Policy Changes that have Increased Uptake along the Cascade:Highlights from Cameroon<br />Banso Baptist Hospital <br />The...
PRESENTATION OUTLINE<br />Background<br />Early beginnings<br />Implementation strategies<br />Use of support groups to en...
A. BACKGROUND<br />3<br />
1. THE CBC HEALTH BOARD <br />One of 3 arms of the Cameroon Baptist Convention (Church, Education, and Health)<br />Missio...
2. PMTCT IN CAMEROON <br />Observed increased number of HIV infections in the patient population<br />PMTCT was then initi...
B. EARLY BEGINNINGS<br />6<br />
1. FIRST STAFF & FIRST SITES<br />Trained two nurses as counselor trainers <br />Began in February 2000 with two sites<br ...
2. JUNE 2002 INTERNATIONAL CONFERNECE<br />Organized by the CBCHB, UNICEF, EGPAF and MOH<br />Attended by experts from EGP...
C. IMPLEMENTATION STRATEGIES<br />9<br />
1.  PARTNERSHIPS, WHY?<br />Limited resources for health activities<br />FBOs have deep roots in and significant impact on...
2. Private-Private-Public Partnerships <br />Provider network<br />Private non-profit<br />Public<br />Private for profit<...
3. PUBLIC-PRIVATE PARTNERSHIPS <br />Indispensable, cost-effective, unavoidable<br />The CBCHB signed a partnership accord...
4. BOTTOM UP APPROACH“USE WHAT YOU HAVE TO DO WHAT YOU HAVE TO DO”<br />Community-determined health care approach<br />Com...
5. Faith-Based Organization as Credible Providers<br />HEALTH<br />FAITH  AND HIV<br />14<br />
FOUR-TIER ADVOCACY STRATEGY<br />International<br />National<br />Provincial/Regional<br />Community<br />15<br />
6. PROCEDURE FOLLOWED AT ANC<br />1stAntenatal Clinic - Group counseling by maternity/counselor staff, reviewing 4-5 routi...
D. USE OF SUPPORT GROUPS TO ENHANCE NVP UP TAKE <br />17<br />
Support Group Activities<br />(Left): Banso,  Mbingo (Right)<br />“During our meetings we receive education on PMTT, infor...
Support Group Activities<br />Support Group attending a practical demonstration on nutrition<br /><ul><li>Sharing lessons ...
Sharing experiences and supporting each other to accept and live positively with HIV/AIDS are key goals</li></ul>19<br />
Support Group Activities<br />Counselor and Support Group member doing craftwork<br />Follow up Counselor (standing) visit...
E. PROGRESS MADE<br />21<br />
Evolution of Sites from 2000-2009<br />22<br />
Uptake of Services from 2000-2009<br />23<br />
F. NEW STRATEGIES ADOPTED <br />IN 2005<br />24<br />
1. Revision of Strategies Following Lessons Learnt<br />Provision of NVP at first visit<br />Greater use of support groups...
Evolution of Maternal ARV Uptake<br />26<br />
2. Testing in Labor and Delivery<br />A strategy to identify women who hide their cards or did not go for ANC<br />Only st...
Testing in Labor and Delivery<br />28<br />
3. Partner Testing<br />Training of frontline staff<br />Provision of male friendly services<br />Invitation letters given...
G. USE OF BIRTH ATTENDANTS IN PMTCT SERVICES <br />30<br />
1. Start of Trained Birth Attendants<br />1980: CBCHB Primary Health Care was begun<br />1984: First birth attendants trai...
TBA Delivery Kit<br />32<br />
2. Barriers to Safe Delivery<br />Poor educational standards<br />Low income<br />Bad or non-existent roads<br />Poorly ma...
34<br />
35<br />
3. Use of Birth Attendants to Enhance PMTCT in Rural Areas <br /><ul><li>To extend the benefits of short-course ARV to wom...
