Prevention of MothertoChild Transmission of HIV: Scaleup of Critical Services in Uganda Districtbase

1
Prevention of Mother-to-Child Transmission of
HIV Scale-up of Critical Services in Uganda
(District-based Approach)

• Edward Bitarakwate, MD, MPH
• Technical Director
• EGPAF Uganda

2
National Context

• About 2 million people infected 1 million have
  died 1 million are living with the infection.
• Six percent of Ugandan adults aged 15-49 are
  infected with HIV and prevalence among women is
  higher (8 percent, PMTCT now 6) than among men
  (5 percent)

3
National Context

• 1.2 million pregnancies occur annually in Uganda,
  without intervention, about 30 of HIV positive
  pregnant women transmit the virus to their babies
  which translates into up to 23,400 new HIV
  infections resulting from vertical transmission
  (MTCT)
• About 120,000 people on HAART, 10,000 of whom are
  children

4
EGPAF International Family AIDS Initiatives

• The EGPAF program in Uganda started in 2000 after
  results of the HIVNET 012 trial.
• Using private funds EGPAF Uganda embarked on the
  design, development, management, monitoring and
  technical support of the Uganda Ministry of
  Health PMTCT program.
• Since 2003 USAID (PEPFAR) has supported the
  Uganda EGPAF program. This support enabled the
  strengthening of the Foundations role as a key
  organization working with the MOH.
• EGPAF works closely with other partners in Uganda
  to coordinate PMTCT C/T expansion in Uganda.

5
Background

• EGPAF strategy in Uganda has been to complement
  Uganda Ministry of Health and private partners to
  cover human resource, infrastructure and
  commodity gaps in health districts
• EGPAF Uganda helps with the design, development,
  management, monitoring and technical support of
  the Uganda Ministry of Health PMTCT program

6
EGPAF Uganda Program
7
EGPAF Uganda Program

• Geographical coverage 27 districts (Total 86)
  stretching from western to eastern borders of the
  country
• PMTCT services at 350 (MOH Total 507) sites
  ranging from regional and district hospitals to
  health centers at sub county level
• Integrated affordable, family-based quality
  HIV/AIDS care and ART services at 15 health care
  facilities  

8
Objectives of District-Based Support

• To build district capacity in HIV counseling,
  testing and provision of other HIV/AIDS services.
  
• To implement comprehensive PMTCT services. PMTCT
  functions as a key entry point for families into
  longitudinal HIV/AIDS care and treatment.
• To integrate the PMTCT program into Maternal
  Child Health services and into other district
  health services including community programs like
  VCT and Home Based Care
• To generate sustainable capacity for district led
  program scale up

9
Design Development

• MOH assigns districts to be supported
• Participatory proposal development process-based
  on national guidelines
• Sub grant development process
• - pre-award assessment
• - integration with district health budget
• District stakeholders meeting civil society,
  technical, political/community leaders

10
Systems Support

• Identifying key resource persons from within
  District Health Team to serve as focal person for
  HIV/AIDS program activities
• Foundation TAs embark on a process of mentoring
  these focal persons
• work plan development, integration of all HIV
  programs
• support supervision
• program monitoring
• logistics management
• training, inter-site coordination meetings

11
Technical support

• Sub district program support/coordination teams
  (based at sub district level)
• - support supervision
• - lead CMEs based on performance
  identified knowledge gaps, information updates
  provided by the Foundation
• - training

12
Program Performance

• Over 1,000,000 women have accessed PMTCT services
  in over 350 sites in 27 districts.
• 64,000 HIV mothers have been identified
• 50,000 pregnant mothers have accessed
  Antiretroviral Prophylaxis
• 28,000 babies have accessed Antiretroviral
  Prophylaxis

13
Program Performance
14
Program Performance
15
PMTCT DataApril 1, 2007 March 31, 2008
16
Every Child Deserves A Lifetime
17
Acknowledgements

• International Family AIDS Initiatives Staff
  Uganda, Regional and USA
• Uganda Ministry of Health
• Partner Organizations incl. but not limited to
  JCRC, SCMS, AHF/Uganda Cares
• This presentation was made possible through
  support provided by the Office of HIV/AIDS,
  Global Bureau Center for Population, Health and
  Nutrition, of the United States Agency for
  International Development (USAID), through the
  Presidents Emergency Plan for AIDS Relief
  (PEPFAR), as part of the Elizabeth Glaser
  Pediatric AIDS Foundation's International Family
  AIDS Initiatives (Call To Action Project/
  Cooperative Agreement No. GPH-A-00-02-00011-00).
  The opinions expressed herein are those of the
  authors and do not necessarily reflect the views
  of USAID.