1. National PMTCT and Pediatric HIV Care and Treatment Coordinator, MOHCC
Towards EMTCT and Accelerating Access to Pediatric and Adolescent ART Focus on health system-community partnership coordination by local/ national government
Dr Angela Mushavi
National PMTCT and Pediatric HIV Care and Treatment Coordinator, MOHCC
IAS 2016
18 July 2016
Durban

2. Outline of Presentation
Background of Zimbabwe
Community participation in the eMTCT strategy for Zimbabwe
Village Health Care Workers in eMTCT
Mbereko groups
Mother support groups
Padare’s male involvement strategy
Case Care Workers
Zvandiri Model

3. Zimbabwe Total population: 13mil (2012 Census)
Adult HIV prevalence 14.7%*
ANC HIV prevalence 16.1%)
Total PLHIV 1.4 million
Adults LHIV
Adult need for ART (2015):
Adults receiving ART:
Peds 0-14 years LHIV:
Peds on ART (2015): %
ALHIV (10-19 years):
New HIV infections among children 4900
MTCT rate: 7% (Spectrum)
Adult HIV prevalence has gone up-maybe due to the effect of ART on mortality-and increased survival of PLHIV
New pediatric HIV infections are going down due to scale-up of PMTCT services
Source: *Spectrum 2015 3

4. National Health Strategy (2016-2020)
Reduce morbidity by at least 50% through the provision of accessible, affordable, acceptable and effective quality health services at community and health centre levels:
Strengthen Community Systems
Strengthen community participation
Increase Community Based Workers
Increase number of functional Health Centre Committees
Establish health posts

5. The 7 Strategic Objectives of the eMTCT Plan
Strengthen program leadership, management, coordination and supervision of sites
Strengthen provision of quality PMTCT and Paediatric HIV treatment services integrated within the MNCH platform
Strengthen human resource capacity
Strengthen the supply chain management system for commodities

6. The 7 Strategic Objectives of the eMTCT Plan
Strengthen laboratory capacity to support eMTCT
Strengthen community involvement and participation
Improve generation, dissemination and use of strategic information

7. Realigned Communication Strategy for EMTCT: 2015-2018

8. Maternal ART Coverages 2015

9. Among the GP countries, several have achieved or are close to achieving coverage that is close to elimination
Rwanda is not shown, but ARV coverage is >95% and MTCT rate <2%

10. Plan to get to Elimination for HIV and syphilis
“Pre-elimination” is an attempt to specifically recognize this progress in HIV PMTCT in high burden countries
ELIMINATION
PRE-ELIMINATION
HIV
Syphilis
IMPACT
criteria
MTCT < 2% OR < 5% in BF populations
Case rate ≤ 50 per 100,000 live births
Case rate ≤ 50 per 100,000 live births
No case rate minimum
PROCESS criteria
ANC coverage ≥ 95%
Testing coverage ≥ 95%
ART coverage ≥95%
Testing coverage ≥ 95%
Treatment coverage >95%
ANC ≥ 90%
Testing in ANC ≥ 90%
ART coverage ≥90%
Plan to get to Elimination for HIV and syphilis

11. Tools applied in the assessment of validation
Data verification and impact assessment
Laboratory assessment
Human rights, gender equality and community engagement
Programs and services assessment
Assessment of the scope, quality and sustainability of EMTCT-related programs and services
Country report

12. The role of communities
In Zimbabwe, 7% of women do not present for ANC
20% of women deliver at home and without skilled birth attendant
Women come for with their babies for first immunization visits but go back without HIV exposed babies getting an HIV test
Fewer children in school or OVC programs are not accessing testing
Pregnant and lactating women on Option B+ are lost to follow up
Male participation is low
Disclosure
7% of women do not present for ANC-is it through lack of knowledge on importance of booking and delivering within health care settings?
Culture and religion a barrier in some cases
Poverty and disempowerment of women

