Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) HIV Prevention Training Package Session: Prevention of Mother-to- Child Transmission

Session Learning Objectives After this session  Participants describe the goals and elements of PMTCT.  Participants name four appropriate and two inappropriate roles for PCVs in supporting PMTCT.  Participants name PMTCT indicators and accurately report on PMTCT-related activities.

PMTCT and HIV Prevention  More than 390,000 children were born with HIV globally in 2010 – 90 percent of these infections occur in 21 countries  ARVs administered during pregnancy, delivery, and breastfeeding reduces transmission from mother to child to 2-5 percent  Goal: Eliminate mother-to-child transmission (EMTCT) by 2015

PMTCT’s Four-Pronged Strategy 1.Primary prevention 2.Prevent unintended pregnancies among HIV- positive women 3.HIV testing and access to ARVs for HIV-positive mothers 4.Follow-on care and support to mothers and families

[Country] National EMTCT Strategy  Post adaptation: Note national goals, coverage of current programs, implementers, and priorities

PMTCT Cascade Taken from Global e-learning ( child-transmission-hiv/page/cascade-stages), Global Health e-learning Centerhttp:// child-transmission-hiv/page/cascade-stages

Common Barriers to PMTCT – ‘Supply Side’  Low health facility coverage  Shortages of health care workers  Inadequate quality of care  Stigmatizing, disrespectful, and/or abusive care  Stock out of supplies such as test kits and drugs  Weak systems of client referral, linkage, and follow up  Limited hours of service and long wait times Taken from UNAIDS Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothers alive. Joint United Nations Programme on HIV/AIDS: Geneva.

Common barriers to PMTCT – ‘demand side’  HIV-related stigma  Gender-based obstacles  High costs of care, care seeking, other financial constraints  Perceived poor quality of care  Unsafe community norms, practices and beliefs around pregnancy, childbirth and infant feeding  Mixed messages and confusion on healthy practices Taken from UNAIDS Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothers alive. Joint United Nations Programme on HIV/AIDS: Geneva

National PMTCT Actors  Post adaptation  Initiatives/projects/actors in country – those who represent potential collaborators for PCVs

Role of PCV in PMTCT  PCV activities – Organize campaign to promote PMTCT services, with particular emphasis on existing women’s groups/associations – Work with service providers to examine service delivery data, look at ways to reduce client loss along PMTCT cascade – Train community liaisons to conduct effective follow-up tracking visits – Support formation of mothers’ support groups – Promote adherence through work with PLHA groups/treatment safe motherhood groups – Work with health facility to increase couples HTC – Create a campaign to support HIV-positive pregnant women (reduce stigma, encourage families to be actively involved in pregnancy) – Ensure mothers linked to other health services