Place holder for PhotoFollowing Mother-Infant Pairs

A Best Practice Experience from Zimbabwe

Agnes Mahomva MBChB, MPH

Country DirectorElizabeth Glaser Pediatric AIDS Foundation

17 June 2010

Photo by James Pursey

HIV positive mother and her HIV negative son from a PMTCT program in rural Zimbabwe, 2009

Presentation Outline

• Background and program update• Addressing follow up challenges– Use of the Child Health Card (CHC)– Modification of the existing CHC– Best practices and lessons learnt

• Conclusion• Acknowledgements

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Support to the National Program

• EGPAF has been supporting the national PMTCT program since 2001– USAID funding since 2004 (CTA funds from

2004-2007)

• Achievements by end of 2009 :– Direct support to 620 PMTCT sites – In 32 out of 62 districts in Zimbabwe– Over 600,000 pregnant women reached

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Program Implementation Strategy

• Primary prevention

• Prevention of unintended pregnancies

• Prevention of Mother-to-Child-Transmission of HIV

• Provision of follow up care and support

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Main Program Challenges

• Program coverage– Access to ANC (user fees)

– Access to HIV testing and ARV prophylaxis for PMTCT

• Identification, follow-up and care of mother-baby pairs

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Addressing follow up challenges:Use of the existing CHC

Function of the CHC in Zimbabwe:

• A key tool to assist health workers in providing integrated health care to all children aged 0 – 5 years

• Provides information & education to help mothers look after their children

• Facilitates documentation of wide range of services received by individual children

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Addressing follow up challenge:Modification of the CHC

Gaps in the CHC before modification:

• No way of identifying and tracking mothers and HIV-exposed infants for follow-up

• No documentation of the additional services offered to HIV-exposed children

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Addressing follow up challenge:Modification of the CHC

Revision objective: • To allow identification and follow up of HIV-

exposed infants and their mothers

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Revision process:•Multiple consultations

•Revision in 2004

•Pre-tested in 2005

•New CHC & procedures manual officially launched by the ministry of health and circulated for use in 2006

Pre-Testing the Revised CHC

• Overall objective: To demonstrate the level of acceptability of the revisions

• Structured interviews were used for targeted groups (including people living with HIV)

– Total of 493 interviewed • 71% were community members

• 29% were health workers

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Findings from the Pre-Test

• The revised CHC was generally accepted

• A small percentage (19%) had some negative feedback on the inclusion of HIV Information

– More health care workers (30%) than community members (13.5%) felt the HIV info should be removed from the card

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Modification of the Existing CHC:Additions on the front panel

• A new picture of a man and woman to encourage male support

• Infant feeding messages updated in English and in the two main local languages

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Modification of the existing CHC:Additions on the inside panels

New follow up and care panel: • Additional infant feeding messages• Follow-up & care information for HIV-exposed infants

oARV & cotrimoxazole prophylaxiso Infant HIV testing and parent counselling

Growth & development chart: • Space for recording additional growth & nutritional

measurements• Improved growth monitoring graphics• Revised the “At RISK Factors” and introduced the

“MTCT” At Risk box

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Modification of the Existing CHC:Growth & Development Chart

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Modification of the existing CHC:Additions on the inside panels

Immunization panel:

• Addition of Hepatitis B vaccination

• Addition of vitamin A schedule

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Best Practices• The participatory revision process ensured collective

“buy-in” & ownership

• The revision process and the national launch of the revised CHC raised the national PMTCT program’s profile

• The revised CHC is for all children regardless of HIV status

• Used at multiple entry points– EPI outreach, FCH clinics, OI/ART clinics

• A low-tech intervention with benefits for both healthcare workers and mother-baby pairs

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Conclusions

• The revised CHC has strengthened integration of HIV services for mother baby pairs

• Strengthened identification, follow-up and care of mother-baby pairs in the national PMTCT program

• Is being used in all health facilities

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Revised CHC Being Used in Health Facilities in Zimbabwe

Photo by Jo Keatinge

Mother-baby pairs holding revised CHCs and enjoying a drama session on PMTCT whilst waiting for routine under 5 follow up, care and support 17

Acknowledgements• Ministry of Health and Child Welfare

• EGPAF-FAI Partners

• Mother baby pairs, healthcare workers and Communities that participated in the revision process

• United States Agency for International Development

• Johnson & Johnson

• UK- DFID

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Thank YouThank You

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DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.