13. Village Health Worker (VHW) program: an Opportunity in PMTCT implementation
VHWs have become important in tackling HIV
For PMTCT, VHWs encourage
Early ANC booking and repeated ANC attendance
HIV testing
Facility deliveries
Postnatal mother-baby pair follow-up
Picture: Courtsey of Zvitambo

14. Mbereko groups
Community peer to peer groups of pregnant and lactating mothers and caregivers
Irrespective of HIV status
members of the same village
Led by the Village Health Worker (VHW)
Meeting at least once a month on agreed days
Income generation activities through ISAL scheme
Mbereko in Shona means a wrap that is used to hold a child on the mother’s back in the early years of life
Mbereko Groups: A Model For Improving Access To Health Services For Mothers And Babies In The First 2 Years Of Life

15. Mother Support Groups
What they do
MSG in pictures
HIV-positive mothers join groups soon after booking
MSGs meet twice/month
Groups are led by volunteer coordinators
Health information is given by clinic nurses covering various topics

16. Community initiatives key to tackling low male participation in eMTCT
An organization called Padare/Enkundleni/Men’s forum on gender, is leading an initiative to strengthen the capacity of traditional leaders (chiefs) to increase male participation in PMTCT
Given an opportunity, men can be positively engaged to end vertical transmission
In one such district where the chief is engaged, male participation in PMTCT has increased to 90% (with a national average of 23%)

17. Padare Works Through the Chiefs

18. Working with Case Care Workers and Department of Child Welfare
DEMAND SIDE: Reaching the Community
Community leadership engagement (chiefs, religious, political)
Community structure engagement (Child Protection Committees, District AIDS Coordinator, Vulnerability Assessment Committees)
Volunteers trained to mobilise and create awareness and educate (male mobilisers, mentor mothers)
Volunteers trained to do referrals and case management for adherence & retention (Village Health Workers & CCWs)

19. Working with Case Care Workers and Department of Child Welfare
Additional sources of support
ISALs for caregiver
ECD playgroups
Parenting groups - ECD/PMTCT and parents of older children
Adolescent support groups
Home visits from CHWs for PSS, nutrition, and adherence advice

20. The Zvandiri Programme
A model of differentiated care for children, adolescents and young people with HIV in Zimbabwe

21. Community Adolescent Treatment Supporters (CATS)
HTS mobilisation
Index case finding
Linkage to HTS and follow up
Identification and linkage to OI/ART services
Community ART counselling, monitoring and support
Support Groups
Identification and referral for OIs, treatment failure, child protection, mental health, SRH
Tracing loss to follow
SMS Reminders
Young mothers groups
Vocational skills
At the heart of Zvandiri are CATS – Community Adolescent Treatment Supporters yr old HIV positive young people who work in their own communities between the health facility and homes of children and young people with HIV. They support their peers and younger children with a package of services shown here (in the diagram) with the aim of improving linkage and retention in care as well as other outcomes including sexual and reproductive health and mental health.
They work under the health facilities who have been trained by MoHCC and Africaid. They are being integrated as a critical component of the package of services provided by MoHCC for CAYPLHIV. They are promoting the active identification, referral, tracking and monitoring of CAYLPHIV through the HIV care cascade as they grow up in to adulthood. Monthly meetings with clinic staff, VHWs, social workers, CCWs and community nurses have been critical in ensuring a collaborative approach in managing CAYPLHIV between the facility and community. CATS, VHWs, CCWs and Community nurses are referring to one another and conducting joint visits.
Linkage with Clinic, Village Health Workers, Social Workers, Case Care Workers, Community Nurses

22. Acknowledgements MOHCC HIV Program and Director Nursing Services
UN Family
Implementing Partners
Civil Society Organisations
EGPAF
OPHID
Padare
World Education
EPAZ-FACT Mutare
Africaid Zvandiri

23. Thank you Tatenda! Siyabonga!