Effective Monitoring for HIV Prevention: Re-testing HIV-Negative Pregnant Clients
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Transcript of Effective Monitoring for HIV Prevention: Re-testing HIV-Negative Pregnant Clients
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Effective Monitoring for HIV Prevention: Re-testing HIV-Negative Pregnant Clients
Presenter: Phylis Mutiso, mothers2mothers NOPE Conference, Nairobi
June 2014
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Presentation Outline
• Introduction– About m2m– KMMP services
• Mentor Mother M/E tools• Methods • Lessons learnt
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Background mothers2mothers (m2m)
• Provide Peer Education (PE) and Psychosocial support (PSS) to HIV positive pregnant women and new mothers to promote PMTCT
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Background• m2m directly implements this model at 30
high volume health facilities under umbrella of MOH Kenya Mentor Mother Program (KMMP)
• The KMMP seeks to improve PMTCT uptake and retention by integrating mothers living with HIV into health facilities to provide PE & PSS to their peers as Mentor Mothers (MMs)
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Background
• MMs are competitively recruited and undergo a two-week national KMMP curriculum-based Pre-Service Training(PST)
• PST prepares them to provide quality services to clients through task shifting approach
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KMMP Services
• one-on-one/couple PE and PSS
• support groups • defaulter tracing
• internal referrals and linkages
• services are captured in appropriate KMMP M&E tools
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KMMP Monitoring & Evaluation ToolsLongitudinal records
HIV+ logbook tracks HIV + mother-baby pairs from pregnancy to 18 months post-partum
HIV- logbook tracks HIV- women through pregnancy for retesting at three months
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Context
• PMTCT national guidelines recommend re-test of HIV pregnant clients after three months
• Roll out of re-testing has been slow across the country
• Monitoring of client uptake and outcomes of re-testing remains a challenge
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Description
• MMs provide services through interaction with HIV positive pregnant clients & new mothers
• They provide 2 part-focused interaction (first visit and return visit for re-testing) with HIV negative to motivate them to return for re-testing and influence their male partners to come in for testing at the health facility
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Description
• Client details are recorded in an HIV negative longitudinal register which is updated when clients return for services
• Client return date is booked in a calendar diary
• Diaries are reviewed daily to identify clients due for re-testing who have missed appointments
• The defaulter tracing process is started the next day
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Description• MMs conduct telephonic defaulter
tracing• Depending on client consent, it starts
with an SMS• If a client does not respond to the sms
a telephone call is made• MMs develop list of clients for home
visiting by CHWs through the CHEW
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Lessons Learned
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Lessons Learnt
• Re-testing remains a challenge• Most clients come late in pregnancy• Re-testing uptake lower in Western
Kenya than in Nairobi• Sero-conversion is higher in Western-
(Nyanza where prevalence is at 15.1% KAIS 2012)
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Lessons Learnt
• Data from 30 health facilities from Jan to Dec indicates that only 23% of HIV negative clients returned for re- testing (7,816 out of 34,103)
• 1 % (89 out 7816) sero converted during pregnancy and tested HIV positive, standing a high chance of infecting their infants
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Conclusion
• Effective program monitoring is an essential part of PMTCT programming
– To ensure available services are being utilized
– To link high risk clients to care as quickly as possible
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Conclusion
• Monitoring for re-testing should include post natal period
• Re-testing must be integrated in to health system monitoring