Expanding Prevention of Mother-To-Child Transmission of HIV Services
We have been working to expand prevention of mother-to-child transmission of HIV (PMTCT) services in government-operated health facilities in Côte d'Ivoire since 2007. In Bouaké, testing for HIV among pregnant women increased from 10% in 2007 to more than 90% in 2009 due to the expansion of PMTCT.
Building upon the success of increased testing, we are continuing its partnership with the Ministry of Health in 30 facilities in 7 districts to provide on-site training and coaching to health workers, improving laboratory and pharmacy systems to reduce stock-outs of essential medications and supplies and develop national treatment protocols. We also work with local community-based organizations to form support groups for HIV-positive pregnant women and mothers, encouraging them to stick to their treatment, and bring their partners and children in for testing.
Onsite Training and Coaching
Our approach is to work side-by-side with our Ministry of Health counterparts for every step of the training process. Curriculums are developed with strict adherence and approval to national protocols. Typically, PMTCT training is carried out at each health clinic over 1-5 days, with subsequent weekly and bi-weekly follow-up (coaching) of trainees for many months to solidify the results of the training and solve problems under the conditions within which each trainee works. Frequent follow-up visits have been a key tactic not only to ensure effective implementation of new ideas and systems, but also to help create good and sustainable habits.
Developing Strategies to Improve Health Systems
Ongoing technical assistance is provided by experienced HAI PMTCT nurses, midwives and social workers, most of whom are from the region in which they work and have a deep understanding of the context and culture of the area. They work with the HAI Training Coordinator to assess the PMTCT training, capacity, and conditions among all health facilities in the three regions. HAI logistics staff help ensure adequate district-level procurement and distribution of appropriate drugs and supplies.
Developing Health Policies at a National Level
In all our partnerships with the Minsitry of Health and Regional and District Directors, our staff advocate for comprehensive antenatal care, including PMTCT, syphilis screening, treatment for malaria (including treated mosquito nets), iron/folate supplementation, tetanus immunization, anti-parasite treatment, and nutritional counseling. Family-centered PMTCT care is advocated for all regions and all sites. As the program scales up, we focus on identifying the district-specific and facility-specific gaps and providing a plan to address them individually.
Follow-up Care for HIV-Positive People and their Children
We help organize "maternities" and immunization clinics to identify and treat HIV-positive women (and their children) who missed PMTCT care or were lost to follow-up. A major focus is to ensure eligible HIV-positive people are initiated on antiretroviral therapy as soon as appropriate, and that appropriate measures are taken for prophylaxis, infant feeding, infant tracking for 6-week polymerase chain reaction (PCR) testing as available, and clinical follow-up with HIV testing at 18 months.
Psychosocial Support and HIV Prevention
Our social workers, in partnership with health facility personnel and local NGOs, work to establish monthly support groups among HIV-positive women and their children. These support groups give women a chance to talk about the challenges they face with medical treatment as well as with issues of stigma within the community. The HAI Community Outreach Coordinator works to develop and monitor prevention and stigma reduction strategies with local NGOs, the Ministry of Health, and donors. We also conduct assessments of risk behavior and change that are initiated by and followed up with local Ministry of Health staff. Support is also provided to local partner NGOs that are working on street theater, radio, to improve PMTCT utilization.
This project is funded by CDC/PEPFAR.