Nande Putta MD MPH Technical Assistant PMTCT & Paediatric HIV Care Ministry of Health
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Transcript of Nande Putta MD MPH Technical Assistant PMTCT & Paediatric HIV Care Ministry of Health
Human Resource Constraints and Roll out of more efficacious regimens for PMTCT
The Zambian experience
Nande Putta MD MPHTechnical Assistant PMTCT & Paediatric HIV CareMinistry of Health
HIV in Zambia Prevalence rate of HIV is 16% (15-49 yrs) One in five pregnant women is HIV
positive (19% ANC seroprevalence) Estimated 150,000 children are living
with HIV Mother-to-child transmission accounts for
over 90% of childhood HIV infections Estimated 97,000 HIV infected pregnant
women (~~HIV exposed infants) Each year estimated 28,000-40,000
children acquire the virus from their mother
Zambia's Program Scale Up plan for pMTCT and Paed. ART
developed with clearly outlined objectives and strategies
Overall objectives for Zambia by 2010:
To provide comprehensive prevention of mother-to-child transmission services to at least 80% of pregnant women
To provide ART to at least 80% of HIV-positive children in need of ART
Progress in Service Provision
Steady progress from 74 sites in 2003 to 678 in 2007
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2003-74
(6%)
2006-307
(24%)
2007-678
(53%)
# of Sites
Performance 2007
678 PMTCT sites (53% coverage)
Of estimated 500,000 annual pregnancies, 306,000 tested (61%)
Of estimated 97,000 HIV positive pregnant women, 52,800 identified (54%)
Of estimated 97,000 HIV positive pregnant women, 35,300 accessed ARVs (36%)
Performance 2007 contd. Of estimated 97,000 HIV exposed babies,
15600 accessed ARV proph. (16%)
Of estimated 97,000 HIV exposed babies, 11,900 receive Cotrimoxazole proph.(12%)
Of estimated 97,000 HIV exposed babies, 7600 received a virological test within 2 months (8%)
Performance 2007 contd.
0%
10%
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70%
PW tested HIV+ PWidentified
HIV+ PWrcv ARVs
HIV exp infrcv ARVs
HIV exp infrcv CPT
HIV+ expinf tested
2007
Progress over last 3 years (2005-2007)
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PWtested
HIV+pw
HIV+PW rcvARVs
HIVexp
babiesrcv
ARVs
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2007
Guidance for PMTCT regimens in Zambia
More efficacious regimens incorporated into revised pMTCT guidelines and training package
Adapted from the WHO guidelines Single dose NVP dispensed at first contact
to be taken at onset of labor AZT dispensed beginning at 28 weeks AZT/3TC given at onset of labor with NVP AZT/3TC given through labor and as a tail
for 7 days
Guidance for PMTCT regimens in Zambia
For baby Single dose Nevirapine soon after
birth 7 day tail of AZT (28 days if mother
received less than 4 weeks of ARVs)
Guidance for PMTCT regimens in Zambia as quoted from the guidelines
“At the first visit after confirming the mother is HIV positive, the woman can be given her single NVP dose to take home so she can take it at the onset of labour. Where blister packs are available she may be given the full course of drugs for her to take during antenatal, labour, delivery and in the postpartum period………
Guidance for PMTCT regimens in Zambia as quoted from the guidelines
………… How ever it needs to be emphasized that she will need to be seen every four weeks for review. At these visits assess adherence and other issues such as disclosure, side effects and testing of other family members…………
Guidance for PMTCT regimens in Zambia as quoted from the guidelines
…………These visits can also be used to reinforce messages such as infant feeding, family planning, early infant HIV testing and other aspects of continuum of care. She will also be given the babies NVP dose at the 32 week visit to be taken soon after birth and she should be advised on safe storage.”
Uptake of ARVs by Pregnant women for PMTCT
Of HIV positive women identified through ANC testing and counseling, 67% are taking ARVs for PMTCT
Of all estimated HIV positive women 36% are taking ARVs for PMTCT
Current estimates show about 25% of women taking ARVs are using more efficacious regimens (sdNVP and AZT)
Constraints contributing to low uptake of more efficacious regimens Late 1st ANC visit booking and low average
frequency of ANC visits Low institutional deliveries and postnatal
attendance Lack of holistic care within MCH Poor linkages to other facets of treatment and
care Poor reporting and recording Data tools not integrated and all inclusive Inadequate training of staff (refer to mapping
exercise) Inadequate community involvement
Constraints contributing to low uptake of more efficacious regimens Suboptimal logistic and supply
management at all levels (refer to mapping exercise)
Slow dissemination of guidelines Inadequate Monitoring and Evaluation
(mentorship, support supervision and feedback on these)
Inadequate or inappropriate staff Inadequate integration of PMTCT into
outreach visits
Human resource situation in Zambia
Human resource inadequacy is a huge problem facing the health sector
Staff attrition caused by job seeking outside the country, job seeking to private and non governmental sector and illness & death
Average estimate is that most health institutions are running at 50% capacity
Some health facilities being run by unqualified staff
Human resource situation in Zambia in PMTCT care provision
High turn over of trained staff with inadequate compensatory training of staff
Inadequate retraining or updating of staff trained when single dose Nevirapine was standard of care
Human resource retention strategies in place though competing with time to provide universal access for PMTCT (rural retention scheme, direct entry midwifery training)
Effect of Human Resource inadequacy on roll out of more efficacious regimens Poor quality of counseling and care Poor reporting and recording Suboptimal logistic management at
facility level Inadequate follow up of clients Inadequate performance self
assessment
Possible solutions to Human Resource inadequacy and roll out of more efficacious regimens
Task shifting Involvement of the community in mother baby
tracking Involvement of peer support through initiatives
like Mother2mother Easier delivery mechanisms such as blister
packs Strengthen Supervision, mentoring and
feedback mechanisms Over and above – “Health Systems
Strengthening” to cope with evolution of Scientific based recommendations
Thank YouZikomo
Natotela
Any Questions?