PMTCT in Humanitarian Settings:Lessons Learned and Recommendations

ART patient files from a flooded clinic in Mozambique drying in the sun © MSF

Alice Fay*Save the Children

Sarah KarminUNICEF

Gabriel MuneneUNHCR

Heidi Becher Independent Consultant

*a.fay@savethechildren.org.uk

Video

Background

Problem Burden of HIV high in many risk prone, emergency affected and fragile

settings Shortcomings in emergency preparedness Gaps and barriers in addressing HIV and PMTCT in humanitarian

settings (natural disasters, armed conflict /civil disturbance)

Consequences Women and infants lose access to ARVs for PMTCT Initiation, continuation and scaling up of PMTCT programmes is affected

Objectives

1. Synthesize lessons learned and develop recommendations from PMTCT programmes implemented in humanitarian settings

2. Develop a “How to Guide” from lessons learned on ways to implement PMTCT programmes in humanitarian settings.

Methodology

1. Literature review – peer reviewed and grey literature

Search strategy and results- Search terms and time frame: all 4 prongs of PMTCT, reproductive

health & humanitarian contexts between 2003 - 2014 - Sources: Pubmed and Popline, agency websites and unpublished

documents shared by agencies

Documents included- Related to PMTCT or ART in humanitarian settings

2. Key informant interviews

58 semi-structured telephone interviews- Humanitarian and development NGOs- UN agencies- Organisations of people living with HIV - Donor agencies

Focus on 3 levels

• Preparedness

• Service Delivery

• Individual level

Preparedness

Preparedness and contingency planning mitigate the impact of a shock on PMTCT programmes

Develop a contingency plan- Analyse how regular programmes could be affected by an emergency- Prepare to minimise the risk of disruption of access to PMTCT treatment- Task shifting, task sharing, buffer stockEx: pre- seasonal flooding, signs for increased risks of violence

Absence of contingency planning can lead to treatment interruptions with risk of treatment failure and ART resistance- CAR 2013/2014 complex emergency

- Mozambique 2013 floods, Gaza province: 50% estimated ART interruption in Chokwe district

Service delivery

Facility-based services Pre-position buffer stocks; use NGO buffer stock Redistribute drugs in case of localised shortage Access ARVs for temporary health facilities from the

national system (Re)-open PMTCT/ARV providing services as soon as

possible Integrate ARV dispensing in camp health facilities

Mobile and community services Mobile outreach teams and mobile clinics for ARV

dispensing Home dispensing at pre-arranged meeting points Dispensing ARV through other patients Facilitate transport Integrate patient education into community programming

Individual

Patient education Physical tracing Patient networks House to house and community information

campaign Information at camp registration point Radio, TV messages Public messaging during mobile clinics,

immunisation campaign, food distribution, etc. Mobile phone tracing

Consider: context, size of cohort, available and most efficient means of communication

Combined methods seem to reach best coverage.

Context-specific priority setting

Impact of shock Preparedness Alternative service delivery method

ü  Transport routes for drug supply impassable

ü  Facility becomes

inaccessible (flooded, looted, etc.)

ü  Patients access to health

facility impossible ü  Patients flee to other areas

ü  Order buffer stock in advance

ü  Secure drugs and patient

registers in flood safe location (.e.g. 2nd floor)

ü  Provide extra supply of

ARVs to patients in advance ü  Provide patient passports

& inform patients about alternative treatment sites in advance

ü  Set up temporary health facilities in accommodation sites affected population

ü  Supply temporary health

centres with all commodities needed from district buffer stock

Recommendations

Integrate preparedness and contingency planning into regular PMTCT/ART programming and include PMTCT/ART in general national disaster preparedness plans

Ensure drug and commodities supply in humanitarian settings

Take leadership and support coordination to assure that PMTCT/ART is included in emergency response from the very start in generalised HIV epidemics

Make rapid funding available for PMTCT/ART response in humanitarian emergencies

Organise and adapt service delivery for rapid response in humanitarian settings

Adapt monitoring system for patient cohorts in humanitarian settings

Thank you