Changes to the Child Health Card:

1. Acceptability of the Revised Child Health Card by Health Workers and Clients in Mozambique: Continuum of Care for HIV exposed childrenB. da Silva1, E. Karajeanes2, N. Fernandes3, F. Amod1, E. Mbalane2, D. Trovoada4, F. Mbofana5Ministry of Health, Mozambique1; Elizabeth Glaser Pediatric AIDS Foundation, Mozambique2 ; FORTE Saúde, Mozambique3; World Health Organization, Mozambique4; National Institute of Health, Mozambique5 In 2007, the Ministry of Health of Mozambique reported 151,431 pregnant women with HIV identified at health facilities; 29.7% of them received antiretroviral (ARV) prophylaxis and only 14% of HIV-exposed children were tested at 18 months. Follow up of HIV exposed and identifying HIV-positive children as early as possible is critical to improve care and access to ARV treatment. The Ministry of Health, in collaboration with EGPAF and other partners, assessed the acceptability of including HIV specific information on the MOH child health card. A cross-sectional study was implemented in December 2008 in six health facilities in three provinces, using interviews and focus group discussions. The study surveyed 63 health workers including 30 MCH nurses and 270 mothers attending MCH clinic services of which 49 (18%) were HIV-positive. Focus groups discussions were done with 27 volunteers and 11 community leaders. Data were entered in EPIdata and analyzed using SPSS. Qualitative data were reviewed for key themes manually. More than 90% of the health workers and 87% of mothers considered it important to include information regarding the provision of ARV prophylaxis, cotrimoxazole prophylaxis, HIV testing and antiretroviral treatment for children. Only 27% of health workers and 10% of mothers responded that they think these additions to the health card will not be accepted by the community, mostly because of stigma and discrimination. No difference in responses was seen between HIV-positive and negative mothers All health workers, volunteers and community leaders thought that the changes would improve the follow up of HIV-exposed children. • Changes to the Child Health Card: • Recording of exposure status of child, administration of ARV prophylaxis to mother and infant, cotrimoxazole administration, HIV testing for child, ART regimen for HIV infected children. • Immunization follow-up and inclusion of HiB vaccine • Information oncurrentinfantfeedingpractice and promotion of exclusive breastfeeding until 6 months of age • Update of Antropometric parameters and introduction of 4th growth curve (P97) • Registration of anti-parasite treatments • Registration of neonatal follow up • Registration of milestones up to the age of 5 years Including HIV specific information on child health cards will likely be accepted by health staff and communities in Mozambique and will provide a critical tool to improve the follow-up HIV-exposed children and contribute to a continuum of care. The revised Child Health Card was launched nationally and the impact on improving the identification of children with HIV will be evaluated. EGPAF would like to acknowledge the tireless efforts of the PMTCT partners in Mozambique whose work made this poster possible. We would like to thank the thousands of women and their family members for facing HIV with courage and being the champions of our mission. We also thank the host governments for their partnership and for allowing the continuation of our PMTCT work. We acknowledge the contributions of Forte Saúde and World Health Organization. EGPAF's PMTCT Program appreciates the generous financial support of USAID, CDC, Bill and Melinda Gates Foundation, Johnson & Johnson, Boehringer Ingelheim, Jewelers for Children, the Oprah Winfrey Foundation and Ronald McDonald House Charities. This poster was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief (PEPFAR), as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.