Realizing a Continuum of Care in Elimination of

Mother to Child Transmission of HIV

During the quarter January –March 2013, 889 pregnant

and lactating mothers were receiving Antiretroviral

therapy (ART) as an option B plus intervention at 13

hospitals. Out of the 1018 HIV exposed infants below two

years tested, 61(5.9 percent) were found HIV-infected; and

88 percent of these initiated on ART.

The USAID Strengthening Uganda’s Systems for Treating

AIDS Nationally (SUSTAIN) project supports the

Uganda Ministry of Health (MoH) to ensure delivery of

quality Human Immunodeficiency Virus (HIV)/ Acquired

Immune Deficiency Syndrome (AIDS) prevention, care

and treatment services. SUSTAIN has successfully

worked with 13 public Regional Referral and General

Hospitals to roll out Option B Plus interventions for

elimination of mother to child transmission of HIV.

Objectives

To support scale-up and provision of effective and comprehensive Elimination of Mother Child Trans-

mission of HIV (EMTCT) and Early Infant Diagnosis services in line with Ministry of Health (MoH)

guidelines

To improve the quality, and demonstrate outcomes of quality improvement on EMTCT services

To strengthen linkages between maternal, newborn

and child health services, reproductive health

services and other HIV related services

At the hospitals, healthcare for HIV– infected pregnant and lactating

mothers and HIV exposed infants is most effectively provided through integration with routine maternal, new born and child health (MNCH)

services. Health workers within the MNCH setting also provide HIV/AIDS services.

Service delivery emphasizes a continuum of care approach.

i. A mother receives an HIV test together with other routine antenatal

tests

ii. Health workers offer the following services stepwise;

Psychological support, emphasizing adherence, disclosure, positive

prevention and exposed infant care

Examination of the pregnant mother

Enrolment into HIV care and initiation onto Highly Active Antiretroviral

Therapy (Option B+) for all HIV positive mothers

Enrolment of mother into a family support group (FSG)

Scheduling clinic appointments for ongoing counseling, testing

Provision of early infant diagnosis, post natal and family planning services

The mother is then enrolled into the HIV clinic

3 Years of Improving EMTCT Services—SUSTAIN Impact 2010 2011 2012 2013

Uganda adopted World Health

organization Option A guide-lines for PMTCT and guidelines

for children below two years of age to be enrolled on ART as

soon as they are diagnosed as HIV-infected.

At the start of SUSTAIN

project,;

38 percent of HIV positive pregnant women were

enrolled into HIV care

9.6 percent of the HIV exposed infants tested were HIV positive

25 percent of HIV-

infected children below two years of age were initiated

on ART upon diagnosis.

SUSTAIN supported MOH to roll

out the released WHO guidelines. The approaches used included;

training and mentorship of healthcare workers, provision of

job aids tools and equipment and quality improvement.

By end of December 2011,

54 percent of HIV positive

pregnant women were enrolled into HIV care

8 percent of the HIV

exposed infants tested were HIV positive

57 percent of HIV – infected children below two years of

age were initiated on ART upon diagnosis.

Implementation of Option B

Plus as per the national roll out plan. SUSTAIN

continued training, mentor-ship and QI approaches.

By end of December 2012,

77 percent of HIV positive pregnant women were enrolled

into HIV care

7 percent of the HIV exposed infants tested

were HIV positive

78 percent of HIV –infected children below

two years of age were initiated on ART upon

diagnosis

Continued roll out of Option

B plus to all 16 supported facilities. 294 health workers

were trained and mentored and are fully implementing.

1289 HIV pregnant and lactating mothers have been

initiated on option B plus

87 percent of HIV positive pregnant women

were enrolled into HIV care

5.9 percent of the HIV

exposed infants tested were HIV positive

88 percent of HIV –infected children below

two years of age were initiated on ART upon

diagnosis

Key Interventions

UNIVERSITY RESEARCH CO., LLC www.urc-chs.com

SUSTAIN is funded by the United States Agency for International Development (USAID) and this publication is made possible by the generous support of the American People. SUSTAIN is managed by University Research Co., LLC (URC) in partnership with the AIDS Support Organization (TASO), Integrated Community Based Initiatives (ICOBI), Health Research Inc. (HRI), and Initiatives Inc. For more information, please visit www.sustainuganda.org website or contact Dr. Cordelia Katureebe – Senior Technical Advisor PMTCT (ckatureebe@urc-chs.com)

Above/ Family Support Group (FSG): Members of a support group

attending a meeting at Kawolo Hospital. May 2013

USAID SUSTAIN project key interventions follow the six blocks of

health systems strengthening

—Training and mentorship for service providers: SUSTAIN has trained and mentored health workers to carry out EMTCT

services. Hospitals are now addressing understaffing challenge through use of volunteers and expert clients as a form of task

shifting. —Ensuring un-interrupted delivery of medicines and test kits;

SUSTAIN has strengthened systems in the antenatal and ART clinics to ensure timely and accurate ordering and reporting

—Ownership; We are working with service provider teams to embrace delivery of Option B+ activities country wide. Through

periodic meetings involving hospital management personnel and MNCH teams, implementation of EMTCT activities is tracked

and discussed. —Data Management and Information Systems; SUSTAIN has pro-moted the use of national tools for collection and management

of data, and supported midwives to make accurate and timely reports. In addition, MNCH units are supported to routinely

utilize their data to improve performance

—Service Delivery; Our goal is to have the chronic care

concept introduced in MNCH units. The units are supported to

provide ART, psychological, antenatal, and support group

services, appointments and follow-up to HIV-infected mothers.

The approach is key in promoting retention of mother-baby

pairs in care.

Family Support Groups (FSG) provide a forum for

follow-up of EMTCT services for women, children, couples, adolescents and their families. SUSTAIN’s approach is

having HIV positive mothers receive routine antenatal care, EID services, ARV drug refills, ongoing counseling and attend

the midwife -led FSG meetings.

This approach has promoted ownership by the health

workers and a ‘one stop’ point for mothers to receive

comprehensive HIV services. This will be key in ensuring

sustainability of the family support groups.