Birth Attendants could play a key role in implementing effective interventions in rural settings
With appropriate supervision, training and support, TBAs could offer HIV prevention services and help with ARV prophylaxis...
4. Tasks for Trained Birth Attendants in PMTCT<br />Identify pregnant women in their communities and facilitate their use ...
Rapid Test by Birth Attendants<br />38<br />
5. Preventing Mother to Child Transmission<br />Maternal and Child Health provided<br /><ul><li>Updating on trends and tra...
Interactive Group Discussion Led by a TBA<br />40<br />
Imagine all these children without any intervention! <br />41<br />
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Policy Changes That Have Increased Uptake Along the Cascade: Highlights from Cameroon

  1. 1. Policy Changes that have Increased Uptake along the Cascade:Highlights from Cameroon<br />Banso Baptist Hospital <br />The first two PMTCT sites in Cameroon (Feb 2000)<br />Mbingo Baptist Hospital<br />Tih Pius MuffihMPH, PhD<br />Cameroon Baptist Convention Health Board<br />
  2. 2. PRESENTATION OUTLINE<br />Background<br />Early beginnings<br />Implementation strategies<br />Use of support groups to enhance NVP uptake<br />Progress made<br />New strategies adopted in 2005<br />Use of TBAs in PMTCT<br />Conclusion<br />2<br />
  3. 3. A. BACKGROUND<br />3<br />
  4. 4. 1. THE CBC HEALTH BOARD <br />One of 3 arms of the Cameroon Baptist Convention (Church, Education, and Health)<br />Mission: The Cameroon Baptist Convention Health Board seeks to assist in the provision of care to all who need it as an expression of Christian love…<br />Health services started 1938 as missionary activities; Health Board created in 1975<br />AIDS Care and Prevention Program created in 1999<br />First PMTCT provider in Cameroon (Feb 2000)<br />4<br />
  5. 5. 2. PMTCT IN CAMEROON <br />Observed increased number of HIV infections in the patient population<br />PMTCT was then initiated to prevent mother to child HIV transmission<br />No prior experience in PMTCT<br />Assistance from external sources like Johnson & Johnson, Abbott Fund, EGPAF, USAID<br />5<br />
  6. 6. B. EARLY BEGINNINGS<br />6<br />
  7. 7. 1. FIRST STAFF & FIRST SITES<br />Trained two nurses as counselor trainers <br />Began in February 2000 with two sites<br />On-site training of staff and initiating activities<br />Only 5 sites by Dec. 2000 and 9 sites by Dec. 2001<br />No other PMTCT services existing elsewhere in the country at that time to share experiences<br />Adopted group training in 2002, scaled up to 58 sites<br />7<br />
  8. 8. 2. JUNE 2002 INTERNATIONAL CONFERNECE<br />Organized by the CBCHB, UNICEF, EGPAF and MOH<br />Attended by experts from EGPAF, UNICEF, CDC, MOH, WHO and other health care providers in the country<br />This was a strategy to launch PMTCT services in the country<br />Sharing of the CBCHB PMTCT experience<br />First national guidelines for PMTCT drafted<br />Mandate for PMTCT scale-up in Cameroon given to CBCHB by MOH<br />8<br />
  9. 9. C. IMPLEMENTATION STRATEGIES<br />9<br />
  10. 10. 1. PARTNERSHIPS, WHY?<br />Limited resources for health activities<br />FBOs have deep roots in and significant impact on society. Work with the poorest of the poor<br />HIV/AIDS pandemic requires collaboration of public and private sectors to combat it<br />MOH and the CBCHB share in providing healthcare and social services in the country<br />HIV/AIDS is a priority health domain for both <br />10<br />
  11. 11. 2. Private-Private-Public Partnerships <br />Provider network<br />Private non-profit<br />Public<br />Private for profit<br />Good neighbor policy<br />11<br />
