PMTCT

Experiences from Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda

This report documents several promising practices focused on community engagement for PMTCT implemented under the Optimizing HIV Treatment Access for Pregnant and Breastfeeding Women (OHTA) Initiative. OHTA, a UNICEF-supported initiative with funding from the Governments of Norway and Sweden, aimed to accelerate access to Option B+ for the elimination of mother-to-child transmission in Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda.

In an effort to strengthen cross-country learning about effective community engagement activities and inform future PMTCT programming, this report includes implementation details, outcomes, factors for success, and considerations for scale-up and sustainability based on the OHTA Initiative’s experiences. The information and data included in this report were collected by project staff in partnership with the Johns Hopkins Center for Communication Programs (CCP) through a desk review of existing OHTA Initiative documents, including annual reports, partner reports, and presentations. CCP and project staff also made site visits to each country to conduct interviews and focus group discussions with the implementing organisations, programme participants, and Ministries of Health (MOHs).

Five promising practices for the elimination of mother-to-child transmission were identified based on the collective experiences in all four countries: male engagement, community client tracing, Community Mentor Mothers, Health Advisory Committees (HACs), and rationalization of implementing partners and services. This report first provides an overview of the HIV/AIDS epidemic in the four countries supported by the OHTA Initiative and of the five promising practices as implemented under the OHTA Initiative. It then follows with a detailed description of each promising practice, including similarities and differences with implementation in each country, outcomes of the promising practice, factors for success, and essential programme elements. Download the country reports of the promising practices here. 

Urgent and ambitious 2020 global targets are on the horizon, yet there has been insufficient progress in paediatric and adolescent HIV to date. Scaling up HIV services for all children and adolescents is needed, in alignment with the UNAIDS super-fast-track framework. It’s time to make sure that nobody is left behind.

This series of 12 policy briefs by the Child Survival Working Group (CSWG) looks at scaling up key interventions for children and adolescents living with HIV. They present evidence, policy and monitoring considerations, implementation guidance and tools necessary to scale up 12 key interventions which have proven successful in identifying, linking and supporting children and adolescents to access and remain in quality care and treatment.

They are designed for program managers in government and civil society programs, particularly at country-level, and provide practical information and direction.

Learn more in the Foreword and download the briefs below. 

• Addressing the service delivery needs of children of key populations

• Strategies to improve retention of mother-baby pairs in PMTCT programs

• A child-centred approach for HIV programs

• Providing differentiated service delivery to children and adolescents

• Point-of-care testing as a solution for timely early infant diagnosis

• Complementary and connected: Engaging community and faith-based organizations to deliver PMTCT and pediatric HIV services

• Sensitizing health workers to providing responsive care for adolescents and young people living with HIV

• Family-based index case testing to identify children with HIV

• Meaningful engagement of adolescents and young people in national and local HIV programming

• Scaling up optimal antiretroviral treatment for children: A long overdue intervention

• Preventing and treating tuberculosis among children living with HIV

• Providing peer support for adolescents and young people living with HIV

To reach global pediatric HIV targets, efforts must extend beyond clinic doors. Community-based organisations (CBOs), faith-based organisations (FBOs) and places of worship can play a pivotal role in accelerating and expanding services. However, for their contribution to be amplified, they must be engaged as integral implementing partners in service delivery and effectively linked to the health system. A systematic approach is required to formally establish and resource these linkages, as well as embed them in district planning and coordination.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more. 

Approximately half of HIV infections among children take place during breastfeeding. While there has been success in retaining pregnant women on antiretroviral therapy (ART) during pregnancy, there has been inadequate focus on retention support to
mother-baby pairs (MBPs) during the breastfeeding period.

Literature shows that the majority of MBPs not retained in prevention of mother-to-child transmission (PMTCT) programs are due to loss to follow-up (LTFU) rather than death. These children are at higher risk of vertical acquisition of HIV compared to breastfeeding infants who remain in care. Current postpartum LTFU rates limit successful implementation of PMTCT programs in sub-Saharan Africa. Cumulative sub-Saharan Africa PMTCT LTFU rates in 2011 were estimated to range from 20-28% during antenatal care, then sharply increase to 70% at four months postpartum and reach approximately 81% six months after birth.

Given these staggering statistics, the quality and effectiveness of PMTCT services should include an assessment of the proportion of MBPs retained in care and early infant diagnosis (EID) rates.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

This publication shares the perspectives of women from all over the world, including policymakers and researchers, doctors and campaigners who are helping lead the HIV response for women and children. Their testimonies illuminate and personalize the data and the narrative in the rest of the report.