1. Use of improved tracking of exposed infants during early infant diagnosis (EID) to reinforce PMTCT outcomes in a low resource setting. Lessons from East-central Uganda Abstract No: TUAC1005 Presenter: Dr Kazibwe Francis Herbert ICASA 2011 - 16th International Conference on AIDS & STIs in Africa 4-8 December 2011 – Addis Ababa, Ethiopia 6 th December 2011, Room A3: Fasiledes

2. STAR-EC program:  Five years (2009-2014) program funded by USG through USAID  Implemented by JSI in collaboration with Ministry of Health-Uganda  Serves about 9% of the country’s population (Approx. 3M people)  Works through district based structures  Operates in 9 Districts of East Central Uganda Background The 9 districts served: Bugiri, Buyende, Namutumba, Namayingo, Mayuge, Iganga, Luuka, Kamuli & Kaliro Project Aim: To increase access to, coverage of, and utilization of quality and comprehensive HIV&AIDS and TB prevention, care and treatment services

3. Program description  Ministry of Health, Uganda adopted PMTCT using Option A following 2009 WHO advise. Prior to this, 2006 PMTCT guidelines were in use; Mother: ARV prophylaxis from 28 – 32 weeks till 1 week post delivery Exposed babies: Single dose Nevirapine & 1 week AZT syrup

4. Program description  Option A entails; Mother : early enrolment of HIV positive pregnant women onto prophylactic ARVs or HAART until 1 week after delivery Exposed babies: ARV prophylaxis from birth until weaned at 12 months. The intention is to minimise the mother-to-child HIV transmission yet allowing the baby to enjoy the benefits of breast feeding.

5. Program description  Before the advent of the 2010 guidelines, PMTCT and EID implementation was plagued with high loss to follow up of mother baby pairs.  In this regard Ministry of health Uganda developed the PMTCT-EID strengthening program to mitigate this loss to follow up that was undermining the outcomes of PMTCT interventions in the country.  The Hall mark lies in ensuring strict tracking of the mother- baby pair in the facility and community

6. Program description ANC/PMTCT (pre- birth) Maternity (at birth) PNC/YCC/Immun ization Facility Laboratory ART/Pediatric ART OPD Community EID care point (ART or Maternity) Paediatric ward

7. Program description  STAR-EC facilitated this policy roll out to 68 PMTCT facilities during the period October 2010 – March 2011 by supporting the following; Trainings and mentorships; Logistics management and laboratory support (CD4 & PCR). Distribution of MOH registers, client charts, EID equipment, IEC materials and job aides Client follow up - expert clients (m2m) and health workers/FSGs Data management

8. RESULTS

9. ART eligibility assessment of HIV +ve Pregnant women using CD4 & WHO classification

10. HIV exposed infants started on ARVs for prophylaxis at birth

11. HIV exposed children tested for HIV (1st and 2nd PCR tests

12. Overall PMTCT outcomes by quarter, October 2009 - March 2011

13. Lessons learned Inclusion of well coordinated tracking for the mother-baby pair in the facilities and the communities has the potential to improve PMTCT service utilization and outcomes in the following ways:  Exponential improvement in ART eligibility assessment  Improved enrolment of HIV exposed babies to NVP syrup at birth  Improved access of Exposed babies to PCR testing

14. Next steps  Following these positive PMTCT-EID outcomes, STAR- EC and Ministry of Health rolled out this strengthening program from 68 to 85 facilities (100% hospitals - 4, HC IV - 12, HC III - 59 and 5% HCII – 201) offering PMTCT.  Between October 2011 – September 2012, STAR-EC in collaboration with MOH plans to consolidate on these gains through continued mentorships and monitoring of the intervention

15. Acknowledgements  USAID  JSI Research & Training Institution Inc  PMTCT-EID team, Ministry of health, Uganda  District personnel ICASA 2011 - 16 th International Conference on AIDS & STIs in Africa  Authors