  12. 12. 3. PUBLIC-PRIVATE PARTNERSHIPS <br />Indispensable, cost-effective, unavoidable<br />The CBCHB signed a partnership accord with the public sector (MOH)<br />Mutual respect and fair treatment of each other<br />Complies with the national health policy<br />Performance is paramount, not money nor political gain<br />The CBCHB complements, not competes, with the public sector<br />EGPAF ILA facilitated this partnership<br />12<br />
  13. 13. 4. BOTTOM UP APPROACH“USE WHAT YOU HAVE TO DO WHAT YOU HAVE TO DO”<br />Community-determined health care approach<br />Community-based, from periphery to central facilities<br />Public health approach<br />Realistic response to crisis <br />Staff trained and responsibilities delegated<br />Service delivery decentralized<br />Use of existing systems/structures<br />Compare with other PMTCT programs’ top-down medical approach<br />13<br />
  14. 14. 5. Faith-Based Organization as Credible Providers<br />HEALTH<br />FAITH AND HIV<br />14<br />
  15. 15. FOUR-TIER ADVOCACY STRATEGY<br />International<br />National<br />Provincial/Regional<br />Community<br />15<br />
  16. 16. 6. PROCEDURE FOLLOWED AT ANC<br />1stAntenatal Clinic - Group counseling by maternity/counselor staff, reviewing 4-5 routine antenatal lab tests (Hb, UA, Syphilis, + Blood Type, HIV)<br />Interactive group discussion of HIV test: Emotional response if positive, how to disclose to spouse, potential of living many years if HIV+ if maintain healthy lifestyle and reduce exposure, availability of free NVP for PMTCT, opt-out strategy.<br />Individual pretest counseling<br />Rapid HIV testing on-site if consent, same day results<br />Prenatal exam while awaiting for HIV test results<br />Individual post-test counseling<br />Information on mother’s NVP dose at onset of labor<br />Emphasis on baby’s dose within 72 hours of life<br />16<br />
  17. 17. D. USE OF SUPPORT GROUPS TO ENHANCE NVP UP TAKE <br />17<br />
  18. 18. Support Group Activities<br />(Left): Banso, Mbingo (Right)<br />“During our meetings we receive education on PMTT, information and communication on HIV/AIDS, sexual issues, writing a will, maternal and infant nutrition, and practical demonstration on food preparation, strategies of living positively and coping with HIV/AIDS, and sharing of individual experiences.” <br />~Mme. ManthoF<br />18<br />
  19. 19. Support Group Activities<br />Support Group attending a practical demonstration on nutrition<br /><ul><li>Sharing lessons on nutrition and hygiene to improve on the nutritional status of families are helpful
  20. 20. Sharing experiences and supporting each other to accept and live positively with HIV/AIDS are key goals</li></ul>19<br />
  21. 21. Support Group Activities<br />Counselor and Support Group member doing craftwork<br />Follow up Counselor (standing) visits a Support Group member’s Tailoring workshop<br />Learning how to make crafts is a way of providing skills for clients to earn a living e.g. knitting of traditional gowns, knitting of traditional caps, gardening<br />20<br />
  22. 22. E. PROGRESS MADE<br />21<br />
  23. 23. Evolution of Sites from 2000-2009<br />22<br />
  24. 24. Uptake of Services from 2000-2009<br />23<br />
  25. 25. F. NEW STRATEGIES ADOPTED <br />IN 2005<br />24<br />
  26. 26. 1. Revision of Strategies Following Lessons Learnt<br />Provision of NVP at first visit<br />Greater use of support groups<br />Use of Trained birth attendants (TBAs) for services in rural areas<br />Male partner involvement<br />Move from mono to bi therapy<br />Focus on quality improvement<br />Data review and provision of feedback<br />Testing in the counseling room<br />Testing in labor and delivery<br />25<br />
  27. 27. Evolution of Maternal ARV Uptake<br />26<br />
