ZAMBIANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

Couple Counseling Increases Antiretroviral (ARV) Uptake by Pregnant Women: A Case Report in Zambia Defense Force Health Facilities
by: Maureen Chilila1; Hilda Shasulwe1; Joseph Banda1; Joseph Nikisi1; Webby Kanjipite1; and Major Joyce Mulilo2 1 Jhpiego, 2Zambia National Service

Background
Zambia has a total population of 11.4 million (2004). The national HIV prevalence rate is 14.3%. The majority of HIV infections in infants occur through mother-to-child transmission (MTCT). More than 95% of women attending antenatal care services (ANC) are tested for HIV, although only 10% of couples in Zambia have tested for HIV together. As of December 2009, 63% of pregnant women living with HIV were provided with antiretroviral drugs (ARVs) for PMTCT. The Zambia Defense Force (ZDF) runs a parallel health system to the public health sector. ZDF has a network of 54 health facilities representing 16% of all health services in Zambia. ZDF has not received the same level of funding as the public sector although 80% of clients are civilians. DFMS* Units
* Zambia Defense Force Medical Services
Northern Eastern Luapula Copperbelt Central Lusaka Northwestern Western Southern
MUFULIRA 1 Engineering KASAMA ZNS Kasama MANSA ZNS Mansa Luamfumu (ZA Luapula HQ) MBALA ZNS Mbala ZAF Mbala NDOLA ZA Tug-Argan (2ZR)/25 LAD ZA Kalewa (10 Midium)/ School of Artillery 17 Calvary 1 Commando ZA Mushili (3 Infant Brigade HQ)

Project Goal
To reduce the spread of HIV and AIDS and mitigate the impact of the epidemic by building the capacity of the Zambian Defense Force (ZDF) both to prevent infections and provide treatment and care

Results
2,579 pregnant women and their partners from seven sites were counseled and tested together between 2009 and 2011. This is in sharp comparison to the previous years (2005 2008) when none of the pregnant women came with their spouses in the same sites. During the same period (20092011), the number of women taking ARVs for prophylaxis increased by 20% between 2009 and 2010. The majority of pregnant women are now coming with their partners during their first visit to the antenatal clinic. Data from the Defense Force Health Survey of 2011 show the following: The disclosure of HIV test results to partners has increased from 59.4% in 2004 to 84.1% in 2011. The knowledge of partners HIV status has increased from 13.2% in 2004 to 84.1% in 2011.

Approach
Revision of the PMTCT guidelines by the MOH to strengthen recommendations for couple counseling Development and provision of job aids to reinforce the practice by health care providers Mentorship to improve provider skills and to foster change of attitude regarding male involvement Provision of data management tools to capture the information on couple counseling Orientation of Unit Commanders to encourage male involvement in PMTCT and other health programs in their camps Couples being given group education on PMTCT

Improved ARV Prophylaxis Uptake

ARV prophylaxis
100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% Increase in ARV prophylaxis uptake

93%

72.10%

KABWE ZA Miltez/OTF Chindwin (ZA 16 Tails) ZNS Kabwe ZAF Kabwe

SOLWEZI ZNS Katandano ZNS Kamitonte (ZA NW HQ)

MPIKA ZNS Mpika KITWE ZNS Kitwe ZA ZCCF Kitwe

LUNDAZI ZNS Lumezi CHIPATA ZA Gondar (ZA Eastern HQ)

SERENJE ZA Kanona MKUSHI ZNS Munsakamba ZNS Luanshimba NYIMBA ZNS Nyimba CHONGWE ZNS Chongwe ZA Mikango

KASEMPA ZNS Mumbezhi

CHIBOMBO ZNS Chisamba KAOMA ZA Kaoma ZNS Mangango KAFUE ZNS Kafue MUMBWA ZAF Mumbwa CHOMA ZNS Choma

KATETE ZNS Chiwoko ZNS Mtetezi

Couples receive education about PMTCT

ZNS HQ ZNS Makeni ZNS Sopelo ZNS Airport Farms ZNS LDB HQ ZAF Mt. Eugenia ZAF Twin Palm ZAF Lusaka Air HQ ZAF Logistic Command

30.00% 20.00% 10.00% 0.00%

LIVINGSTONE ZAF Livingston School of Ordinance (ZA Southern HQ)

LUSAKA Maina Soko Military (ZA Central Hospital Mechanical Depot) Arakan 1ZR/ (ZECCO Camp) Army HQ (ZA Burma Clinic) L 85 ZNS Safaris Staff college ZNS Chamba Valley (1 BRIDGE ZNS Lusaka West Emmasdale) Builders Brigade

Year 2009

Year 2010

The military has not been spared from the pandemic. (The AIDS epidemic poses a special threat to military populations because of their demographic makeup and conditions of deployment.) The military has a high prevalence rate compared to the general population. Elevated infection rates in the military pose a threat to the surrounding community, as military personnel may transmit HIV to family members and local sexual partners. They have similar risk factors as the general population. The Department of Defense (DOD) HIV/AIDS project began in 2005. Jhpiego is working in 20 of the 54 health facilities. They provide health services to military personnel, families and surrounding communities. 80% of clients accessing services are civilians. Catchment population is ~135,000.
Data management using electronic medical records (SmartCare)

Lessons Learned
Mentorship in antenatal care at ZNS Mtetezi camp clinic

Couple counseling is a good strategy to encourage ARV uptake by pregnant women.

Next Steps
As we scale up PMTCT services in ZDF facilities, the strategy of couple counseling should be scaled up too. Couple counseling should form part of the PMTCT core competencies and therefore should be part of the training.
ZDF Unit Commanders orientation to health programs, including male involvement

This work has been supported by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through DOD under the terms of Grant No. N00244-09-1-0050.