Preventing Mother to Child

Transmission (PMTCT) of HIV

Programme

Presentation to MinMEC, July 2001

 Overall Objectives of the
Programme
 Feasibility of integrating PMTCT
programme into existing routine MCH
services
 Ability of PMTCT to avert vertical
transmission and reduce childhood
mortality rates
 Specific Objectives
 Feasibility of providing VCT in clinics
offering routine ANC services
 Acceptability of VCT in the context of
PMTCT
 Acceptability of ARV therapy for PMTCT
 Feasibility of providing counselling on safe
infant feeding practices for HIV+ women
 Impact of infant feeding counselling
 Specific Objectives
 Costs of establishing and running a PMTCT
programme
 Feasibility of integrating follow-up of
infants born to HIV+ women
 Mechanisms of improving follow-up care
for HIV+ women post delivery
 Impact of PMTCT interventions on other
PHC and HIV/AIDS programmes
 Status quo of Preparations
for PMTCT
 Protocol has been developed
 Procurement and distribution system in place
 Training manual printed and distributed
 Financial resources made available
 Additional human resources made available
 Nevirapine (NVP) been registered
 Sites selected and provinces are in various states
of readiness
 Ordering of provincial supplies intiated
 Research Framework

Routine data collection: Collected at 18 sites

- Uptake of the PMTCT interventions
Local operational research:
- Provincial research
Specialised research:
- e.g. Resistance studies
 Research Framework
9 research areas:
A: Demographic, socio-economic and health
status characteristics of catchment population
B: General and healthcare infrastructure of
catchment area
C: Organisation of healthcare system and health
service accessibility/utilisation
D: Uptake and quality of PMTCT service
 Research Framework
E: Cohort follow-up of children and mothers
F: Effect of PMTCT programme on the rest of
the healthcare system
G: Cost
H: The community and community response
I: Clinical research
–Nevirapine resistance
–Cotrimaxazole
 Challenges
 Do women want to enrol ?
 Can the system cope with the demand for VCT
with the assistance of lay counsellors?
 Will there be an influx from non-PMTCT areas
and how to handle this?
 Is formula feeding going to increase the incidence
of diarrhoeal diseases in areas with poor water
supply?
 Challenges
 Will the system be able to adequately follow the
mother and infant pair after delivery - in particular
monitoring the growth of the infants?
 How can inter-departmental collaboration at
community level for the follow-up of HIV positive
women and their infants effectively be
established?
 Will routine data collection/analysis be done
correctly and without posing too much of a
burden?
 Challenges: DOH national
 Transferring funds to the provinces for
implementation
 Delaysin ordering of supplies
 New appointee – little time to get up to
speed
 Provincial Progress: Eastern Cape

 Sites: Cecilia Makiwane, Frere, Rietvlei

(UNITRA providing support to Rietvlei)
– Training conducted
– Lay counsellors to provide VCT
– Follow-up in well baby clinics
– Use NGOs for community mobilisation
– Cecilia Makiwane: educated 366 pregnant women,
44 agreed to voluntary counselling, 25 (57%) agreed
to voluntary testing, 15 tested positive (60%)
– Since March 15 babies delivered
 Provincial Progress: Eastern Cape

 Challenges
– Access to NVP for baby in case of home delivery
– Exclusive breastfeeding – what to do if woman has
to leave infant behind
– Availability of safe drinking water for bottle-feeding
Provincial Progress: Free State
 Sites: Frankfort, Virginia
– Trained 60 nurses
– Lay counsellors will do counselling
– Follow-up of infants at well baby clinics
– Monitoring tools available
– Undertaken health promotion activities
– IEC materials being prepared
– Provincial coordinator has been appointed
– Virginia started on 3 July 2001
– Frankfort will start on 14 July 2001
Provincial Progress: Free State
 Challenges
– Delay in availability of funds
– Limited accommodation at the clinics for
counselling service
 Provincial Progress: Gauteng
 Sites: J Dumane, Natalspruit, Pretoria West,
Kalafong
– Training conducted
– Follow-up mechanisms in place
– Data collection mechanisms in place
– Designing information pamphlet
– Implementation started 25 May
– Appointment of provincial coordinator in progress
 Provincial Progress: Gauteng
 On average women agreeing to test:
– J Dumane - 55% out of which 39% test positive
– N Spruit - 71% (32% test positive)
– P West - 65% (10% test positive)
– Kalafong - 23% (33% test positive)
 Overall 107 women were given NVP
 Overall, 37 children were delivered (only 1 died)
 All women chose to formula feed
 Provincial Progress: Gauteng
 Challenges
– Counsellors not keeping records
– Registers not given to coordinator
– Not all patients are post counselled because some do
not want results on the same day
– Not all negative results counselled
– Limited accommodation at the clinics for counselling
service
 Provincial Progress: KwaZulu-Natal

 Sites: King Edward, Prince Mshiyeni,

Greys/Northdale, Edendale, Church of Scotland
– Training conducted
– Follow-up mechanisms in place
– Data collection mechanisms in place
– To date Durban sites counselled 880 women of which
89% (784) agreed to voluntary testing
 30% tested positive, and 64% of them received NVP
 All 53 children born received NVP
Provincial Progress: KwaZulu-Natal
– In Pietermaritzburg, 1078 women counselled, 88%
(945) agreed to voluntary testing
 29% tested positive, 67% received NVP, 9 children
received NVP
 Provincial Progress: KwaZulu-Natal

 Challenges:
– Women who come from outside the province to
get access to NVP
 Provincial Progress: Mpumalanga

 Sites: Evander, Nkomazi sub-district

 Implementation started 1 July 2001
 Gauteng to assist with training of trainers
 MTCT coordinators – interviews held 6 June
2001
 Will use lay counsellors
 Health promotion activities to be in phases
 Provincial Progress: Mpumalanga

 Challenges:
– Funds not yet transferred from national
– Awaiting delivery of orders
 Provincial Progress: Northern Cape

 Sites: De Aar, Galashewe

 MTCT coordinator appointed May 2001
 Training conducted in March 2001
 Lay counsellors identified and trained
 Health promotion activities undertaken
 Monitoring and evaluation systems in place
 Provincial Progress: Northern Cape

 Challenges
– Equipment and space for the programme
Progress Report: Northern Province

 Training has begun: 18 nurses trained and

18 more being trained
 Project management structure in place
 Community mobilisation in progress
 Coordinator and admin clerk employment
currently being processed
 Launch scheduled for 6 August 2001
 Provincial Progress: North West

 Sites: Tlhabane HC, Lehurutshe

– Training conducted
– Lay counsellors to do VCT
– Follow-up mechanisms in place
– Data collection mechanisms in place
– Campaigns and media releases to mobilise
communities
– Launched 3 July 2001
Provincial Progress: Western Cape

 Western Cape: Paarl, Gugulethu

– Nurses trained
– Lay counsellors used for VCT
– Follow-up mechanisms in place
– Monitoring and evaluation mechanisms established
– Community information session
 Western Cape: Paarl
 Paarl booked 454 women, 432 (95%)
accepted HIV test
- 7% tested positive and all were counselled
- 8 women delivered live babies
- All mothers and babies received NVP
- 7 babies started formula feed and 1 exclusive
breast-feeding
- No problems
 Western Cape: Gugulethu

– Started April 2001

– Gugulethu counselled 437 women, 387 (89%)
accepted the HIV test and 73 (19%) tested
positive and all received NVP
– 17 women delivered alive babies and all babies
received NVP (14 bottle-feed, 3 exclusive
breastfeed)
– No problems