Community interventions and PMTCT: the other “p” B. Ryan Phelps Office of HIV/AIDS, USAID

New HIV infections in children Source: Universal Access Report, 2011 Indicators Target Number of new pediatric HIV infections430,000390,000<43,000

Two literature reviews –Retention along the PMTCT continuum of care –Community-based strategies that work Objectives

PMTCT care continuum

The PMTCT Effectiveness in Africa: Research and Linkages to Care (PEARL) Study SdNVP coverage in pregnancy

More PMTCT Options Status of B+ DecisionCountries MOH-endorsed plan for national implementation of B+ Malawi Rwanda Haiti MOH-endorsed plan for phased implementation of B+ Uganda Kenya National Steering Group recommendation to move to B+; not yet MoH-endorsed Namibia South Africa Piloting B+Mozambique (large pilot – 241 sites) Cameroon (small pilot) Swaziland Considering transition to B+Tanzania South Africa

HAART coverage in pregnancy L. Ferguson et al. Linking HIV-positive pregnant women to treatment services Trop Med and Intl Health; v17 no 5 pp 564–580, May 2012 Killam et al, Zambia, 2010 Mandala et al, Zambia, 2010

PMTCT care continuum

All pregnant mothers at first ANC Pregnant mothers accepting testing Pregnant mothers testing positive (25%) Delivery6 months postpartum 36 week ANC Ahoua, Ayikoru et al Cook, Ciampa et al Manzi, Zachariah et al Retention of HIV-exposed infants (1)

Eligible HIV-exposed infants 2 months after enrolment 18 months of age Enrolled HIV- exposed infants Eligible HIV- exposed infants Return for at least one visit 4 month visit Hassan, Sakwa et al Sherman, Jones et al Ioannidis, Taha et al Retention of HIV-exposed infants (2)

(Unpublished CHAI data, 2009) Retention of HIV-exposed infants (3)

PMTCT care continuum

Two literature reviews –Retention along the PMTCT continuum of care –Community-based strategies that work Objectives

1st AuthorCountryInterventionOutcome Futterman.South Africa Mentor mother-guided education and support HIV knowledge increased Orne- Gliemann Zimbabwe Community sensitization with peer educators Increased HIV awareness; increased PMTCT knowledge; increased condom use (reported) BalogunNigeriaN/A TBA counseling of HIV exposed clients and referral for testing depended on knowledge level TeasdaleSouth AfricaM2M programIncreased NVP coverage (mothers and infants) TorpeyZambia Lay counselors and traditional and religious leader engagement More pregnant women tested and receiving results; seropositive pregnant women receiving complete course of ARV prophylaxis FaraquharKenyaPartner engagement Women whose partners came for testing ~ 3x more likely to return and report taking NVP ChandisarewaZimbabwe Community counselor- driven opt-out testing More women tested, received results; more diagnosis in ANC, and more NVP uptake BekkerSouth Africa Community counselor providing PSS/support More women started ART KurewaZimbabweSupport groups, and community tracking Less LTFU among mother-infant pairs

PEPFAR-supported Acceleration Plans TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD Mediterranean Sea Sea EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO NIGERIA BENIN DTVOIRE SIERRA SENEGAL GHANA THE GUINEA LIBERIA CAMEROON SOUTH AFRICA MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND Indian Ocean LESOTHO NAMIBIA ANGOLA Atlantic Ocean WESTERN Red UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE BURKINA GUINEA LEONE GAMBIA BISSAU Walvis Bay SOUTH REPUBLIC AFRICAN THE AFRICA Legend 6 Original Acceleration Countries 8 New Acceleration Countries PEPFAR PMTCT programs in Global Plan countries* SOUTH SUDAN * PEPFAR supports programming in India (not pictured) Acceleration Plans all required to have community engagement elements

New HIV infections in children Source: Universal Access Report, 2011 Indicators Target Number of new pediatric HIV infections430,000390,000<43,000

Thank you. Kea leboga. Niyabonga.