HIV+ logbook tracks HIV + mother-baby pairs from pregnancy to 18 months post-partum HIV- logbook tracks HIV- women through pregnancy for retesting at three months

1. Effective Monitoring for HIV Prevention:
Re-testing HIV-Negative Pregnant Clients
Presenter: Phylis Mutiso, mothers2mothers
NOPE Conference, Nairobi
June 2014

2. Presentation Outline
• Introduction
– About m2m
– KMMP services
• Mentor Mother M/E tools
• Methods
• Lessons learnt

3. Background
mothers2mothers (m2m)
• Provide Peer Education
(PE) and Psychosocial
support (PSS) to HIV
positive pregnant women
and new mothers to
promote PMTCT

4. Background
• m2m directly implements this model at 30
high volume health facilities under
umbrella of MOH Kenya Mentor Mother
Program (KMMP)
• The KMMP seeks to improve PMTCT uptake
and retention by integrating mothers living
with HIV into health facilities to provide PE
& PSS to their peers as Mentor Mothers
(MMs)

5. Background
• MMs are competitively
recruited and undergo a
two-week national
KMMP curriculum-based
Pre-Service Training(PST)
• PST prepares them to
provide quality services
to clients through task
shifting approach

6. KMMP Services
• one-on-one/couple
PE and PSS
• support groups
• defaulter tracing
• internal referrals
and linkages
• services are
captured in
appropriate KMMP
M&E tools

7. KMMP Monitoring & Evaluation Tools
Longitudinal records
HIV+ logbook tracks HIV
+ mother-baby pairs
from pregnancy to 18
months post-partum
HIV- logbook tracks
HIV- women through
pregnancy for retesting
at three months

8. Context
• PMTCT national guidelines recommend
re-test of HIV pregnant clients after
three months
• Roll out of re-testing has been slow
across the country
• Monitoring of client uptake and
outcomes of re-testing remains a
challenge

9. Description
• MMs provide services through
interaction with HIV positive pregnant
clients & new mothers
• They provide 2 part-focused interaction
(first visit and return visit for re-testing)
with HIV negative to motivate them to
return for re-testing and influence their
male partners to come in for testing at
the health facility

10. Description
• Client details are recorded in an HIV
negative longitudinal register which is
updated when clients return for services
• Client return date is booked in a
calendar diary
• Diaries are reviewed daily to identify
clients due for re-testing who have
missed appointments
• The defaulter tracing process is started
the next day

11. Description
• MMs conduct telephonic defaulter
tracing
• Depending on client consent, it starts
with an SMS
• If a client does not respond to the sms
a telephone call is made
• MMs develop list of clients for home
visiting by CHWs through the CHEW

12. Lessons Learned

13. Lessons Learnt
• Re-testing remains a challenge
• Most clients come late in pregnancy
• Re-testing uptake lower in Western
Kenya than in Nairobi
• Sero-conversion is higher in Western-
(Nyanza where prevalence is at 15.1%
KAIS 2012)

14. Lessons Learnt
• Data from 30 health facilities from Jan
to Dec indicates that only 23% of HIV
negative clients returned for re- testing
(7,816 out of 34,103)
• 1 % (89 out 7816) sero converted
during pregnancy and tested HIV
positive, standing a high chance of
infecting their infants

15. Conclusion
• Effective program monitoring is an
essential part of PMTCT programming
– To ensure available services are being
utilized
– To link high risk clients to care as quickly
as possible

16. Conclusion
• Monitoring for re-
testing should include
post natal period
• Re-testing must be
integrated in to health
system monitoring