Preventing Mother to Child Transmission (PMTCT) of HIV Programme

1. Preventing Mother to Child Transmission (PMTCT) of HIV Programme Presentation to MinMEC, July 2001

2. Overall Objectives of the Programme • Feasibility of integrating PMTCT programme into existing routine MCH services • Ability of PMTCT to avert vertical transmission and reduce childhood mortality rates

3. Specific Objectives • Feasibility of providing VCT in clinics offering routine ANC services • Acceptability of VCT in the context of PMTCT • Acceptability of ARV therapy for PMTCT • Feasibility of providing counselling on safe infant feeding practices for HIV+ women • Impact of infant feeding counselling

4. Specific Objectives • Costs of establishing and running a PMTCT programme • Feasibility of integrating follow-up of infants born to HIV+ women • Mechanisms of improving follow-up care for HIV+ women post delivery • Impact of PMTCT interventions on other PHC and HIV/AIDS programmes

5. Status quo of Preparations for PMTCT • Protocol has been developed • Procurement and distribution system in place • Training manual printed and distributed • Financial resources made available • Additional human resources made available • Nevirapine (NVP) been registered • Sites selected and provinces are in various states of readiness • Ordering of provincial supplies intiated

6. Research Framework Routine data collection: Collected at 18 sites - Uptake of the PMTCT interventions Local operational research: - Provincial research Specialised research: - e.g. Resistance studies

7. Research Framework 9 research areas: A: Demographic, socio-economic and health status characteristics of catchment population B: General and healthcare infrastructure of catchment area C: Organisation of healthcare system and health service accessibility/utilisation D: Uptake and quality of PMTCT service

8. Research Framework E: Cohort follow-up of children and mothers F: Effect of PMTCT programme on the rest of the healthcare system G: Cost H: The community and community response I: Clinical research Nevirapine resistance Cotrimaxazole

9. Challenges • Do women want to enrol ? • Can the system cope with the demand for VCT with the assistance of lay counsellors? • Will there be an influx from non-PMTCT areas and how to handle this? • Is formula feeding going to increase the incidence of diarrhoeal diseases in areas with poor water supply?

10. Challenges • Will the system be able to adequately follow the mother and infant pair after delivery - in particular monitoring the growth of the infants? • How can inter-departmental collaboration at community level for the follow-up of HIV positive women and their infants effectively be established? • Will routine data collection/analysis be done correctly and without posing too much of a burden?

11. Challenges: DOH national • Transferring funds to the provinces for implementation • Delays in ordering of supplies • New appointee – little time to get up to speed

12. Provincial Progress: Eastern Cape • Sites: Cecilia Makiwane, Frere, Rietvlei (UNITRA providing support to Rietvlei) • Training conducted • Lay counsellors to provide VCT • Follow-up in well baby clinics • Use NGOs for community mobilisation • Cecilia Makiwane: educated 366 pregnant women, 44 agreed to voluntary counselling, 25 (57%) agreed to voluntary testing, 15 tested positive (60%) • Since March 15 babies delivered

13. Provincial Progress: Eastern Cape • Challenges • Access to NVP for baby in case of home delivery • Exclusive breastfeeding – what to do if woman has to leave infant behind • Availability of safe drinking water for bottle-feeding

14. Provincial Progress: Free State • Sites: Frankfort, Virginia • Trained 60 nurses • Lay counsellors will do counselling • Follow-up of infants at well baby clinics • Monitoring tools available • Undertaken health promotion activities • IEC materials being prepared • Provincial coordinator has been appointed • Virginia started on 3 July 2001 • Frankfort will start on 14 July 2001

15. Provincial Progress: Free State • Challenges • Delay in availability of funds • Limited accommodation at the clinics for counselling service

16. Provincial Progress: Gauteng • Sites: J Dumane, Natalspruit, Pretoria West, Kalafong • Training conducted • Follow-up mechanisms in place • Data collection mechanisms in place • Designing information pamphlet • Implementation started 25 May • Appointment of provincial coordinator in progress

17. Provincial Progress: Gauteng • On average women agreeing to test: • J Dumane - 55% out of which 39% test positive • N Spruit - 71% (32% test positive) • P West - 65% (10% test positive) • Kalafong - 23% (33% test positive) • Overall 107 women were given NVP • Overall, 37 children were delivered (only 1 died) • All women chose to formula feed

18. Provincial Progress: Gauteng • Challenges • Counsellors not keeping records • Registers not given to coordinator • Not all patients are post counselled because some do not want results on the same day • Not all negative results counselled • Limited accommodation at the clinics for counselling service

19. Provincial Progress: KwaZulu-Natal • Sites: King Edward, Prince Mshiyeni, Greys/Northdale, Edendale, Church of Scotland • Training conducted • Follow-up mechanisms in place • Data collection mechanisms in place • To date Durban sites counselled 880 women of which 89% (784) agreed to voluntary testing • 30% tested positive, and 64% of them received NVP • All 53 children born received NVP

20. Provincial Progress: KwaZulu-Natal • In Pietermaritzburg, 1078 women counselled, 88% (945) agreed to voluntary testing • 29% tested positive, 67% received NVP, 9 children received NVP

21. Provincial Progress: KwaZulu-Natal • Challenges: • Women who come from outside the province to get access to NVP

22. Provincial Progress: Mpumalanga • Sites: Evander, Nkomazi sub-district • Implementation started 1 July 2001 • Gauteng to assist with training of trainers • MTCT coordinators – interviews held 6 June 2001 • Will use lay counsellors • Health promotion activities to be in phases

23. Provincial Progress: Mpumalanga • Challenges: • Funds not yet transferred from national • Awaiting delivery of orders

24. Provincial Progress: Northern Cape • Sites: De Aar, Galashewe • MTCT coordinator appointed May 2001 • Training conducted in March 2001 • Lay counsellors identified and trained • Health promotion activities undertaken • Monitoring and evaluation systems in place

25. Provincial Progress: Northern Cape • Challenges • Equipment and space for the programme

26. Progress Report: Northern Province • Training has begun: 18 nurses trained and 18 more being trained • Project management structure in place • Community mobilisation in progress • Coordinator and admin clerk employment currently being processed • Launch scheduled for 6 August 2001

27. Provincial Progress: North West • Sites: Tlhabane HC, Lehurutshe • Training conducted • Lay counsellors to do VCT • Follow-up mechanisms in place • Data collection mechanisms in place • Campaigns and media releases to mobilise communities • Launched 3 July 2001

28. Provincial Progress: Western Cape • Western Cape: Paarl, Gugulethu • Nurses trained • Lay counsellors used for VCT • Follow-up mechanisms in place • Monitoring and evaluation mechanisms established • Community information session

29. Western Cape: Paarl • Paarl booked 454 women, 432 (95%) accepted HIV test • 7% tested positive and all were counselled • 8 women delivered live babies • All mothers and babies received NVP • 7 babies started formula feed and 1 exclusive breast-feeding • No problems

30. Western Cape: Gugulethu • Started April 2001 • Gugulethu counselled 437 women, 387 (89%) accepted the HIV test and 73 (19%) tested positive and all received NVP • 17 women delivered alive babies and all babies received NVP (14 bottle-feed, 3 exclusive breastfeed) • No problems