MCHIP supported prevention of mother-to-child transmission of HIV (PMTCT) programming and provided technical assistance in Kenya, Ethiopia and Mozambique. MCHIP PMTCT programs were rooted in the community with the goal of increasing access to and uptake of essential maternal and child health services inclusive of PMTCT interventions.
In-country PMTCT Activities
Kenya: MCHIP in collaboration with Bondo District in Kenya adapted a successful approach used in immunization campaigns to improve the performance of their PMTCT programs. The approach—called Reaching Every District (RED)—was used to identify communities with large numbers of pregnant women and to mobilize community health workers (CHWs) and the community at large to play a proactive role in bringing these women (and later their infants) into care, and to actively monitor and take action to increase PMTCT and maternal, newborn and child health service coverage. The approach also allowed prioritization and decision making at the community level by community members. By using this adapted approach, MCHIP and the Bondo District Health Management Team identified communities with large numbers of pregnant women who would otherwise have limited access to (and be less likely to utilize) the comprehensive maternal and child health package.
Ethiopia: MCHIP initiated PMTCT services in 39 health facilities in rural Ethiopia. The implementation focused on ways of minimizing barriers for women and their families. Therefore, MCHIP provided “enhanced support” by working closely with health care workers in these facilities to improve the availability and quality of services. In addition, expanding services out and down was achieved through targeted outreach services. As a result, first antenatal care (ANC) visits and labor & delivery coverage in the new facilities increased from 44.6% to 76% and 5.5% to 15.1%, respectively. To reach more mothers, MCHIP supported health facilities to regularly provide outreach ANC services integrating HIV testing and counseling (HTC)—and 100% of pregnant women tested and received their test result.
Mozambique: The Model Maternity Initiative (MMI) was a national program to create health facilities that are models for high-quality, humanized maternal and newborn health (MNH) care, and that served as clinical training sites. Between April 2011 and March 2013, the MMI expanded from 34 to 94 health facilities. These facilities provided integrated MNH services, including essential newborn care, basic emergency obstetric and newborn care, and ANC including PMTCT and malaria in pregnancy.
Using this MCHIP platform, between April 2011 and March 2013, 200,078 pregnant women received HIV HTC for PMTCT and received their test results. In addition:
- 99% of pregnant women presenting at their first ANC visit were tested for HIV.
- Between January 2012 and March 2013, 25,456 HIV-positive pregnant women received antiretroviral therapy to reduce the risk of mother-to-child transmission.
- MCHIP provided technical support to the Ministry of Health (MoH) to develop the National Plan to Eliminate Mother-to-Child Transmission of HIV (2012-2015). MCHIP also provided assistance to the MoH to develop the training package for PMTCT using Option B+. The Program is also supporting the MoH, in partnership with UNICEF, to plan and conduct regional meetings to introduce the national strategic plan, discuss the rollout of Option B+, and provide technical assistance to revise the provincial plans, targets and indicators in order to be aligned with the national plan.
- MCHIP provided support to the MoH in the development and revision of performance standards for the MMI (including PMTCT).
Results
- From June 2010 to June 2012, women in Bondo district delivering under the care of a skilled birth attendant increased from 23% to 47% coverage. Similarly, the proportion of HIV-exposed infants (HEIs) tested at six weeks increased from 27% to 78%. Both increases are attributed to using the RED approach in Bondo with the help of CHWs.
- In a conference in Kenya focused on integration, the Kenya PMTCT experience was shared as an encouraging initiative to integrate PMTCT with maternal, newborn and child health, and to engage CHWs in the process.
- The Kenya experience was also shared at the 2013 Conference on Retroviruses and Opportunistic Infections, one of the most prestigious global HIV conferences.