1. PMTCT at Different Levels of Care: The Uganda Experience Dr. Saul Onyango National PMTCT Coordinator Ministry of Health 1 1

2. 2 Background… MTCT is 2nd major mode of transmission of HIV in Uganda Major mode of transmission of HIV to children (>95%): Approx. 25,000 infected babies each year Accounts for up to 25% of all new infections in the country PMTCT is a major intervention for prevention of HIV infection particularly among children Priority intervention in the NSF and HSSP II 2

3. 3 PMTCT Programme Started as a pilot intervention in 2000 Targeted 7 sites within 5 districts, with regional balance Government and NGO health facilities Aim to learn: ◦ Integration within existing system ◦ Impact of intervention on family and community 3

4. 4 The PMTCT Interventions HIV counselling and testing Comprehensive antenatal care, Improved care during labour & delivery Post natal care and follow up for mother & baby Anti-retro viral drugs for HIV+ mothers and their babies Counselling on appropriate infant feeding for HIV+ mothers Promotion of community & male partner support 4

5. Households /Communities/ Villages HC II HC III Referral Facility (HC IV or Hospital) Regional Referral Hospital National Referral Hospital HC II HC III 5,000 20,000 100,000 2,000,000 Health Sub- District (HSD) National Population District: 500,000 National Health System 5

6. National Health System… HC II (2008 facilities) ◦ Ambulatory services HC III (955 facilities) ◦ Preventive, promotive & curative services ◦ Basic laboratory & maternity care HC IV (161 facilities) ◦ 2 nd level referral services for HSD, includes surgical & obstetric emergency care Hospitals (113 facilities) ◦ Comprehensive services 6

7. Antiretroviral Drugs for PMTCT 1. Basic Regimen This is applicable in situations where: there is no capacity for HIV disease staging HAART is not available it is not feasible to refer a woman during pregnancy for further HIV disease evaluation the woman gets to know her HIV status at 38 weeks of gestation or later 7

8. Antiretroviral Drugs for PMTCT… 2. Combination Regimen This is applicable situations where: the woman presents for antenatal care before 28 weeks of gestation there is no capacity for HIV disease staging. it is not feasible to refer the woman for further HIV disease evaluation she is not eligible for treatment by the WHO staging HAART is not available but the woman is eligible for treatment on WHO staging 8

9. Antiretroviral Drugs for PMTCT… 3. HAART This is applicable in situations where: the woman presents for antenatal care from 14 weeks of gestation onwards clinical evaluation for WHO disease staging was performed and she is stage 3 or 4 investigations have been done to confirm eligibility for treatment: full blood count, CD 4 cell counts and other laboratory assessments. use of HAART is recommended such as in WHO clinical stage 2 with a CD 4 count of <350 9

10. 10 Practical Application Basic package:HC II facilities Intermediate package:HC III facilities Comprehensive package:HC IV facilities & Hospitals

11. Challenges Human resources for health ◦ Category of professional cadres ◦ Absolute numbers of professional cadres ◦ Competence (capacity building) Logistics and supplies management ◦ National ◦ District and health facility levels Infrastructure 11

12. 12 Finally