HIV (AIDS) is the leading cause of death among women of reproductive age and a major contributor to maternal mortality in high prevalence settings. Although recent estimates have suggested that maternal mortality is decreasing worldwide, worrying increases have been noted in some countries in sub-Saharan Africa. WHO estimates that the maternal mortality ratio increased by more than 40% in all countries in southern Africa between 1990 and 2005.1 According to recent estimates, HIV-infected pregnant or postpartum women have about eight times higher mortality than their HIV-uninfected counterparts. Moreover, despite a 24% drop in new pediatric infections, 900 children are still newly infected every day.
The global fight against HIV in women, children and families has intensified. And for the first time, the global community has the tools needed to virtually eliminate pediatric HIV and keep HIV+ women alive and healthy, and there is discussion of the possibility of ending the HIV pandemic. In the last two years, three HIV prevention interventions have been emphasized based on their ability to prevent new infections and effectively treat people living with HIV (PLWH): expansion of antiretroviral treatment (ART); prevention of mother-to-child transmission of HIV (PMTCT); and acceleration and scale up of voluntary medical male circumcision (VMMC). In addition, it is vital that people are accessing HIV testing and counseling (HTC) to know their status and, if found positive, are linked to care in order to reach the 2015 PMTCT and treatment goals.
MCHIP continues to focus on a strategic approach that helps countries scale up high impact interventions to prevent new infections and ensure that HIV+ persons are linked to the care and treatment they need.
In the area of eMTCT (elimination of mother-to-child transmission of HIV), MCHIP continues to have great success in engaging communities to increase access to services. The number of women who are lost from care at each level of the service remains the key challenge for successful eMTCT programs. Partnering with the community, therefore, plays a huge role to not only increase access, but also to improve utilization of services at the community and facility levels. Using an integrated approach, with PMTCT services imbedded in antenatal and postnatal care, ensures that women and their families receive the appropriate care they need for all aspects of their health. MCHIP is committed to ensuring that women and their families have access and are encouraged to utilize the continuum of care.
HTC remains a critical gateway to treatment, care and prevention interventions. Specifically, HTC is an essential component for achieving 2015 treatment goals, VMMC targets, and PMTCT goals. MCHIP is undertaking key assessments to evaluate different approaches to HCT. These assessments will be used to guide technical and implementation practices for improving and developing successful HTC models that can be deployed throughout MCHIP programs.
With the provision of VMMC services at scale, MCHIP has made great strides employing research findings related to VMMC while ensuring implementation from the ground up. VMMC programs are performing well, guidance documents have been developed, VMMC services are truly country-owned, and services are integrated with the existing systems. MCHIP continues to focus on refining implementation at scale while providing high-level guidance to countries and ensuring that new research is employed when applicable (such as circumcision devices), quality is maintained, and results are documented and disseminated.
Key Contributions to Reducing HIV
By adapting the Reaching Every District (RED) approach for PMTCT in Kenya, MCHIP and the Bondo district health office were able to achieve increased coverage of the district by CHWs from 38% in June 2010 to 100% in June 2012. The proportion of those who completed four focused antenatal care (ANC) visits (proxy indicator of early ANC attendance) improved from 25% to 41% and delivery with a skilled attendant increased from 23% to 47% between 2010 and 2012.
Implementing MCHIP VMMC programs in three countries: Malawi, Lesotho and Tanzania:
- As of June 2013, 192,629 VMMCs have been performed, which will avert approximately 28,000 new HIV infections according to modeling data. As a result of this contribution by MCHIP for the last four years, Iringa, Tanzania has doubled the VMMC prevalence from 29% to 60%.
- MCHIP has supported the development of key global VMMC documents and meetings with the aim of providing implementers with a comprehensive and consistent process for establishing new and existing VMMC services for HIV prevention.
MCHIP is improving HTC systems by conducting HTC research as well as scale up of provider initiated testing and counseling (PITC).
- In South Sudan, a total of 56 health facility staff were trained in PITC, which is now being implemented in 15 health facilities in two states. Since January 2013, 4,450 people have been tested through the PITC program.
1 Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled communitybased data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Basia Zaba, Clara Calvert, Milly Marston et. al, Lancet 2013; 381: 1763-71.