A.28.ST. GABRIEL’S PMTCT Program
Issue: In a rural poor setting several factors such as ignorance, stigma, poverty and endemic malnutrition can jeopardise appropriate response to the HIV epidemic.
Description: In June 2002, St. Gabriel’s Hospital (168 beds) started a community- based HIV/AIDS program with the aim of preserving the family unit through provision of a continuum of care from Prevention of Mother to Child Transmission (PMTCT) to Antiretroviral Therapy (ART). Initial activities consisted of community mobilisation and advocacy resulting in setting up of Community AIDS Committees (CAC) and Village AIDS Committees (VAC) for a population estimated at 200, 000. From January 2003, Prevention of Mother to Child Transmission (PMTCT) interventions were initiated with a package of care consisting of a hospital-based Voluntary Counselling and Testing (VCT) clinic 11 outreach antenatal clinics. Services at the hospital include provision of Nevirapine to mothers and babies, education on appropriate infant feeding, free access to continuous care and supplementary feeding to HIV infected and affected families. Since March 2004 eligible PMTCT mothers and/or their spouses are offered antiretroviral therapy with supervision by treatment helpers selected among HIV positive clients.
Lesson learnt: Community mobilisation resulted in Twenty Village AIDS Committees (VAC) with six hundred (600) volunteers actively involved in community advocacy. From January 2003 to December 2004, out of nine thousand three hundred eighty nine mothers who attended antenatal clinic, eight thousand one hundred eighty seven (87%) accepted voluntary counselling and testing and three hundred twenty three (3.9%) tested HIV positive and two hundred sixty four delivered over the two years period. One hundred seventy one delivered in the hospital (65%), whilst ninety three delivered either at home or at the TBA (35%). Among the hundred seventy one (65%) of women who delivered in the hospital, one hundred fifty seven (92%) received Nevirapine. There were one hundred sixty babies who received Nevirapine. From March to December 2004 forty (40) clients have been started on ART with an adherence rate of 98%.
Eighty percent of the HIV Positive clients with chronic food shortage are benefiting from food supplementation to enhance their nutritional status.
Recommendation:St. Gabriel’s Hospital is implementing an integrated PMTCT Program that involves community participation and addresses not only medical but socio-economic needs of the clients.
Community mobilisation helps to confront stigma.
Free access to care reduces morbidity and prevents premature death.
Food supplementation contributes to better nutrition.
Involving HIV positive clients in ART supervision helps to achieve high adherence rate.