Using Community Health Workers (CHWs) to bridge pMTCT, early infant diagnosis, and pediatric HIV services in three community health centres in Lilongwe, Malawi.

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Using Community Health Workers (CHWs) to bridge
pMTCT, early infant diagnosis, and pediatric HIV
services in three community health centres in
Lilongwe, Malawi.

• Saeed Ahmed Maria Kim

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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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BACKGROUND Malawi HIV Stats

• Population of 13.6 million
• Estimated HIV prevalence of 12
• 890,000 people living with HIV
• 89,000 infected children

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BACKGROUND Malawi pMTCT Stats

• 540,000 deliveries per year
• Antenatal prevalence 15
• 81,000 HIV infeected women deliver per year
• 38,000 infants are infected through MTCT
• Transmission rate 45
• Why is transmission so high?

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BACKGROUND pMTCT Problems

• Why are transmission rates so high?
• Preliminary data from the Ministry of Health
  Early Infant Diagnosis Pilot Program
• 46 of HIV-positive pregnant women eligible for
  ART were referred for ARV services
• 61 of eligible HIV-positive pregnant women
  received sd-NVP
• 17 of the infants of HIV positive mothers
  returned at 6 weeks for DNA PCR with even fewer
  coming back at 10 weeks for their results

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Drop Out From PMTCT
Data extracted from Malawi Early Infant
Diagnosis Program Database April 2007-January 2008
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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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OBJECTIVES

• Reduce perinatal transmission of HIV through
  improved utilization and linkages of pMTCT and
  EID services
• Reduce HIV transmission through breastfeeding via
  improved counseling and follow up
• Improve early diagnosis and referral to care for
  HIV-infected infants

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Why Community Health Workers?

• Large potential work force
• Easily integrated into current health care system
• Health care system already has a large number of
  CHWs
• Relatively simple to recruit and train more
• Lighten the load on an already overburdened
  health care system

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Community Health Workers as a Bridge Between
PMTCT Services

• Pregnant mother assigned a CHW from initial
  diagnosis/identification at ANC
• CHW continues to follow mother-infant pair from
  ANC until infant diagnosed positive and enrolled
  in care, or definitively negative
• CHW ensures that ALL pMTCT services are utilized
  by the mother-infant pair

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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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Research Team
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Research Team Composition

• One research clinician- trained pediatrician
• One statistician-pHD in epidemiology and is
  locally based
• One data officer
• Three site supervisors- trained nurses
• 18 community health workers

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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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METHODS

• HYPOTHESIS
• CHWs can be used to dramatically improve pMTCT
  and EID services

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METHODS

• LOCATION 3 Community Health Centers (catchment
  area 500,000 people)
• STUDY POPULATION
• HIV Infected Pregnant Women and their infants
• Enrollment over 1 years with 18 month follow-up
• Total Study Period 2.5 years

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METHODS

• Main data collection tools- register and patient
  mastercards
• Mastercards serve both as adata collection tool
  and job aid for CHWs
• Data to be entered into Access Database
• Comparisons between the subject group and
  historical/contemporary controls will be analyzed
  using Epi-Info and STATA

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Community Health Workers as a Bridge Between
PMTCT Services
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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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IMPACT

• Improvement in coordination and linkages between
  pMTCT services
• Improved utilization of CHWs
• Development of new cost-effective system of
  community based health care delivery
• Drop in Malawi MTCT Rates

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Establishing Continuum of Care
Infection of Mom HIV Prevention
Mother to Child Transmission
Breast feeding related transmission
Diagnosis and referral to care
Continued quality care
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Overview
Background
Objectives
Research Team
Methods
Impact
Cost
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CHWs Transforming PMTCT
COST 250,000 USD
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Zikomo.