Preventing Mother to Child Transmission (PMTCT) of HIV Programme

1
Preventing Mother to Child Transmission (PMTCT)
of HIV Programme

• Presentation to MinMEC, July 2001

2
Overall Objectives of the Programme

• Feasibility of integrating PMTCT programme into
  existing routine MCH services
• Ability of PMTCT to avert vertical transmission
  and reduce childhood mortality rates

3
Specific Objectives

• Feasibility of providing VCT in clinics offering
  routine ANC services
• Acceptability of VCT in the context of PMTCT
• Acceptability of ARV therapy for PMTCT
• Feasibility of providing counselling on safe
  infant feeding practices for HIV women
• Impact of infant feeding counselling

4
Specific 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

5
Status quo of Preparations for 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

6
Research Framework

• Routine data collection Collected at 18 sites
• - Uptake of the PMTCT interventions
• Local operational research
• - Provincial research
• Specialised research
• - e.g. Resistance studies

7
Research Framework

• 9 research areas
• A Demographic, socio-economic and health status
  characteristics of catchment population
• B General and healthcare infrastructure of
  catchment area
• C Organisation of healthcare system and health
  service accessibility/utilisation
• D Uptake and quality of PMTCT service

8
Research Framework

• E Cohort follow-up of children and mothers
• F Effect of PMTCT programme on the rest of the
  healthcare system
• G Cost
• H The community and community response
• I Clinical research
• Nevirapine resistance
• Cotrimaxazole

9
Challenges

• 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?

10
Challenges

• 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?

11
Challenges DOH national

• Transferring funds to the provinces for
  implementation
• Delays in ordering of supplies
• New appointee little time to get up to speed

12
Provincial Progress 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

13
Provincial Progress 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

14
Provincial Progress Free State

• Sites 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

15
Provincial Progress Free State

• Challenges
• Delay in availability of funds
• Limited accommodation at the clinics for
  counselling service

16
Provincial Progress 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

17
Provincial Progress 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

18
Provincial Progress 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

19
Provincial Progress 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

20
Provincial Progress KwaZulu-Natal

• In Pietermaritzburg, 1078 women counselled, 88
  (945) agreed to voluntary testing
• 29 tested positive, 67 received NVP, 9 children
  received NVP

21
Provincial Progress KwaZulu-Natal

• Challenges
• Women who come from outside the province to get
  access to NVP

22
Provincial Progress Mpumalanga

• Sites Evander, Nkomazi sub-district
• Implementation started 1 July 2001
• Gauteng to assist with training of trainers
• MTCT coordinators interviews held 6 June 2001
• Will use lay counsellors
• Health promotion activities to be in phases

23
Provincial Progress Mpumalanga

• Challenges
• Funds not yet transferred from national
• Awaiting delivery of orders

24
Provincial Progress Northern Cape

• Sites De Aar, Galashewe
• MTCT coordinator appointed May 2001
• Training conducted in March 2001
• Lay counsellors identified and trained
• Health promotion activities undertaken
• Monitoring and evaluation systems in place

25
Provincial Progress Northern Cape

• Challenges
• Equipment and space for the programme

26
Progress Report Northern Province

• Training has begun 18 nurses trained and 18
  more being trained
• Project management structure in place
• Community mobilisation in progress
• Coordinator and admin clerk employment currently
  being processed
• Launch scheduled for 6 August 2001

27
Provincial Progress 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

28
Provincial Progress 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

29
Western Cape Paarl

• Paarl 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

30
Western 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

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