Prevention of MothertoChild Transmission of HIVAIDS in Ethiopia

1
The Hareg Project

• Prevention of Mother-to-Child Transmission of
  HIV/AIDS in Ethiopia

2
Hareg Project Partners

• USAID
• CDC
• UNICEF
• Ministry of Health
• HIV/AIDS Prevention and Control Office (HAPCO)
• Regional Health Bureaus
• Regional HAPCO
• Regional Teams

• Implementing agencies
• PRIME II (IntraHealth, Save and ACNM)
• JHPIEGO
• JHU/CCP
• Save the Children/US
• LINKAGES
• UNICEF
• MSH/RPM
• I-TECH

3
HIV/AIDS Overwhelming Ethiopia

• Total population 70.7 million
• Living with HIV/AIDS 3 million Adults 15-49 2
  millionChildren 230,000
  
• Overall prevalence 6.6Urban 13.7Rural
  3.7
  
• AIDS orphans 1.2 million
• Life expectancy Fallen to 45 years
• Hospital beds 50 to AIDS patients

4
HIV/AIDS Infection in Ethiopia

• 91 of infections in adults 15-49 years
• 21.1 prevalence in women 15-24 years
• As high as 25 prevalence among pregnant women in
  urban areas
  

• 170,000 HIV women give birth each year
• 60,000 of their newborns infected through MTCT

5
PMTCT Barriers
Antenatal Care
22 Skilled
32None
.5 TBA
77None
67 Skilled
1 TBA
Urban Rural
Birth Place
2 Health facility
32Health facility
68 Home
98 Home
Urban Rural
6
Preventing MTCT
Prevent infection in parents-to-be
Prevent unwanted pregnancies in HIV women
Prevent transmission from HIV mothers to th
eir infants
Care and support for HIV (infected or affected)
7
Hareg Project Scope

• 8 regions
• 12 primary focus areas
• First year pilot sites
• Roll out plan
• 4 additional regions
• Include more health centers
• Scope based on research in Nigat

8
Hareg Project Potential
9
Baseline Assessment

• Topics
• Service delivery
• Site audit
• Staffing/personnel
• Provider performance
• VCT
• Client perspective
• Facility mapping
• Family planning
• TB referral

• Tools
• Site audit
• Provider interview
• Client interview
• Provider observation
• Client flow
• Focus groups
• Community mapping
• PRA

10
Key Strategies

• Community based
• Partnerships developed with systems and service
  delivery
  
• Platform created to expand care, treatment and
  support for HIV/AIDS patients
  

11
Sites of Service Delivery to Stop MTCT
Community / Health Post
Health Center
District
Regional Center
Central Center
12
Teams Working Together
Ethiopian National Framework
Central Medical Centers
RMC
RMC
RMC
Community Mobilization
13
Teams Working Together
Discussion and consensus building
Finding solutions
14
Hareg Major Accomplishments
2003
15
Key Progress from existing sites

• 126 health workers newly trained or retrained in
  PMTCT
  
• 80 pregnant women with at least one ANC visit
  who consented to HIV test, received test,
  results, and post-test counseling (Nigat)
  
• 50 HIV pregnant women received complete course
  of ARV prophylaxis to reduce risk of MTCT

16
Short-Term Target

• Nevirapine administration in 6 new regions by
  late January 2004
  
• Focus areas
• Supply system strengthening
• Regional follow-up
• PMTCT site readiness plan
• Joint monitoring and evaluation
• Community readiness
• Policy dialogue

17
Long-Term Target

• National PMTCT coverage
• Impact Indicator
• Number of HIV infections averted by ARV
  prophylaxis
  

18
Challenges

• Opt in/Opt out
• Infant feeding
• Home-based delivery
• NVP within 72 hours
• Confidentiality
• Stigma
• Competing demands with one of worlds highest
  MMRs
  
• Safe motherhood/PMTCT integration
• Universal precautions

19
Goals for September 2004

• PMTCT initiation and expansion
• PMTCT service delivery for 23 new sites and
  strengthening of 4 existing sites
  
• Improved links between facilities and
  communities
  
• System strengthening for service delivery
• Sound HMIS system that generates data for
  monitoring and scale-up

20
Eyes on the Prize Averted infections are the
ultimate goal