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PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers

PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers. June 19, 2012 Johannesburg, South Africa. m 2 m Goals. Reduction in early and late transmission of HIV Reduction in maternal mortality associated with HIV Improved RMNCH Empowerment of women

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PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers

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  1. PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers June 19, 2012 Johannesburg, South Africa

  2. m2m Goals • Reduction in early and late transmission of HIV • Reduction in maternal mortality associated with HIV • Improved RMNCH • Empowerment of women • Reduction in stigma associated with HIV

  3. m2m Overview • Operating for over 10 years • Trains and employs women living with HIV from local communities to provide PMTCT peer education and support • Serves pregnant women, new mothers & their male partners • Employed more than 4,000 Mentor Mothers since m2m’s founding • Employs 1519 staff, in 609 health facilities in 7countries

  4. Key findings from m2m 2010 and 2011 client cohorts

  5. Gestational age at 1st visit by country: most women present late for care n=3474 n=751 n=983 n=10435 n=1624 n=308 n=669 N=18244

  6. Uptake of any ARV during pregnancy, by country, 2010 and 2011 Cohorts *53% Uptake in Low to Middle income countries 2010: n= 1313 n=991 n= 2059 n=4217 n=898 2011: n=771 n=724 n=3568 n=11123 n=1765 * UNICEF. (2011). Children and AIDS: Fifth stocktaking Report, 2010. Geneva: UNICEF, UNAIDS, WHO & UNFPA.

  7. m2m clients receiving more psychosocial support report higher uptake of ARV during pregnancy m2m Kenya* m2m Lesotho** n-=781 n=499 n=871 n-=164 n=127 n=242 *X2 =399.09, p<.001 **X2 =71.33, p<.001

  8. Coefficients and odds ratio from logistic regression of uptake of any antenatal ARV amongst m2m clients in 2011

  9. High Disclosure rates amongst clients receiving psychosocial support in 2010 and 2011 Cohorts 2010: n= 1133 n= 2366 n= 4069 n= 4947 n=2573 n=15088 2011: n=1579 n=1250 n=5763 n=17200 n=4225 n=32120

  10. *Uptake of PCR testing amongst m2m clients higher amongst those enrolled earlier in psychosocial support… m2m client type overall pattern… m2m Country differentials… n=12842 n=7200 *Fishers exact test for differences within countries, p<.001

  11. *Infant PCR test positivity is lower amongst m2m clients enrolled earlier in psychosocial support… *Fishers exact test for differences between clients enrolled during pregnancy vs. enrolled post delivery p<.001

  12. Discussion • m2m evidence shows that retention in psychosocial care improves outcomes • “Dose response” importance of psychosocial visits=health facility dose • Disclosure key to uptake and adherence of services • Earlier enrolment and follow through in psychosocial services improve outcomes • Challenges • Late presentation of women for antenatal care • Implications for retention and initiation in care • Retention is challenging given inter-health facility movements in health systems

  13. Demand Creation and Retention m2m services: • integrated in facilities, promote referrals • generate demand for PMTCT services, treatment, and care to keep mothers alive • stigma reduction diminishes demand-side barriers to ARV uptake

  14. Retention Initiatives Let’s SOAR (Strengthening Outcomes by Analyzing Results): enables site staff to understand data/improve program Active Client Follow Up (ACFU): active client follow-up improves client retention in PMTCT cascade through phone calls, SMSes, and/or home visits

  15. HOW we ‘SOAR’ 1) Daily site-level data collection 2) Quarterly data review and action planning 3) Improve client health!

  16. Thank you! m2m Program Department

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