Improving the performance of primary providers in family planning and other reproductive health care around the world Prevention of Mother-to-Child Transmission.

Improving the performance of primary providers in family planning and other reproductive health care around the world

Prevention of Mother-to-Child Transmission of HIV/AIDS in Ethiopia

The Hareg ProjectThe Hareg Project


ETHIOPIAETHIOPIA

USAID

CDC

UNICEF

Ministry of Health

HIV/AIDS Prevention and Control Office (HAPCO)

Regional Health Bureaus

Regional HAPCO

Regional Teams

Hareg Project Partners Hareg Project Partners

Implementing agencies:

PRIME II (IntraHealth, Save and ACNM)

JHPIEGO

JHU/CCP

Save the Children/US

LINKAGES

UNICEF

MSH/RPM+

I-TECH


ETHIOPIAETHIOPIA

Total population 70.7 million

Living with HIV/AIDS 3 million Adults 15-49 2 millionChildren 230,000

Overall prevalence6.6%Urban 13.7%Rural 3.7%

AIDS orphans 1.2 million

Life expectancy Fallen to 45 years

Hospital beds >50% to AIDS patients

HIV/AIDS Overwhelming Ethiopia HIV/AIDS Overwhelming Ethiopia


ETHIOPIAETHIOPIA

91% of infections in adults 15-49 years

21.1% prevalence in women 15-24 years

As high as 25% prevalence among pregnant women in urban areas

6.425%

6.425 - 9.7%

9.7 - 12.433%

12.43 - 15.6%

15.6 - 17.275%

HIV Prevalence in Pregnant Women in Ethiopia

Data adapted June 11, 2003 from AIDS in Ethiopia 2000, an Ethiopia MOH publication

HIV/AIDS Infection in Ethiopia HIV/AIDS Infection in Ethiopia

0 5% 10% 15% 20% 25%

Gondar

Jimma

Nazereth

Jijiga

Bahir Dar

Dire Dawa

Addis

B/Gumez

Mekele

Pregnant Women HIV PositiveSentinel Site Prevalence

170,000 HIV+ women give birth each year

60,000 of their newborns infected through MTCT


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PMTCT BarriersPMTCT Barriers

Antenatal Care

Urban Rural

Birth Place

67%Skilled1%

TBA

32%None

22% Skilled

.5% TBA77%None

32%Health facility

68%Home

2% Health facility

98% Home

Urban Rural


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Preventing MTCTPreventing MTCT

Care and support for HIV+ (infected or affected)Care and support for HIV+ (infected or affected)

Prevent infection in parents-to-be

Prevent infection in parents-to-be

Prevent unwanted pregnancies in HIV+ women

Prevent unwanted pregnancies in HIV+ women

Preventtransmission from HIV+ mothers to their infants

Preventtransmission from HIV+ mothers to their infants


ETHIOPIAETHIOPIA

8 regions

12 primary focus areas

First year pilot sites

Roll out plan

4 additional regions

Include more health centers

Scope based on research in Nigat

Hareg Project ScopeHareg Project Scope


ETHIOPIAETHIOPIAProject SiteFemale Population Age 14–45

Adama 42,921

Addis Ababa 325,450

Assosa 29,722

Axum 4,768

Bahr Dar 28,283

Dire Dawa 28,485

Gondar 19,474

Harari 20,240

Jimma 294,198

Jijiga 35,888

Hareg Project PotentialHareg Project Potential


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Baseline AssessmentBaseline Assessment

Topics

Service delivery

Site audit

Staffing/personnel

Provider performance

VCT

Client perspective

Facility mapping

Family planning

TB referral

Tools

Site audit

Provider interview

Client interview

Provider observation

Client flow

Focus groups

Community mapping

PRA


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Key StrategiesKey Strategies

Community based

Partnerships developed with systems and service delivery

Platform created to expand care, treatment and support for HIV/AIDS patients


ETHIOPIAETHIOPIACommunity / Health Post

Sites of Service Delivery to Stop MTCTSites of Service Delivery to Stop MTCT

Health Center

District

Regional Center

Central Center


ETHIOPIAETHIOPIAEthiopian National Framework

Community Mobilization

RMC RMC RMC

Central Medical Centers

Teams Working TogetherTeams Working Together


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Teams Working TogetherTeams Working TogetherDiscussion and consensus buildingFinding solutions


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Hareg Major AccomplishmentsHareg Major Accomplishments

2003

September • Hareg Project launch

• Baseline assessment completed

October • Axios application accepted

November • Regional network formation

• 7 workshops, 140 participants• 7 signed MOUs among regional teams

• Solutions for clientflow for all 10 hospitals and 10 health centers

• Overall coordination of activities


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Key Progress from existing sitesKey Progress from existing sites

126 health workers newly trained or retrained in PMTCT

80% pregnant women with at least one ANC visit who consented to HIV test, received test, results, and post-test counseling (Nigat)

50% HIV+ pregnant women received complete course of ARV prophylaxis to reduce risk of MTCT


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Nevirapine administration in 6 new regions by late January 2004

Focus areas:

1. Supply system strengthening

2. Regional follow-up

3. PMTCT site readiness plan

4. Joint monitoring and evaluation

5. Community readiness

6. Policy dialogue

Short-Term TargetShort-Term Target


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Long-Term TargetLong-Term Target

National PMTCT coverage

Impact Indicator

Number of HIV infections averted by ARV prophylaxis


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ChallengesChallenges

Opt in/Opt out Infant feeding Home-based delivery NVP within 72 hours Confidentiality Stigma Competing demands with one of world’s

highest MMRs Safe motherhood/PMTCT integration Universal precautions


ETHIOPIAETHIOPIA

Goals for September 2004Goals for September 2004

PMTCT initiation and expansion

PMTCT service delivery for 23 new sites and strengthening of 4 existing sites

Improved links between facilities and communities

System strengthening for service delivery

Sound HMIS system that generates data for monitoring and scale-up


ETHIOPIAETHIOPIA

Eyes on the Prize Averted infections are the ultimate goal

Eyes on the Prize Averted infections are the ultimate goal

Improving the performance of primary providers in family planning and other reproductive health care around the world Prevention of Mother-to-Child Transmission.

Documents

reproductive health

family planning

hiv women

health facility

ethiopia data

mtct care

hiv prevalence

hareg project slide