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