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Integration of Antiretroviral Therapy (ART) in Maternal and Child Health (MCH) settings: the way forward for increasing access to ART for HIV-positive pregnant women in Zimbabwe IAS – JULY 2011 A. Muchedzi 1 , T. Nyamundaya 1 , B. Makunike-Chikwinya 1 , A. Mushavi 2 , R. Mugwagwa 2

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Background zimbabwe hiv context

Integration of Antiretroviral Therapy (ART) in Maternal and Child Health (MCH) settings: the way forward for increasing access to ART for HIV-positive pregnant women in Zimbabwe

IAS – JULY 2011

A. Muchedzi1, T. Nyamundaya1, B. Makunike-Chikwinya1, A. Mushavi2, R. Mugwagwa2

1Elizabeth Glaser Paediatric AIDS Foundation, Harare, Zimbabwe, 2Ministry of Health and Child Welfare -PMTCT Unit, Harare, Zimbabwe

Abstract number:- WEAX0203


Background zimbabwe hiv context

Background – Zimbabwe HIV context

  • Popn - 12 million

  • HIV prevalence:

    • 24.6% to 13.7% ( 2009)

    • ANC 16.1%

  • PMTCT since 1999

  • PMTCT in 95% of sites

  • National Goal- Eliminate MTCT of HIV- WHO Option A


Background

Background:

  • EGPAF supports the national PMTCT program

  • By June 2010, over 818,000 pregnant women received PMTCT services at 724

  • ARV prophylaxis for PMTCT-91%

  • However, only 7% of all HIV (+ve ) women received ART due to:

    • Limited access to CD4 testing

    • Vertical service delivery with weak linkages

    • Centralised ART program – limited expansion


Background art in mch integration

Background:ART in MCH integration

  • Provision of ART in ANC & PNC

  • In 2009, MOHCW instituted a sub committee

  • Learning sites selected -20

  • With support from EGPAF

    • Learning visit to Swaziland

    • Development of SOPs

    • Stakeholder sensitisation meeting- Draft plans

    • Trainings on OI/ART management

    • Placement of nurses at centres of excellence

    • Resources mobilisation for POC CD4 machines


Method progress review

Method:- Progress Review

  • Six months after the planning process a progress review was conducted at the learning sites to:

    • Assess site readiness & progress

    • Identify challenges and lessons learnt

    • Make recommendations for future integration of ART in MCH

  • A checklist used to collect data (SOPs)

  • Progress assessed using adapted implementation model –T.S Stevens


Results readiness towards integration

Results:- Readiness towards integration

A total of 19/20 learning sites visited

  • Coordinator appointed- 12/19

  • Supply chain management ARVs- 18/19

  • OI/ART trained staff (N=245)

    • Adult (43%), Pediatric 21%

  • Nurses initiating ART- 8/19

  • Availability of CD4 machines-16/19

  • All sites PMTCT M& E tools in place

  • Only 2 sites using ART M&E tool (SOPs)


Results phase of art in mch implementation

Results:- Phase of ART in MCH implementation

  • Pre planning (4/19)

    • Facilities referring to co-located/offsite

    • Integration not started

    • Management still needed to buy in

  • Planning (5/19)

    • Local consultations, planning, logistics and client flow system discussions

Phased approach implementation model adapted from Thomas P. Stevens


Results stage of art in mch implementation

Results:- Stage of ART in MCH implementation

  • Implementation phase (8/19)

    • Women being initiated on ART

  • Maintenance phase (2/19)

    • Implementation on going, M&E and sharing experiences

  • Of these 10 sites providing ART for pregnant women within the MCH (ANC& PNC)

    • Five sites had started < 3 months prior review

    • Rest >3 months prior


Challenges

Challenges

  • Lack of policy allowing nurses to prescribe ART

  • Frequent breakdown and unavailability of CD4 reagents

  • Inadequate number of OI/ART trained nurses

  • Increased workload

  • Shortage of space for the integration

  • Unavailability secure storage for ARVs

  • Lack of job aides to facilitate implementation

  • Lack of local level support at some facilities


Results lessons learnt

RESULTS: Lessons Learnt

  • Integrating ART in MCH is feasible in Zimbabwe

  • Nurses can initiate women on ART

  • Cornerstones for successful integration of ART into MCH

    • Sensitizations of stakeholders, clear SOPs

    • Access to CD4 testing

  • On-the-job training, mentorship, support and supervision is important

  • Lack of management support affect progress


Recommendations

Recommendations

  • Advocacy for a task shifting policy

  • Mobilize resources for POC CD4 machines

  • Advocacy at local level buy in

  • Intensified site support & mentorship required

  • All ART in MCH sites to use ART program M/E tools

  • Develop national plans to roll out nurse led ART in MCH integration

    • Track the changes in proportions of women initiated on ART

    • Assess quality of service of the nurse led program


Acknowledgements

Acknowledgements

  • Zimbabwe MOHCW

  • ART in MCH Subcommittee

    • Family AIDS initiative partners- OPHID Trust, KAPNECK Trust, ZAPP-UZ

    • Zvitambo,, CHAI,UNICEF

  • Elizabeth Glaser Pediatric AIDS Foundation

  • USAID & DFID

  • Healthcare workers and women at the 19 learning sites


Background zimbabwe hiv context

Thank you


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