PMTCT

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PMTCT

• Kenya National Program
• Experiences, Challenges, Lessons emerging
• W. Mutsotso, MPH
• RAP- 12/13 Dec 2005.

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Overview

• Back ground information- Kenya National PMTCT
  program
• PMTCT practice in ANC and Maternity settings-
  The up-scaling, progress, challenges
• Towards providing a more comprehensive package of
  PMTCT- A conceptual framework

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Kenya National PMTCT Program

• In 2000 , Government recommended use of
  Nevirapine for PMTCT
• 2000- Pilot sites set up for PMTCT
• In 2002, developed guidelines for PMTCT programs
• 2003- Developed National PMTCT Strategic plan
  (2003-2007)
• 2004- National PMTCT curriculum for service
  providers adopted

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Mission Statement

• Prevent transmission of HIV from mother to child
  and improve the health of mothers and their
  families by providing integrated, quality,
  accessible, cost effective services through
  technical support, resource mobilization and
  effective coordination.
• Source National PMTCT Strategic Management Plan
  2003-2007

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National PMTCT Program Goals

• 80 ANC women to have access to PMTCT services
• 80 uptake HIV counseling and testing
• 80 uptake of prophylactic ARV
• 50 infant HIV infections averted by 2010
• Source National PMTCT Strategic Management Plan
  2003-2007

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PMTCT Core interventions

• Routine ANC and Maternity HIV testing
• ARV Prophylaxis Standard minimum package
• - SD Nevirapine, or
• - Combination ARV (AZT)-Limited
• settings
• Expanded package
• -HAART where feasible and women meet national
  eligibility criteria.
• Infant feeding counseling

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Uptake of Testing by Testing Strategy KDH
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PMTCT National Scale Up
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PROPORTION OF ANC WOMEN REACHED WITH PMTCT
SERVICES
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PROPORTION OF ANC WOMEN REACHED WITH PMTCT
SERVICES
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National PMTCT Maternal ARV Prophylaxis coverage
Infant Nevirapine coverage 2005 56
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PMTCT services in Maternity settings

• HIV CT has shown to be feasible in Kenyatta
  National Hospital- increased opportunity for
  averting infant HIV infections.
• Over 90 women admitted in the maternity with
  unknown HIV status accepted HIV C T and
  appropriate interventions.
• Source Ongech John et.al A multi pronged
  approach to improve program effectiveness in KNH
  2004.( Poster)

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PMTCT services in Maternity settings-District
Hospital.

• Overall 50 women delivering in district
  hospitals do not know HIV status
• Presents missed opportunities.

Data from 9 facilities
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Factors contributing to program expansion

• National coordination and supervisory framework
  provided by MOH organs (NASCOP and DRH )
• A strong national PMTCT TWG (advisory)
• Use of national standardized data collection
  tools and PMTCT curriculum.
• The national program is a partnership between the
  MoH and implementing partners
• Integration of PMTCT services into existing MCH
  services

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Moving the program Forward

• What strategies will ensure that all HIV
  mothers identified through the PMTCT program
  receive appropriate care and follow up?
• At the health facility level, where will these
  mothers receive the care?
• Given the rapid expansion and growth of ARV
  clinics, what linkage will ensure continuity of
  care for the HIV mothers and the HIV exposed
  infants?
• What about the care and follow up of infants?

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PMTCT services in MCH- A conceptual Framework
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PMTCT services in MCH-postnatal/Child clinic

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Key lessons-Emerging issues

• Providing care and follow up at ARV clinic
  associated with low uptake of services.
• Providing care and follow up at MCH settings
  provides better linkages for follow up of both
  HIV mother and HIV exposed infant.
• High cost of lab tests prohibitive to many-affect
  quality of care.
• Physical infrastructure in most facilities
  inadequate
• Inadequate Supplies-ARVs
• Infant feeding -concern

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Thank you!!