03 Hadebe I.M 5 Th Sahara Conference Pmtc

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03 Hadebe I.M 5 Th Sahara Conference Pmtc

  1. 1. ACCELERATION OF PMTCT IN SWAZILAND BY INNOCENT MAHLUBI HADEBE HIV/AIDS PREVENTION COORDINATOR (NERCHA) SWAZILAND.
  2. 2. LAYOUT • BACKGROUND • ANC AND HIV • PMTCT COMPREHENSIVE PACKAGE • PMTCT UPTAKE • CHALLENGES • SOLUTIONS / WAYFORWARD
  3. 3. BACKGROUND • Population 1,018,449, 000 • National HIV prevalence (15-49) population 26% • HIV prevalence ≥2 yrs population –19%
  4. 4. ANC AND HIV • HIV prevalence rate among pregnant women 42% • Deliveries per annum 43,001 • Pregnant women accessing ANC - 97% • Delivery by skilled attendant - 74 % • MMR - 589/100 000
  5. 5. HIV INFECTION TRENDS AMONG ANC CLIENTS IN SWAZILAND SINCE 1992 1992-2008
  6. 6. NEONATES AND UNDERFIVES • Neonatal Mortality 85/1000 • Under five mortality 120/1000 • Children in need of ART 4,529 (2007 spectrum projections) • Children receiving ART by end of October 2008 – 2759 (61%)
  7. 7. CHILD MORTALITY ESTIMATES 1986-2007 140 120 106 89 99 85 78 72 1986 PHC 1991 DHS 1997 PHC 2006-07 SDHS Infant Under-five
  8. 8. PMTCT COMPREHENSIVE PACKAGE PMTCT implementation started in 2003 • PMTCT comprehensive package includes: – HIV testing and counseling – Provision of family planning and counseling – Identification and management of STIs – Screening for TB – Prophylaxis – CTX – ARV- including HAART – Infant feeding counseling – Provision of continuum of care (Intrapaturm, postpartum, child welfare including EID) – Linkages and referrals
  9. 9. PMTCT UPTAKE • 138 out of 172 health facilities providing ANC provide PMTCT • 67% success rate (2007) • Adopted the new WHO PMTCT guidelines for ARV drug prophylaxis recommend giving HIV infected pregnant women. – SACD minimum standards
  10. 10. LESSONS LEARNT • Political commitment (MOHSW full support) • Improved implementation through integration of PMTCT in sexual and reproductive health programmes • Integration of PMTCT in MCH has improved maternal and child health care services in MCH • Capacity building of health workers has improved service uptake • Availability of resources – human and basic supplies • Integration of monitoring indicators in the existing registers and patients cards (e.g. ANC, CWC)
  11. 11. CHALLENGES • Prevention of unwanted pregnancy among HIV infected women (low uptake of FP services) • Primary prevention of HIV infection among women testing HIV negative during pregnancy (follow-up counseling on HIV prevention). • Periodic shortage of basic commodities (HIV testing kits, ARV drugs, OI drugs – (issues in procurement and supply management for drug and laboratory supplies) • Limited access to care and treatment (CD4 testing, DNA PCR, ART) due to lack of decentralization of services. • Limited mechanisms for linkages and referral between programmes at facilities levels and community. • Infant feeding in the context of HIV and EID (meeting AFASS and prevent malnutrition)
  12. 12. WAY FORWARD NSF 2009 -2014 Outcome level results: • % HIV infected infants born of HIV + mothers is reduces from 21.5% in 2007 to 5% by 2014 • % of HIV positive pregnant women who received a course of ARV prophylaxis to reduce MTCT is increased from 65% in 2007 to 90% by 2014
  13. 13. WAY FORWARD (CONT) • Integration of FP in chronic HIV care and ART • Continue counseling HIV negative on HIV prevention at every postnatal visit • Expand access to early HIV infant diagnosis and Treatment (all health facilities to provide service) • Conduct Integrated HIV trainings (e.g. IMCI) through in-service trainings at the training institutions • Advocate for transportation of specimens to lab (CD4 and DBS). • Improve coordination of partners and programs relevant to implementation of services • Establish quality improvement for PMTCT and Paediatric AIDS care • Improve commodity procurement and supply systems
  14. 14. WAY FORWARD (CONT) • 80% HIV+ women have assess to dual contraception • 60% of health facilities offer both PMTCT and ART services • % of health facilities providing minimum package of PMTCT increased from 78% in 2008 to 95% in 2014
  15. 15. WAY FORWARD (CONT) • Increase the proportion of HIV exposed children below 12 months receiving virological tests from 30% to 50% • Increase the proportion of HIV exposed children receiving CTX 55% to 70%
  16. 16. PARTNERS • WHO • UNICEF • UNFPA • USG – EGPAF and ICAP, Clinton Foundation, Baylor – COE NGOs • M2M • Global Fund, MSF) • Support from partners (HR, technical, financial equipment and supplies, clinical support, etc)
  17. 17. NGIYANIBONGA! I THANK YOU!

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