PREVENTION OF VERTICAL TRANSMISSION OF HIV:

THE FAMILY CENTRED AND COMMUNITY BASED APPROACH IN

PERI-URBAN ZAMBIA

Presented by Beatrice CholaExecutive DirectorBwafwano Integrated Services OrganizationGeorgetown Conference Centre, Washington DC, USA

SITUATIONAL ANALYSIS

HIV and AIDS continue to be one of the major health concerns impeding Zambia’s development aspirations

Currently, 14.3% of Zambia’s adult population aged between 15-49 are living with HIV (ZDHS-2007)

16.1% of women in the same age group are known to be living with HIV in Zambia (ZDHS-2007)

Vertical transmission of HIV accounts among the five key drivers of the transmission of HIV in Zambia

BACKGROUND

Established in 1996 due to increasing number of deaths due to HIV and TB in Chazanga

There was no clinic in the catchment area

Bwafwano established a community health clinic as an entry point for health services

Worked with community leaders to identify community volunteers to be trained as home-based caregivers

Linked the home-based care to the community clinic

PARTNERSHIP WITH THE COMMUNITYBuilt a strong partnership with the community through involvement in theplanning, implementation, monitoring and evaluation of programs

As a result this has built strong ownership of the programs leading to sustainability of the programs HIV+ mothers with their babies attending a

health education session at Bwafwano Community Clinic

- HIV prevention

- Treatment

- Care and support

- Maternal and child health

- Social support to meet the needs of mothers and children

FOCUS OF BISO PROGRAMS

Child born of HIV+ mother being weighed during a Growth Monitoring Clinic Session at Bwafwano Community Clinic by a growth monitor.

PMTCT PROGRAM

Bwafwano started PMTCT in 2008

The main part of the program are:

Client identification

Clinical services

Community-based support

CLIENT IDENTIFICATION

The success of the program to prevent vertical transmission of HIV hugely lies on the identification of clients.

HIV+ mothers are identified through community-based strategies, such as: Community Volunteers who conduct Home-Based

Counseling and Testing (HCT) Inclusion of men in home-based care as providers to

improve male involvement Formation of Male Support Groups Safe Motherhood Action Groups (SMAGs)

CLIENT IDENTIFICATION

Clients are also identified through the community clinic in: Integrated Management of Childhood Illness Clinic

Maternal and Child Health Outpatient clinic ART clinic

CLINICAL FACILITY

Pre-natal Care Monitoring CD4 count Treatment Plan General examination of the patient Monitoring Pregnancy Treating opportunistic infections Referral for obstetric care (when

necessary) Health Talks

CLINICAL FACILITY

Post-natal Care Maternal health and family planning

services Physical examination of newborn Growth monitoring and immunization of

the child Sensitization on importance of PCR PCR for early infant diagnosis Pediatric ART Infant feeding options, e.g. breastfeeding

for six months

CLINICAL FACILITY

Good quality care by monitoring patients through the community laboratory

Laboratory testing includes: TB diagnosis Malaria HB STI Full blood count Hematology analyzer Chemistry analyzer

COMMUNITY-BASED SERVICES

Enrolment in the Community Home Based Care Program

Home visitations Treatment adherence Addressing stigma and discrimination Counseling and testing of family members Disclosure of status Follow-up of lost patients

Mother Support Groups as peer educators

COMMUNITY-BASED CARE

Health talks, including nutrition and cooking demonstration using locally

available foods Hygiene PCR sensitization

Community outreach

Linkages with other support providers (FBOs, CBOs, government health clinics)

SOCIAL SUPPORT SERVICES

Community Facilitator reaching out to women during one on one outreach

Income Generation Skills Training for HIV+ mothers

• Business skills training

• Savings and loan• Skills training,

(tailoring, bead-making)

SOCIAL SUPPORT SERVICES

Support and services for children includes:

Early childhood development program Community school Integrated into government schools

Nutrition Support – school feeding program

SOCIAL SUPPORT SERVICES

Psychosocial Support Counseling Spiritual Recreation

Shelter provision Child Protection Services Skills training for youth

RESULTS

Increase in women enrolled in PMTCT 1,032 women enrolled in PMTCT 232 on ART 800 have their CD4 count monitored

Low defaulter rate

RESULTS

Low HIV infection rates among children born of HIV+ mothers

Reduction in child mortality rate 2000 to 2007 – ART only - 209

deaths 2008 to 2012 – PMTCT included - 26

deaths

Currently 94 children enrolled in pediatric ART

BEST PRACTICES

Involvement of Community Leaders and Community Volunteers in client identification and follow-up

Family-based approach model which ensures men involvement in PMTCT, maternal, neonatal and child health issues

Women enrolled in PMTCT have access to ART,, family planning services, and ongoing support through home-based care

BEST PRACTICES

Integrated model of service provision (One Stop Shop) allows clients to receive all services from one facility without being referred elsewhere

Partnerships with other support programs, such as with Habitat for Humanity Zambia widens the range of support to overcome social challenges

Specific program of support focused on the needs of the infant and child

Stigma and discrimination addressed early in the support groups and community outreach

CHALLENGES

Increasing male Involvement

Limited alternative infant feeding options

Inadequate financial resources and clinical human resources to provide medical care

An HIV+ woman receiving micro-nutrients for her twin children

THANK YOU