ZIMBABWE’S EFFORTS TO

SCALE UP AND INTEGRATE

COMMUNITY SUPPORT WITH

MEDICAL SERVICES TO END

VERTICAL TRANSMISSION

Dr Angela Mushavi

National PMTCT and Pediatric HIV Care and Treatment Coordinator

Symposium on Closing the Gap: Ending Vertical Transmission Through Community Action

Georgetown Hotel and Conference Center

20/07/2012

Outline of Presentation

Background of Zimbabwe

Community participation in the eMTCT

strategy for Zimbabwe

Village Health Care Workers in eMTCT

ZAPP-UZ Community Mobilisers

MSF support for mentor mothers

Padare’s male involvement strategy

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Zimbabwe

Population 12 million

PLHIV 1.1 million

HIV prevalence in ANC

16,1%

Background of Zimbabwe

90 % ANC attendance-and only 19% in the first trimester (ZDHS 2010/11)

86% of HIV positive pregnant women receive ARVs for PMTCT (2011 data)

65% of live births delivered in a health facility*

Maternal Mortality Ratio (MMR) has increased from 555/100 000 (ZDHS 2005/6) to 960/100 000* 26% of MMR is attributable to HIV/AIDS

21% of the Under 5 Mortality (<5MR) is attributed to HIV/AIDS (MIMS 2009)

Contraceptive prevalence rate is 66%* with unmet need for FP of 13%

*ZDHS 2010/11

Zim’s Commitment to the Global

Plan on eMTCT

Zimbabwe committed to the global goal of eliminating new HIV infections among children by 2015; and keeping their mothers alive

To this end, an eMTCT strategy 2011-2015 was developed; taking into account successes and bottlenecks to implementation of PMTCT under the 2006-2010 strategic plan

Of the 7 strategic objectives in Zim’s eMTCT strategy, objective 6 speaks to strengthening community involvement and participation in eMTCT and Pediatric HIV care and treatment

Bottlenecks to eMTCT that Community

Based Workers Can Best Tackle

Late booking for ANC

Low percentage of pregnant women

presenting for at least 4 ANC visits

Low proportion of institutional deliveries

Low male participation

Low postnatal follow-up rates

N.B. Indeed community based workers can deal

with all of the bottlenecks along the

PMTCT/EID cascade

Zimbabwe’s Village Health

Workers

The History of Village Health Worker Programme

The VHW dates back to 1981, when Ministry of Health and Child Welfare introduced this cadre for the first time at community level

This cadre is selected by her own community, and trained for 8 weeks

Works on assigned duties part time-and stays in her community

The VHW program is national-anticipated to have 15 000 in post

Village Health Worker (VHW) program: an Opportunity in PMTCT implementation

VHWs have become important in tackling HIV

For PMTCT, VHWs encourage Early ANC

booking and repeated ANC attendance

HIV testing

Facility deliveries

Postnatal mother-baby pair follow-up

•Picture: Courtsey of Zvitambo

Village Health Care Workers in

PMTCT

Zvitambo supports VHWs in 2 of the country’s

districts

Elizabeth Glaser Pediatric AIDS Foundation

(EGPAF) is supporting an expanded role for

VHWs to support activities for eMTCT in 8

districts

Early reports are showing that average age at

booking has improved to 21 weeks gestation-

from an average of 25 weeks at booking

ZAPP’s Community Involvement in

the PMTCT Program

ZAPP-UZ was first in Zimbabwe to meaningfully involve community in PMTCT as peer counsellors-known as community mobilisers (CMs)

CMs are men and women who have benefited from the PMTCT program

Recruited in collaboration with the Community Advisory Board in Chitungwiza - link between community and health services

Trained to serve as community advocates; mobilizing and educating communities on PMTCT, EID and pediatric treatment

ZAPP-UZ Community Mobilizers

Performing Drama at a Church Meeting

MSF support for mentor mothers in

Bulawayo

Modelled along the lines of the M2M program in South Africa

Women living with HIV provide support to other such women during pregnancy and beyond as mother-infant pairs

24 mentor mothers each looking after 15 clients at any given time

Promising results coming out of clinic sites where mentor mothers are operating

RESULTS - PROGRAMMATIC DATA

P value

<0.0005

After testing - did mother obtain result?

P value

<0.0005

Male Partner HIV Testing in ANC in

Zimbabwe

Community initiatives key to

tackling low male participation in

eMTCT An organization called

Padare/Enkundleni/Men’s forum on gender, is

leading an initiative to strengthen the capacity

of traditional leaders (chiefs) to increase male

participation in PMTCT

Given an opportunity, men can be positively

engaged to end vertical transmission

In one such district where the chief is

engaged, male participation in PMTCT has

increased to 70% (with a national average of

10%)

Padare Works Through the

Chiefs

Recommendations

There is no underestimating the role that

communities can play in supporting the goal of

eMTCT

Various initiatives are in place-and all of these

will need to be scaled-up as the country strives

to attain the goal of eliminating new HIV

infections among children and keeping

mothers and children alive

And the discussion now is how to move these

initiatives to cover all districts

Acknowledgements

MOHCW Director Nursing Services

MOHCW PMTCT Program

EGPAF

ZAPP-UZ

Zvitambo

MSF Zimbabwe

UNAIDS

Padare

Thank you

Tatenda

Siyabonga

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