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

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

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

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

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

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

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

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

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?

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?

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

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

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

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

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

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

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

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

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

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

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

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

Provincial Progress: Mpumalanga Challenges: – Funds not yet transferred from national – Awaiting delivery of orders

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

Provincial Progress: Northern Cape Challenges – Equipment and space for the programme

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

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

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

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

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