Safeguard the Family Project Lilongwe Medical Relief Fund Trust

1. Safeguard the Family ProjectLilongwe Medical Relief Fund Trust Safe water kits as an effective incentive for ANC visits, reduced diarrhea, improved ART adherence, increased HIV screening of couples Presented by Innocent Mofolo On behalf of Safeguard The Family Project, Malawi

2. INTRODUCTION • Lilongwe Medical Relief Trust (LMRFT) is a service arm of the University of North Carolina (UNC) Project • UNC Project is a NGO that does Research, care and service, and capacity building. • UNC Project has since 2002 implemented PMTCT interventions mainly in Lilongwe district in partnership with MOH • LMRFT is implementing a USAID funded Safeguard the Family Project in the Central West Zone of Malawi and in Dowa district

3. Background • Safeguard the Family Project • UNC Project and the Ministry of Health initiative • Geographic coverage – Expansion of the current PMTCT program from 41 public health facilities in Lilongwe to 130 facilities in the Central West Zone (Lilongwe, Dedza, Ntcheu and Mchinji) and in Dowa District • Target population: ≈ 3,863,365 people with about 153,000 expected beneficiaries every year.

4. UNC: 20 years in Malawi • 14 million people • 2 physicians/100,000 people • Antenatal HIV prevalence: 9% overall , 11% Lilongwe district • Under 5 mortality ~13% • Fertility rate: ~6 pregnancies per woman

6. PMTCT Program, Malawi HIV testing at 1st antenatal visit for all pregnant women “Option B +” universal lifelong ART since July 2012 Provides 3TC/TDF/EFV to all pregnant women ART prophylaxis for mother and infant at HIV diagnosis

7. Diarrhea and HIV • Dilemma for HIV-exposed infants: • Breastfeeding increases risk of vertical transmission • Early weaning makes infants more susceptible to diarrheal illnesses • Diarrhea worsen HIV progression and is the leading cause of death in children under the age of five in developing countries

8. Goal • Introduced P&G safe water packets to all households of HIV-infected mothers to help prevent water borne diseases during pregnancy, breastfeeding and weaning period. • P&G Water Packet:

9. Overall Objective • Reduce infant and maternal diarrhea • Improve Post natal retention in care for HIV infected mothers and exposed infants • Address unmet contraceptive needs • Encourage male involvement in PMTCT

10. Methods-Pilot program (October 2008 – March 2009) • Before program implementation , a pilot study was conducted in 2 large health centers in Lilongwe where PMTCT programs were ongoing (area 18 and area 25) • Monthly visits for HIV infected mother and exposed or infected infant from 6 months to 18 months post-partum • The pilot targeted 474 mother infant pairs

11. Findings of the Pilot Implementation of the pilot program was successful Hygiene and nutrition package was well accepted, >96% Monthly visits with benefits improved post natal retention (75%) and increased infant diagnosis (86%) Diarrheal illnesses were less frequent in mothers (1%) and infants (5%) compared to other published figures Contraceptive use among these HIV infected mothers was high and the pregnancy rate low Expansion of the program was warranted

12. Program Expansion • From February 2011, LMRFT/UNC Project was asked by MOH to scale up PMTCT mentorship and technical support services from 1 District (Lilongwe) to 5 Districts. • With funding for USAID, P&G and other stakeholders the program has expanded to cover 130 facilities in the 5 districts of Malawi targeting 153,000 households.

13. Clean Water Program intensity • From August 2011 to March 2012, the P&G clean water packets have been distributed in 87 facilities with 5,300 HIV affected households benefitting. • LMRFT/UNC Project hired a coordinator to run the program. • All program nurses (18) and data team involved • Renting a warehouse to store products • Distribution logistics involves both a motorcycle officer and vehicle to reach the remotest facilities.

14. Monthly Activities Education of all implementers on how to use the P&G water packets and all antenatal aspects P&G water packets with filter cloth are supplied to all HIV +ve women in antenatal or at a support group meeting Hygiene, nutrition, breastfeeding and family planning counseling 2kg of vitamin fortified porridge (VitaMeal, from Feed the Children) ART and primary care clinic referrals

15. Achievements to-date Major qualitative achievements • Assessment of all 130 facilities including questions of water sources in all the surrounding areas • Conducted sensitization of the project activities in all facilities and surrounding areas involving chiefs and other stakeholders • PMTCT Technical officers deployed in District Hospital assist with distribution using motorcycle • Provision of monthly supportive supervision and mentorship in all 130 facilities and education on how to use clean water packets • Reported reduced diarrhea among users of P&G safe water kits • Program has seen an increase in male participation from 2% to 20% in urban facilities and up to 80% in rural facilities

16. Challenges • Most households do not possess appropriate buckets – will start providing buckets soon • People need to be shown how to use the P&G packets by seeing a demonstration and proper usage needs to be reinforced regularly during clinic visits • Diarrhea and product use data is all self report

17. Opportunities Available opportunities: • Antenatal attendance is high- Potential for increasing service access • HIV psycho-social Support groups helpful entry point for accessing P&G water packets and nutrition product • Mentoring and technical support- Potential to improve quality of service • Government and communities commitment to improving maternal and child health. • Partners working together with common goals of improving the health of Malawian mothers and their children

18. ZIKOMO-Thank You!