From 22-27 July, the XIX International AIDS Conference is being held in Washington, DC, with an expected 20,000 delegates from nearly 200 countries in attendance. Convened by the International AIDS Society, this six-day meeting will bring together leaders in the fight against HIV to “translate recent momentous scientific advances into action that will address means to end the epidemic, within the current context of significant global economic challenges.” Daily highlights and a live webcast are available at the conference website.

In honor of the event, below is one of a series of blogs from our MCHIP experts in HIV and infectious diseases discussing the Program’s work to “turn the tide” on this pandemic. Other blogs in this series are:

Kenya: Using an Adaptation of RED Approach to Increase Uptake of PMTCT Services
 
Two Birds With One Stone: Integrating Maternal Health Services to Tackle Both TB and HIV

Malawi Launches Male Circumcision Campaign to Reduce New HIV Infections

100,000 Men and Counting: Scaling up Voluntary Medical Male Circumcision to Prevent the Spread of HIV in Tanzania

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A little over three years ago, HIV/AIDS care and treatment services in Ethiopia were not offered in many settings. Women who received antenatal care (ANC) and intrapartum care services in facilities without antiretroviral therapy (ART) service provision did not receive HIV counseling and testing (HCT). Moreover, women were expected to travel a long distance (4-8 hours) for testing and then received little to no follow-up if they tested HIV positive. And because ART is not provided in every facility, many women did not even start treatment or, if they started, they later dropped out, thereby exposing their newborns to HIV.

But now, as part of the national effort to increase the coverage of prevention of mother-to-child transmission of HIV (PMTCT), MCHIP is supporting the Ethiopian Government to take positive steps towards improving the provision of comprehensive maternal, newborn and child health (MNCH)/PMTCT services. In less than one year of implementation, three of the regions where MCHIP is working—Amhara, Oromia and SNNPR—are noting improvements from baseline data.

In these regions, there were 19 health centers that did not provide PMTCT services; even in places where HCT was provided, only 58% of women attending ANC were being counseled and tested for the virus. In order to address the low PMTCT coverage in ANC settings, MCHIP identified sites that are not supported by other partners and conducted a baseline assessment to identify service delivery  gaps, and provided technical assistance to regional health bureaus on improving the quality of service delivery, and post-training follow up.

As a result, to date:

• 36 nurses, midwives and health officers have been  trained on comprehensive MNCH/PMTCT service delivery; 
• PMTCT services have been  initiated in 18 new health centers in 3 regions where there were no previous services;
• 941 (78%) pregnant and 62 delivering mothers who visited the 18 health centers for ANC and labor and delivery were able to get access to HIV testing—a significant improvement from the baseline of 58%;
• Out of the 941, 3 pregnant mothers tested HIV positive and were successfully referred and linked to the nearest ART sites for antiretroviral (ARV) prophylaxis. These women are being followed up and remain on treatment.

Moreover, of those women who came for ANC, 120 (12.8%) were provided with counseling and testing with their male partners. This is a step forward in supporting the government’s PMTCT accelerated plan, which was endorsed December 2011. The plan was designed to rapidly increase service provision sites, improve the quality of services, and increase utilization so as to reach the ambitious goals set in the Government of Ethiopia’s Health Sector Development Plan to provide ARVs for PMTCT to 80% of eligible pregnant women by 2015. The Government of Ethiopia is currently adopting Option A of the WHO guidelines (2010).

The other contribution MCHIP is making is in integration of MNCH and PMTCT services to address the four prongs in PMTCT. Through a collaboration with facility-based health care providers and community-based health extension workers (HEWs), the HEWs received a knowledge update on PMTCT and discussed integration of testing at various service delivery points. HEWs in turn pass the information on to their communities. There is now an increasing awareness among mothers of the importance of HCT, and when they attend the health center for family planning, immunization and under-fives services, they are requesting and receiving HCT. Over a six week period in six health centers, 327 mothers came for HCT after being referred by HEWs.

Integrating MNCH and PMTCT services is a crucial a step in averting new HIV infections in newborns. MCHIP once again reaffirms the global consensus on bringing effective interventions together and aims to ensure that every pregnancy is wanted. This is achieved through universal access to voluntary contraception integrated with HIV prevention (dual protection) for the survival of the mother and to ensure that every child is born free of HIV and every childbirth is safe.

A regular supportive follow up phone call  is carried out  by MCHIP Ethiopia’s PMTCT advisor, an opportunity to provide technical guidance to the recently trained health care providers on  issues such as HIV testing algorithm, integration of PMTCT with other MNCH services, and tracing mechanisms of lost to follow up from ANC, and partner testing. This provides real time support and also ensures that program implementers are able to respond to concerns when the happen.

We know that the combination of political commitment, the right policies, financing, and service delivery that reaches the community will make rapid maternal and child health progress possible, even in a resource-constrained settings such as Ethiopia, and we will continue to collaborate with the Government of Ethiopia in turning the tide.


Tadele Bogale, MCHIP/Ethiopia Deputy Country Director
Tigist Belete, MCHIP/Ethiopia PMTCT Advisor