiti

MOH-endorsed plan for phased implementation of B+

UgandaKenya

National Steering Group recommendation to move to B+; not yet MoH-endorsed

NamibiaSouth Africa

Piloting B+ Mozambique (large pilot – 241 sites)Cameroon (small pilot)Swaziland

Considering transition to B+ Tanzania South Africa

HAART coverage in pregnancy

L. Ferguson et al. Linking HIV-positive pregnant women to treatment services Trop Med and Intl Health; v17 no 5 pp 564–580, May 2012

Killam et al, Zambia, 2010

Mandala et al, Zambia, 2010

PMTCT care continuum

All pregnant mothers at first ANC

Pregnant mothers accepting testing

Pregnant mothers testing positive (25%) Delivery 6 months

postpartum36 week ANC

Ahoua, Ayikoru et al. 2010

Cook, Ciampa et al. 2011

Manzi, Zachariah et al. 2005

Retention of HIV-exposed infants (1)

Eligible HIV-exposed infants

2 months after enrolment

18 months of ageEnrolled HIV-

exposed infants

Eligible HIV-exposed infants

Return for at least one visit

4 month visit

Hassan, Sakwa et al. 2011

Sherman, Jones et al. 2004

Ioannidis, Taha et al. 1999

Retention of HIV-exposed infants (2)

(Unpublished CHAI data , 2009)

Retention of HIV-exposed infants (3)

PMTCT care continuum

• Two literature reviews– Retention along the PMTCT continuum of care– Community-based strategies that work

Objectives

1st Author Country Intervention OutcomeFutterman. South Africa Mentor mother-guided

education and supportHIV knowledge increased

Orne-Gliemann

Zimbabwe Community sensitization with peer educators

Increased HIV awareness; increased PMTCT knowledge; increased condom use (reported)

Balogun Nigeria N/A TBA counseling of HIV exposed clients and referral for testing depended on knowledge level

Teasdale South Africa M2M program Increased NVP coverage (mothers and infants)

Torpey Zambia Lay counselors and traditional and religious leader engagement

More pregnant women tested and receiving results; seropositive pregnant women receivingcomplete course of ARV prophylaxis

Faraquhar Kenya Partner engagement Women whose partners came for testing ~ 3x more likely to return and report taking NVP

Chandisarewa Zimbabwe Community counselor-driven opt-out testing

More women tested, received results; more diagnosis in ANC, and more NVP uptake

Bekker South Africa Community counselor providing PSS/support

More women started ART

Kurewa Zimbabwe Support groups, and community tracking

Less LTFU among mother-infant pairs

PEPFAR-supported Acceleration PlansTUNISIA

MOROCCO

SAHARA

ALGERIA

MAURITANIA

MALI NIGE

R

LIBYA

CHAD

Mediterranean Sea

Sea

EGYPT

SUDAN

ETHIOPIA

DJIBOUTI

ERITREA

SOMALIAKENYA

TANZANIA

DEMOCRATIC

CENTRAL

RWANDA

GABON

EQUATORIAL

ANGOLA

CONGO

NIGERIA

BENIN

DTVOIRE

SIERRA

SENEGAL

GHANA

THE

GUINEA

LIBERIA

CAMEROON

SOUTH AFRICA

MALAWI

ZAMBIA

MOZAMBIQUE MADAGASCARZIMBABWE

BOTSWANA

SWAZILAND

Indian

Ocean

LESOTHO

NAMIBIA

ANGOLA

Atlantic

Ocean

WESTERN

Red

UGANDA

OF THE CONGO

REPUBLIC

BURUNDI

GUINEAREP. OF

TOGOCOTE

BURKINA

GUINEA

LEONE

GAMBIA

BISSAU

Walvis Bay

SOUTH

REPUBLIC

AFRICAN

THE

AFRICA

Legend 6 Original Acceleration Countries 8 New Acceleration Countries

PEPFAR PMTCT programs in Global Plan countries*

SOUTHSUDAN

* PEPFAR supports programming in India (not pictured)

Acceleration Plans all required to have community engagement elements

New HIV infections in children

Source: Universal Access Report, 2011

Indicators 2009 2010 2015 Target

Number of new pediatric HIV infections 430,000 390,000 <43,000

Thank you.

Kea leboga.

Niyabonga.