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Prevention of Mother to Child Transmission of HIV (PMTCT) in northern Uganda

Prevention of Mother to Child Transmission of HIV (PMTCT) in northern Uganda. Presentation AIDS 2012, XIX International AIDS Conference, Washington DC, USA Dr Lawrence Ojom and Ketty Opoka. In 1984 AVSI started working in Uganda in the health sector and home based care for persons with AIDS

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Prevention of Mother to Child Transmission of HIV (PMTCT) in northern Uganda

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  1. Prevention of Mother to Child Transmission of HIV (PMTCT) in northern Uganda Presentation AIDS 2012, XIX International AIDS Conference, Washington DC, USA Dr Lawrence Ojom and Ketty Opoka

  2. In 1984 AVSI started working in Uganda in the health sector and home based care for persons with AIDS In 2002 the AVSI PMTCT program started, supporting the government’s program initiated in 2001 In 2011 the PMTCT program covered 24 health facilities AVSI Uganda

  3. Northern Uganda • 22 years of conflict between Lord’s Resistance Army (LRA) and the Government of Uganda • Estimated 66,000 children/youth were abducted during the conflict • Approximately 10,000 killed, thousands more mutilated during the conflict • Relative stability has allowed most people to return to their villages of origin

  4. Northern Uganda • 24 health facilities received PMTCT activities from AVSI in collaboration with the Ministry of Health in northern Uganda throughout and after the conflict

  5. Centrality of the Person: the mother, father, child, and family Starting From the Positive: which strengths does this person have, what are the opportunities in our setting Partnership: working with the ministry, district offices, hospitals, health centers and community based organizations in the region Development of Intermediate Bodies and Subsidiarity: build capacity in partners and create networks Doing with: work together, hand in hand, not alone, following a bottom up rather than top down process. AVSI’s method in PMTCT

  6. Community sensitization Staff support and capacity building ANC and PMTCT services at health facilities Provision of medical equipment and supplies Logistic and administrative support Nutritional education and support Follow up and home based care Family Support Groups Data management Coordination, monitoring and evaluation AVSI PMTCT Program Activities

  7. Indicators PMTCT activities T

  8. In total 136,300 women attended Ante Natal Care services from 2002 – 2011. Increase in attendance of women till 2007, then a decrease due to population returning • Partner involvement increased drastically over the years from 296 in 2002 to 10,723 in 2011. In 2011 73.6% of the women attended ANC with their partner.

  9. Male involvement • Partner involvement increased drastically over the years from 5.9% in 2002 to 73.6% in 2011, supporting the family to have children born FREE from HIV • Nationally male testing only reached 12.3% in 2009/10 (PMTCT annual report, Ministry of Health)

  10. Mothers waiting for ANC services

  11. Acceptance for testing was 93.9% for women and 99.5% for attending men in the AVSI PMTCT sites. • The HIV prevalence over the 10 years is 6.4% for women, and 8.5% for partners. The national prevalence (UAIS 2011) is 7.3%, and 8.3% in the north.

  12. Women with their partners at the ANC

  13. Of the women who were tested positive (8,030) in AVSI PMTCT sites in total 6,033 were started on prophylaxis for PTMCT, while 697 were started on ART (triple therapy). • ART became freely available in Uganda in 2004, however stocks of sufficient supplies in remote conflict affected areas such as northern Uganda delayed till 2006. In 2011 the ART uptake increased to 30%, similar to the national proportion of HIV positive pregnant women receiving ART.

  14. In total 65,735 of the 136,300 ANC women over the 10 years delivered in a health facility (48.2%). Of the women who delivered in a health facility, 4,605 were HIV positive (7.0%). • The reduction in deliveries in health facilities in 2007 can be attributed to women moving back to their villages of origin, away from the internally displaced camps, and thereby often further away from health services.

  15. If an HIV+ pregnant woman does not receive prophylaxis, the chances she delivers an HIV+ baby are 1 out of 3. • Over the years only 6.8% of the babies of HIV positive mothers who received PMTCT services were tested positive. • The variation in prevalence can be attributed to the small number of children tested, especially in the early years (no data available for 2002 and 2003)

  16. Elimination of Mother of Child Transmission of HIV (EMTCT) • Between 2004 and 2011, the HIV prevalence in PMTCT infants declined significantly from 10.3% to 5.0% • The government target of virtual elimination of < 5% of MTCT by 2015 was achieved in the AVSI supported sites.

  17. From replacement feeding to breastfeeding using prophylaxis Feeding practices

  18. Infant and Young Child Feeding (IYCF) - food demonstration using local foods - nutrition education about good feeding practices

  19. Family support groups have been created to support families. They started at community level with drama groups in 2004, and evolved into support groups of mothers and their partners over the years. The groups are facilitated by AVSI, Meeting Point, and health workers and provide education, information sharing, psychosocial, and economic support Family Support Groups

  20. Meeting Point Kitgum is a community based organization which started operating in Kitgum in 1990 AVSI and Meeting Point started their partnership in 1991 Provided home based care, educational and psychosocial support to persons living with HIV/AIDS (PLWHA), when no treatment was available. Facilitates follow up of mothers and children in collaboration with Health facilities in their activities. Meeting Point supports approximately 260 AVSI PMTCT mothers per year in Kitgum district. Meeting Point Kitgum

  21. Meeting Point Kitgum PMTCT in communities Community Dialogue Music and drama Sharing experiences

  22. Home visits by Meeting Point staff

  23. Counseling Health education: ANC attendance, adherence, delivery Promote Breastfeeding and Infant and Young Child Feeding Medical care and referral Male and family involvement Reducing stigma Provision of home based care kits

  24. Lessons learned • Collaboration with the government, districts, community organizations • Community involvement, peer education through men and community groups, Village Health Teams, and family support groups contributed to high ANC attendance, acceptance of PMTCT uptake, and male involvement and children being born FREE from HIV

  25. Research collaboration with Makerere University John Hopkins University & University of San Francisco California on primary prevention of HIV in pregnant women Continue on job mentoring and health system strengthening through UNICEF supported ALIVE program in the 7 Acholi districts Continue lobbying for funding for EMTCT and pediatric HIV/AIDS programs for 2012 and consecutive years to support the GoU program Include HIV/AIDS as a cross-cutting component in all programs (health, education, livelihoods, protection, disability) Plans for EMTCT activities in AVSI Uganda

  26. AVSI calls for continued support and collaboration for EMTCT from the Government of Uganda, the US Government, PEPFAR/USAID, UNICEF, and other donorsApwoyo MatekThank youGrazie mille

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