Effective Monitoring for HIV Prevention: Re-testing HIV-Negative Pregnant Clients

Presenter: Phylis Mutiso, mothers2mothers NOPE Conference, Nairobi

June 2014

Presentation Outline

• Introduction– About m2m– KMMP services

• Mentor Mother M/E tools• Methods • Lessons learnt

Background mothers2mothers (m2m)

• Provide Peer Education (PE) and Psychosocial support (PSS) to HIV positive pregnant women and new mothers to promote PMTCT

Background• m2m directly implements this model at 30

high volume health facilities under umbrella of MOH Kenya Mentor Mother Program (KMMP)

• The KMMP seeks to improve PMTCT uptake and retention by integrating mothers living with HIV into health facilities to provide PE & PSS to their peers as Mentor Mothers (MMs)

Background

• MMs are competitively recruited and undergo a two-week national KMMP curriculum-based Pre-Service Training(PST)

• PST prepares them to provide quality services to clients through task shifting approach

KMMP Services

• one-on-one/couple PE and PSS

• support groups • defaulter tracing

• internal referrals and linkages

• services are captured in appropriate KMMP M&E tools

KMMP Monitoring & Evaluation ToolsLongitudinal records

HIV+ logbook tracks HIV + mother-baby pairs from pregnancy to 18 months post-partum

HIV- logbook tracks HIV- women through pregnancy for retesting at three months

Context

• PMTCT national guidelines recommend re-test of HIV pregnant clients after three months

• Roll out of re-testing has been slow across the country

• Monitoring of client uptake and outcomes of re-testing remains a challenge

Description

• MMs provide services through interaction with HIV positive pregnant clients & new mothers

• They provide 2 part-focused interaction (first visit and return visit for re-testing) with HIV negative to motivate them to return for re-testing and influence their male partners to come in for testing at the health facility

Description

• Client details are recorded in an HIV negative longitudinal register which is updated when clients return for services

• Client return date is booked in a calendar diary

• Diaries are reviewed daily to identify clients due for re-testing who have missed appointments

• The defaulter tracing process is started the next day

Description• MMs conduct telephonic defaulter

tracing• Depending on client consent, it starts

with an SMS• If a client does not respond to the sms

a telephone call is made• MMs develop list of clients for home

visiting by CHWs through the CHEW

Lessons Learned

Lessons Learnt

• Re-testing remains a challenge• Most clients come late in pregnancy• Re-testing uptake lower in Western

Kenya than in Nairobi• Sero-conversion is higher in Western-

(Nyanza where prevalence is at 15.1% KAIS 2012)

Lessons Learnt

• Data from 30 health facilities from Jan to Dec indicates that only 23% of HIV negative clients returned for re- testing (7,816 out of 34,103)

• 1 % (89 out 7816) sero converted during pregnancy and tested HIV positive, standing a high chance of infecting their infants

Conclusion

• Effective program monitoring is an essential part of PMTCT programming

– To ensure available services are being utilized

– To link high risk clients to care as quickly as possible

Conclusion

• Monitoring for re-testing should include post natal period

• Re-testing must be integrated in to health system monitoring