  28. 28. 2. Testing in Labor and Delivery<br />A strategy to identify women who hide their cards or did not go for ANC<br />Only started in 2005<br />High acceptance, up to 4,151 women reached in 2008<br />Increased chances to offer PMTCT interventions<br />Average of over 90% acceptance to test<br />Prevalence very high from the beginning (37.5%) but has dropped to 9.4% in 2009<br />Seems to be dropping as women know they can’t avoid being offered a test<br />27<br />
  29. 29. Testing in Labor and Delivery<br />28<br />
  30. 30. 3. Partner Testing<br />Training of frontline staff<br />Provision of male friendly services<br />Invitation letters given to women for their partners<br />Free testing for HIV<br />Making progress<br />7,757 partners tested in 2009<br />29<br />
  31. 31. G. USE OF BIRTH ATTENDANTS IN PMTCT SERVICES <br />30<br />
  32. 32. 1. Start of Trained Birth Attendants<br />1980: CBCHB Primary Health Care was begun<br />1984: First birth attendants trained<br />1984-2001: Annual training of TBAs<br />31<br />
  33. 33. TBA Delivery Kit<br />32<br />
  34. 34. 2. Barriers to Safe Delivery<br />Poor educational standards<br />Low income<br />Bad or non-existent roads<br />Poorly maintained vehicles<br />Some traditional beliefs and practices<br />33<br />
  35. 35. 34<br />
  36. 36. 35<br />
  37. 37. 3. Use of Birth Attendants to Enhance PMTCT in Rural Areas <br /><ul><li>To extend the benefits of short-course ARV to women in rural areas, a challenge
  38. 38. Birth Attendants could play a key role in implementing effective interventions in rural settings
  39. 39. With appropriate supervision, training and support, TBAs could offer HIV prevention services and help with ARV prophylaxis at delivery</li></ul>36<br />
  40. 40. 4. Tasks for Trained Birth Attendants in PMTCT<br />Identify pregnant women in their communities and facilitate their use of ANC and maternity services<br />Reinforce health messages, including the importance of improved nutrition during pregnancy<br />Supervise directly observed treatment of mother and infant with NVP<br />Offer advice on reducing the risk of HIV transmission to women and their partners<br />Make sure pregnant women and their partners are routinely offered HIV counseling and testing<br />37<br />
  41. 41. Rapid Test by Birth Attendants<br />38<br />
  42. 42. 5. Preventing Mother to Child Transmission<br />Maternal and Child Health provided<br /><ul><li>Updating on trends and transmission of HIV</li></ul>Training in the inclusion of fathers in prenatal health care<br />Lessons in basics of counselling and specifics of pre- and post-test HIV/AIDS counselling<br />Preparation of Village Health Workers on NVP administration<br />Health teaching training using demonstrations, role play, games, use of Problem Posing Pictures, songs and discussions <br />Discussions with Birth Attendants regarding methods for identification of orphans for care<br />39<br />
  43. 43. Interactive Group Discussion Led by a TBA<br />40<br />
  44. 44. Imagine all these children without any intervention! <br />41<br />
  45. 45. SUMMARY<br />We started PMTCT with no experience<br />There were no policies, no protocols<br />We started small, from the bottom-up<br />Private-public partnerships promoted <br />The use of group training, group facilitated counseling, support groups, TBAs, and giving NVP at first ANC visit helped in PMTCT scale-up <br />42<br />
  46. 46. The best time to plant a tree is twenty years ago….<br />The next best time is now<br />-African Proverb<br />43<br />
  47. 47. On behalf of the people of Cameroon,<br />I extend our sincere appreciation to:<br /><ul><li>EGPAF
  48. 48. USAID
  49. 49. Bill & Melinda Gates Foundation
  50. 50. Abbott Fund
  51. 51. Johnson & Johnson
  52. 52. And many other partners & collaborators</li></ul>THANK YOU VERY MUCH<br />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. <br />44<br />

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