What’s the Problem?

1. Mobilising the Children’s Sector on Prevention of Mother To Child Transmission (PMTCT) Campaign:Saving Mothers, Saving Babies

2. What’s the Problem? AIDS has become one of the leading causes of death amongst mothers and children in South Africa • 20% of maternal deaths [ 1 in 5 deaths of mothers] and 40% of under-five deaths [4 of every 10 children] are as a result of AIDS. • 55% of all HIV-1 positive adults are women of child bearing age. • 1700 women die each year from complications in childbirth and pregnancy – these could have been prevented. “In South Africa, approximately 1,100,000 babies are born every year • Every hour in South Africa 9 children die from causes that could have been prevented or treated with simple treatments • That is 75 000 children every year. • 22 000 of these children are new born’s who die in the within the first month of their lives Many of these deaths could be prevented. Saving mothers means that fewer children will become orphans

3. Understanding the Words MTCT : Mother to Child Transmission of HIV PMTCT : Prevention of Mother To Child Transmission of HIV HIV Prevalence: Total number of people in SA living with HIV at a particular time HIV Incidence: Proportion of the population that is newly infected with HIV within a particular year Intrapartum: At the time of Birth In utero: During pregnancy in the womb ANC : Antenatal Clinic

4. How HIV is transmitted from Mother to Child

5. Risk Factors for Mother-to-child-transmission High viral load in mother Low CD4 count in mother Normal Vaginal delivery Unprotected intercourse with an HIV-infected partner during pregnancy Breastfeeding Sexually Transmitted Infections (STIs)

6. National Antenatal Clinic (ANC) Testing Rate 75% ( 3 out of 4 Women) HIV prevalence rate at ANC 29% ( Almost 1 in 3 Women) Women receiving Nevirapine 61% (6 out of 10 Women) Babies receiving Nevirapine 45% (under half)

7. The New Revised PMTCT Policy2008 ‘Routine offer of VCT’ (Provider Initiated) Voluntary Counselling and Testing Addition of AZT (Dual Therapy) Emphasis on getting CD4 counts on all pregnant women to start ARVs in pregnancy Infant Feeding Options Emphasis on infant diagnosis at 6 weeks

8. PMTCT Programme2008 ART - Women who need ARVs – get put onto this ASAP (CD4 count less than 200) FOR WOMEN WITH CD4 COUNTS > 200 Need PMTCT treatment (regimen) Mother - AZT during pregnancy from 28 weeks gestation (7 months) + single tablet Nevirapine in Labour Baby – Single dose Nevirapine + AZT for 7 days (and in some cases upto 28 days) Able to reduce MTCT to 5% with new policy !

9. Mother to Child Transmission One out of four babies (25%) born to all HIV positive mothers will acquire HIV from their mother ( if no intervention is offered ) That means at least 75% of babies are uninfected at birth!

10. PMTCT RATES HIV Infected Women – What risk of having an HIV-infected child ? 95 % HIV Negative Babies ! 75 % HIV Negative Babies 1 in 4 HIV Infected Babies Where no intervention Old policy Sd NVP 1 in 10 Infected 1 in 20 Infected New policy AZT + Sd NVP

11. What are we aiming for ? 95 % HIV Negative Babies 5% Infected

12. Reduce number of infected Women Early Identification Of Sick Women Reduce number of infected Children PMTCT 95% HIV negatives Reduce hospitalization & death in HIV infected Women +ves Early Identification Of all infected infants Reduce hospitalization & death in HIV infected Children Early initiation of ARVs in infants

14. PMTCT is an opportunity to save the lives of mothers and not only babies !

15. NSP Goals KEY Priority Area 1 – PREVENTION Reduce the rate of new infections by 50% by 2011 • Section 3 of the Key Priority area 1 • 3.1 Broaden existing mother to child transmission services to include other related services and target groups • 3.2 Scale up coverage and improve quality of PMTCT to reduce MTCT to less than 5%”

16. Accelerated PMTCT Plan Call by the Minister of Health in 2008 to improve maternal and child outcomes: • Reduce MTCT • Reduce maternal and child mortality APPROACH • Focus is on a Primary Care approach • Unique plan - has a social mobilization component. • Strategic Direction from the NSP 2007-2011 • Plan presented to SANAC Programme Implementation Committee (PIC) and approved • TARGET 18 priority districts in SA

17. Meeting the Challenges for INFANTS • Need to ensure that ALL HIV exposed infants reap the benefits of an enhanced PMTCT programme, which would include-: • Abandoned infants (upto 50% have been noted to have had HIV exposure) • Infants whose mothers are indisposed – death, coma, serious post-partum illness, mental confusion • Infants whose mothers refuse testing • Infants whose mothers refuse any intervention despite knowing their status

18. What is CATCH proposing that we do to make a difference? LEARN about PMTCT INFORM others about PMTCT INTEGRATE PMTCT into your work EXTEND Reach – CONNECT HEALTH with Other critical services for children

19. PMTCT +++ Primary HIV prevention women & girls of childbearing age Prevent unintended pregnancies in PLWHA Prevent HIV transmission from a woman or girl living with HIV to her infant Provide appropriate treatment, care and support to women and girls living with HIV and their children and families. • Health Services • PMTCT • ANC • Well Baby and/or Family • Reproductive Health • VCT for general • Testing, Treatment and • management of HIV • TB services • Outreach • Mobile Clinics • Home visiting • CHW • HCBC Care Adults and children individually and collectively Early identification of need Support of infant feeding choices Nutritional support for the mother and infant Detection of postnatal complications (e.g. infection) in the mother and infant Food Household food security Shelter Succession planning Guardianship Identity – Roots & wings Identity Birth certificates IDs for carers Family and own life story Dreams Family, friends and community connections Specialised Support psychosocial care and support Early detection and support for disabilities Mental Health Crisis support Displaced people Prevention and intervention in violence, abuse, neglect or exploitation including trafficking Social & Development Services Grants: SROD, CSG, CDG, Disability Grant Income generating & skills development Ensure and monitor family or alternative care Human Rights and Legal Services Inheritance rights Preventing and addressing stigma and discrimination Legal advice and representation

20. What can we do as Civil Society Organisations – both Child-focussed and Community-based At our work places – help staff keep healthy and well and seek treatment early Promote employment policies and practices organisational practices staff development/wellness programmes As service providers – integrate PMTCT into Our programmes in initiatives supported in the community When we are sub-contracted by govt to implement programmes As social influence for change in community dialogues and networks, social mobilisation activities May be working with >1 dept and able to support integration In Communities Child care forums and related ECD/ Child care facilities and services Support groups and support services Education institutions Social structures such as FBOs, income related IDP

21. Summary HIV is the leading cause of death in babies and children and one of the causes of maternal deaths There is an effective way to reduce MTCT Govts PMTCT Plan is a good one – It needs Support from all. We can play our part in reducing transmission We can save mothers and babies – NEED to ACT NOW

22. References SA National DOH PMTCT Policy (2008) District Health Barometer (HST 2006/7) Every Death Counts Report Dr Ashraf Covadia, ECHO, Wits University