Community interventions and PMTCT: the other “p” B. Ryan Phelps Office of HIV/AIDS, USAID
Feb 24, 2016
Community interventions and PMTCT: the other “p”
B. Ryan PhelpsOffice of HIV/AIDS, USAID
New HIV infections in children
Source: Universal Access Report, 2011
Indicators 2009 2010 2015 Target
Number of new pediatric HIV infections 430,000 390,000 <43,000
• Two literature reviews– Retention along the PMTCT continuum of care– Community-based strategies that work
Objectives
PMTCT care continuum
The PMTCT Effectiveness in Africa: Research and Linkages to Care (PEARL) Studyhttp://www.pepfar.gov/documents/organization/118151.pdf
SdNVP coverage in pregnancy
More PMTCT Options
Status of B+ Decision CountriesMOH-endorsed plan for national implementation of B+
MalawiRwandaHaiti
MOH-endorsed plan for phased implementation of B+
UgandaKenya
National Steering Group recommendation to move to B+; not yet MoH-endorsed
NamibiaSouth Africa
Piloting B+ Mozambique (large pilot – 241 sites)Cameroon (small pilot)Swaziland
Considering transition to B+ Tanzania South Africa
HAART coverage in pregnancy
L. Ferguson et al. Linking HIV-positive pregnant women to treatment services Trop Med and Intl Health; v17 no 5 pp 564–580, May 2012
Killam et al, Zambia, 2010
Mandala et al, Zambia, 2010
PMTCT care continuum
All pregnant mothers at first ANC
Pregnant mothers accepting testing
Pregnant mothers testing positive (25%) Delivery 6 months
postpartum36 week ANC
Ahoua, Ayikoru et al. 2010
Cook, Ciampa et al. 2011
Manzi, Zachariah et al. 2005
Retention of HIV-exposed infants (1)
Eligible HIV-exposed infants
2 months after enrolment
18 months of ageEnrolled HIV-
exposed infants
Eligible HIV-exposed infants
Return for at least one visit
4 month visit
Hassan, Sakwa et al. 2011
Sherman, Jones et al. 2004
Ioannidis, Taha et al. 1999
Retention of HIV-exposed infants (2)
(Unpublished CHAI data , 2009)
Retention of HIV-exposed infants (3)
PMTCT care continuum
• Two literature reviews– Retention along the PMTCT continuum of care– Community-based strategies that work
Objectives
1st Author Country Intervention OutcomeFutterman. South Africa Mentor mother-guided
education and supportHIV knowledge increased
Orne-Gliemann
Zimbabwe Community sensitization with peer educators
Increased HIV awareness; increased PMTCT knowledge; increased condom use (reported)
Balogun Nigeria N/A TBA counseling of HIV exposed clients and referral for testing depended on knowledge level
Teasdale South Africa M2M program Increased NVP coverage (mothers and infants)
Torpey Zambia Lay counselors and traditional and religious leader engagement
More pregnant women tested and receiving results; seropositive pregnant women receivingcomplete course of ARV prophylaxis
Faraquhar Kenya Partner engagement Women whose partners came for testing ~ 3x more likely to return and report taking NVP
Chandisarewa Zimbabwe Community counselor-driven opt-out testing
More women tested, received results; more diagnosis in ANC, and more NVP uptake
Bekker South Africa Community counselor providing PSS/support
More women started ART
Kurewa Zimbabwe Support groups, and community tracking
Less LTFU among mother-infant pairs
PEPFAR-supported Acceleration PlansTUNISIA
MOROCCO
SAHARA
ALGERIA
MAURITANIAMALI NIGE
R
LIBYA
CHAD
Mediterranean Sea
Sea
EGYPT
SUDAN
ETHIOPIA
DJIBOUTI
ERITREA
SOMALIAKENYA
TANZANIA
DEMOCRATIC
CENTRAL
RWANDA
GABON
EQUATORIAL
ANGOLA
CONGO
NIGERIA
BENIN
DTVOIRE
SIERRA
SENEGAL
GHANA
THE
GUINEA
LIBERIA
CAMEROON
SOUTH AFRICA
MALAWI
ZAMBIA
MOZAMBIQUE MADAGASCARZIMBABWE
BOTSWANA
SWAZILAND
Indian
Ocean
LESOTHO
NAMIBIA
ANGOLA
Atlantic
Ocean
WESTERN
Red
UGANDA
OF THE CONGO
REPUBLIC
BURUNDI
GUINEAREP. OF
TOGOCOTE
BURKINAGUINEA
LEONE
GAMBIA
BISSAU
Walvis Bay
SOUTH
REPUBLIC
AFRICAN
THE
AFRICA
Legend 6 Original Acceleration Countries 8 New Acceleration Countries
PEPFAR PMTCT programs in Global Plan countries*
SOUTHSUDAN
* PEPFAR supports programming in India (not pictured)
Acceleration Plans all required to have community engagement elements
New HIV infections in children
Source: Universal Access Report, 2011
Indicators 2009 2010 2015 Target
Number of new pediatric HIV infections 430,000 390,000 <43,000
Thank you.
Kea leboga.
Niyabonga.