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Background – Zimbabwe HIV context

Integration of Antiretroviral Therapy (ART) in Maternal and Child Health (MCH) settings: the way forward for increasing access to ART for HIV-positive pregnant women in Zimbabwe IAS – JULY 2011 A. Muchedzi 1 , T. Nyamundaya 1 , B. Makunike-Chikwinya 1 , A. Mushavi 2 , R. Mugwagwa 2

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Background – Zimbabwe HIV context

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  1. Integration of Antiretroviral Therapy (ART) in Maternal and Child Health (MCH) settings: the way forward for increasing access to ART for HIV-positive pregnant women in Zimbabwe IAS – JULY 2011 A. Muchedzi1, T. Nyamundaya1, B. Makunike-Chikwinya1, A. Mushavi2, R. Mugwagwa2 1Elizabeth Glaser Paediatric AIDS Foundation, Harare, Zimbabwe, 2Ministry of Health and Child Welfare -PMTCT Unit, Harare, Zimbabwe Abstract number:- WEAX0203

  2. Background – Zimbabwe HIV context • Popn - 12 million • HIV prevalence: • 24.6% to 13.7% ( 2009) • ANC 16.1% • PMTCT since 1999 • PMTCT in 95% of sites • National Goal- Eliminate MTCT of HIV- WHO Option A

  3. Background: • EGPAF supports the national PMTCT program • By June 2010, over 818,000 pregnant women received PMTCT services at 724 • ARV prophylaxis for PMTCT-91% • However, only 7% of all HIV (+ve ) women received ART due to: • Limited access to CD4 testing • Vertical service delivery with weak linkages • Centralised ART program – limited expansion

  4. Background:ART in MCH integration • Provision of ART in ANC & PNC • In 2009, MOHCW instituted a sub committee • Learning sites selected -20 • With support from EGPAF • Learning visit to Swaziland • Development of SOPs • Stakeholder sensitisation meeting- Draft plans • Trainings on OI/ART management • Placement of nurses at centres of excellence • Resources mobilisation for POC CD4 machines

  5. Method:- Progress Review • Six months after the planning process a progress review was conducted at the learning sites to: • Assess site readiness & progress • Identify challenges and lessons learnt • Make recommendations for future integration of ART in MCH • A checklist used to collect data (SOPs) • Progress assessed using adapted implementation model –T.S Stevens

  6. Results:- Readiness towards integration A total of 19/20 learning sites visited • Coordinator appointed- 12/19 • Supply chain management ARVs- 18/19 • OI/ART trained staff (N=245) • Adult (43%), Pediatric 21% • Nurses initiating ART- 8/19 • Availability of CD4 machines-16/19 • All sites PMTCT M& E tools in place • Only 2 sites using ART M&E tool (SOPs)

  7. Results:- Phase of ART in MCH implementation • Pre planning (4/19) • Facilities referring to co-located/offsite • Integration not started • Management still needed to buy in • Planning (5/19) • Local consultations, planning, logistics and client flow system discussions Phased approach implementation model adapted from Thomas P. Stevens

  8. Results:- Stage of ART in MCH implementation • Implementation phase (8/19) • Women being initiated on ART • Maintenance phase (2/19) • Implementation on going, M&E and sharing experiences • Of these 10 sites providing ART for pregnant women within the MCH (ANC& PNC) • Five sites had started < 3 months prior review • Rest >3 months prior

  9. Challenges • Lack of policy allowing nurses to prescribe ART • Frequent breakdown and unavailability of CD4 reagents • Inadequate number of OI/ART trained nurses • Increased workload • Shortage of space for the integration • Unavailability secure storage for ARVs • Lack of job aides to facilitate implementation • Lack of local level support at some facilities

  10. RESULTS: Lessons Learnt • Integrating ART in MCH is feasible in Zimbabwe • Nurses can initiate women on ART • Cornerstones for successful integration of ART into MCH • Sensitizations of stakeholders, clear SOPs • Access to CD4 testing • On-the-job training, mentorship, support and supervision is important • Lack of management support affect progress

  11. Recommendations • Advocacy for a task shifting policy • Mobilize resources for POC CD4 machines • Advocacy at local level buy in • Intensified site support & mentorship required • All ART in MCH sites to use ART program M/E tools • Develop national plans to roll out nurse led ART in MCH integration • Track the changes in proportions of women initiated on ART • Assess quality of service of the nurse led program

  12. Acknowledgements • Zimbabwe MOHCW • ART in MCH Subcommittee • Family AIDS initiative partners- OPHID Trust, KAPNECK Trust, ZAPP-UZ • Zvitambo,, CHAI,UNICEF • Elizabeth Glaser Pediatric AIDS Foundation • USAID & DFID • Healthcare workers and women at the 19 learning sites

  13. Thank you

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