Abstract

5-year results of PMTCT integrated into community based services in Haiti

P. Brunache, F. Guillaume, C. Trout, J. Pollock

Management Sciences for Health, Center for Health Services, Cambridge, United States

Challenges: In Haiti, 25% of births occur in a health-care setting but 85% of pregnant women attend at least one pre-natal visit (EMMUS-IV), which is an opportunity to provide HIV testing and prophylaxis for Prevention Mother to Child Transmission (PMTCT) of HIV. Poverty, transportation costs, food insecurity, cultural factors, stigma and discrimination, are barriers to uptake of HIV testing and successful prophylaxis for HIV+ pregnant women. Less than 50% of pregnant women in Haiti recieved an HIV test in 2009. (MESI database). In 2008, only 43% of HIV+ pregnant women received prophylaxis for PMTCT. (UNAIDS/WHO, 2009).
Intervention response: Since October 2004, Management Sciences for Health (MSH) has promoted a complete package of primary health care including PMTCT to all pregnant women in its USAID-funded network. PMTCT is nested within antenatal and postnatal services. The strategy combines community mobilization, promotion of services, use of traditional birth attendants and community health workers as well as adherence. This is coupled to a prepaid package that covers transportation fees for monthly visits, fees for lab tests, incentives for Traditional Birth Attendants, and the cost of delivery in the health clinics.
Results and lessons learned: Since October, 2004, 175,648 pregnant women were tested for HIV and received their results in the MSH network in Haiti and 6,991 HIV+ pregnant women received propylaxis. HIV+ mothers have become an advocacy group for other HIV+ pregnant women.
Key recommendation: PMTCT is best provided within an integrated and holistic package of Maternal-Child health care.