Realizing a Continuum of Care in Elimination of
Mother to Child Transmission of HIV
During the quarter January –March 2013, 889 pregnant
and lactating mothers were receiving Antiretroviral
therapy (ART) as an option B plus intervention at 13
hospitals. Out of the 1018 HIV exposed infants below two
years tested, 61(5.9 percent) were found HIV-infected; and
88 percent of these initiated on ART.
The USAID Strengthening Uganda’s Systems for Treating
AIDS Nationally (SUSTAIN) project supports the
Uganda Ministry of Health (MoH) to ensure delivery of
quality Human Immunodeficiency Virus (HIV)/ Acquired
Immune Deficiency Syndrome (AIDS) prevention, care
and treatment services. SUSTAIN has successfully
worked with 13 public Regional Referral and General
Hospitals to roll out Option B Plus interventions for
elimination of mother to child transmission of HIV.
Objectives
To support scale-up and provision of effective and comprehensive Elimination of Mother Child Trans-
mission of HIV (EMTCT) and Early Infant Diagnosis services in line with Ministry of Health (MoH)
guidelines
To improve the quality, and demonstrate outcomes of quality improvement on EMTCT services
To strengthen linkages between maternal, newborn
and child health services, reproductive health
services and other HIV related services
At the hospitals, healthcare for HIV– infected pregnant and lactating
mothers and HIV exposed infants is most effectively provided through integration with routine maternal, new born and child health (MNCH)
services. Health workers within the MNCH setting also provide HIV/AIDS services.
Service delivery emphasizes a continuum of care approach.
i. A mother receives an HIV test together with other routine antenatal
tests
ii. Health workers offer the following services stepwise;
Psychological support, emphasizing adherence, disclosure, positive
prevention and exposed infant care
Examination of the pregnant mother
Enrolment into HIV care and initiation onto Highly Active Antiretroviral
Therapy (Option B+) for all HIV positive mothers
Enrolment of mother into a family support group (FSG)
Scheduling clinic appointments for ongoing counseling, testing
Provision of early infant diagnosis, post natal and family planning services
The mother is then enrolled into the HIV clinic
3 Years of Improving EMTCT Services—SUSTAIN Impact 2010 2011 2012 2013
Uganda adopted World Health
organization Option A guide-lines for PMTCT and guidelines
for children below two years of age to be enrolled on ART as
soon as they are diagnosed as HIV-infected.
At the start of SUSTAIN
project,;
38 percent of HIV positive pregnant women were
enrolled into HIV care
9.6 percent of the HIV exposed infants tested were HIV positive
25 percent of HIV-
infected children below two years of age were initiated
on ART upon diagnosis.
SUSTAIN supported MOH to roll
out the released WHO guidelines. The approaches used included;
training and mentorship of healthcare workers, provision of
job aids tools and equipment and quality improvement.
By end of December 2011,
54 percent of HIV positive
pregnant women were enrolled into HIV care
8 percent of the HIV
exposed infants tested were HIV positive
57 percent of HIV – infected children below two years of
age were initiated on ART upon diagnosis.
Implementation of Option B
Plus as per the national roll out plan. SUSTAIN
continued training, mentor-ship and QI approaches.
By end of December 2012,
77 percent of HIV positive pregnant women were enrolled
into HIV care
7 percent of the HIV exposed infants tested
were HIV positive
78 percent of HIV –infected children below
two years of age were initiated on ART upon
diagnosis
Continued roll out of Option
B plus to all 16 supported facilities. 294 health workers
were trained and mentored and are fully implementing.
1289 HIV pregnant and lactating mothers have been
initiated on option B plus
87 percent of HIV positive pregnant women
were enrolled into HIV care
5.9 percent of the HIV
exposed infants tested were HIV positive
88 percent of HIV –infected children below
two years of age were initiated on ART upon
diagnosis
Key Interventions
UNIVERSITY RESEARCH CO., LLC www.urc-chs.com
SUSTAIN is funded by the United States Agency for International Development (USAID) and this publication is made possible by the generous support of the American People. SUSTAIN is managed by University Research Co., LLC (URC) in partnership with the AIDS Support Organization (TASO), Integrated Community Based Initiatives (ICOBI), Health Research Inc. (HRI), and Initiatives Inc. For more information, please visit www.sustainuganda.org website or contact Dr. Cordelia Katureebe – Senior Technical Advisor PMTCT ([email protected])
Above/ Family Support Group (FSG): Members of a support group
attending a meeting at Kawolo Hospital. May 2013
USAID SUSTAIN project key interventions follow the six blocks of
health systems strengthening
—Training and mentorship for service providers: SUSTAIN has trained and mentored health workers to carry out EMTCT
services. Hospitals are now addressing understaffing challenge through use of volunteers and expert clients as a form of task
shifting. —Ensuring un-interrupted delivery of medicines and test kits;
SUSTAIN has strengthened systems in the antenatal and ART clinics to ensure timely and accurate ordering and reporting
—Ownership; We are working with service provider teams to embrace delivery of Option B+ activities country wide. Through
periodic meetings involving hospital management personnel and MNCH teams, implementation of EMTCT activities is tracked
and discussed. —Data Management and Information Systems; SUSTAIN has pro-moted the use of national tools for collection and management
of data, and supported midwives to make accurate and timely reports. In addition, MNCH units are supported to routinely
utilize their data to improve performance
—Service Delivery; Our goal is to have the chronic care
concept introduced in MNCH units. The units are supported to
provide ART, psychological, antenatal, and support group
services, appointments and follow-up to HIV-infected mothers.
The approach is key in promoting retention of mother-baby
pairs in care.
Family Support Groups (FSG) provide a forum for
follow-up of EMTCT services for women, children, couples, adolescents and their families. SUSTAIN’s approach is
having HIV positive mothers receive routine antenatal care, EID services, ARV drug refills, ongoing counseling and attend
the midwife -led FSG meetings.
This approach has promoted ownership by the health
workers and a ‘one stop’ point for mothers to receive
comprehensive HIV services. This will be key in ensuring
sustainability of the family support groups.