PMTCT at Different Levels of Care: The Uganda Experience Dr. Saul Onyango National PMTCT Coordinator Ministry of Health 1 1.

PMTCT at Different PMTCT at Different Levels of Care: Levels of Care: The Uganda The Uganda ExperienceExperience

Dr. Saul Onyango

National PMTCT Coordinator

Ministry of Health

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Background…Background…MTCT is 2nd major mode of

transmission of HIV in Uganda

Major mode of transmission of HIV to children (>95%): Approx. 25,000 infected babies each year

Accounts for up to 25% of all new infections in the country

PMTCT is a major intervention for prevention of HIV infection particularly among children

Priority intervention in the NSF and HSSP II

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PMTCT Programme PMTCT Programme

Started as a pilot intervention in 2000

Targeted 7 sites within 5 districts, with regional balance

Government and NGO health facilities

Aim to learn:◦Integration within existing system◦Impact of intervention on family and community

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The PMTCT InterventionsThe PMTCT InterventionsHIV counselling and testing

Comprehensive antenatal care,

Improved care during labour & deliveryPost natal care and follow up for

mother & babyAnti-retro viral drugs for HIV+ mothers

and their babiesCounselling on appropriate infant

feeding for HIV+ mothersPromotion of community & male

partner support4

Households /Communities/ Villages

HC II

HC III

Referral Facility (HC IV or Hospital)

Regional Referral Hospital

National Referral Hospital

HC II HC II HC II

HC III

5,000

20,000

100,000

2,000,000

Health Sub-District (HSD)

National Population

District: 500,000

National Health System

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National Health System…HC II (2008 facilities)

◦Ambulatory servicesHC III (955 facilities)

◦Preventive, promotive & curative services◦Basic laboratory & maternity care

HC IV (161 facilities)◦2nd level referral services for HSD,

includes surgical & obstetric emergency care

Hospitals (113 facilities)◦Comprehensive services

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Antiretroviral Drugs for PMTCT1. Basic Regimen

This is applicable in situations where: there is no capacity for HIV disease staging HAART is not available it is not feasible to refer a woman during

pregnancy for further HIV disease evaluation

the woman gets to know her HIV status at 38 weeks of gestation or later

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Antiretroviral Drugs for PMTCT…2. Combination RegimenThis is applicable situations where: the woman presents for antenatal care

before 28 weeks of gestation there is no capacity for HIV disease

staging. it is not feasible to refer the woman for

further HIV disease evaluation she is not eligible for treatment by the

WHO staging HAART is not available but the woman

is eligible for treatment on WHO staging

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Antiretroviral Drugs for PMTCT…

3. HAARTThis is applicable in situations where: the woman presents for antenatal care

from 14 weeks of gestation onwards clinical evaluation for WHO disease

staging was performed and she is stage 3 or 4

investigations have been done to confirm eligibility for treatment: full blood count, CD 4 cell counts and other laboratory assessments.

use of HAART is recommended such as in WHO clinical stage 2 with a CD 4 count of <350

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Practical ApplicationPractical Application

A N C IIY C FCH IV

tes t in gIP C P N C sd N

A Z T +sd N

A Z T +3T C +sd N

H A A R T

H C II ± ± ± ± - - -

H C II I ± ± -

H C IV /H o sp ita ls

Basic package: HC II facilitiesIntermediate package: HC III facilitiesComprehensive package: HC IV facilities & Hospitals

Challenges

Human resources for health◦Category of professional cadres

◦Absolute numbers of professional cadres

◦Competence (capacity building)

Logistics and supplies management◦National

◦District and health facility levels

Infrastructure

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FinallyFinally

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