Abstract

PMTCT integrated with a holistic approach of community based services can influence adherence

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

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

Challenges: HIV sero-prevalence among pregnant women is higher than in the general population in Haiti and to date more than 70% of pregnant women are delivering at home with traditional birth attendants. Low use of antenatal services, limited access to maternity care in rural areas, and cultural habits added to economic extremity are major barriers to quality maternal care. Effective PMTCT in Haiti remains a challenge.
Engaging CHW and TBA in MCH while avoiding discrimination among beneficiaries at both institutional and community level is also a challenge.
Intervention Goal: Provision of a complete PHC package including community-based PMTCT to HIV+ pregnant women to help reduce mother to child transmission of HIV and increasing access to and use of antenatal and postnatal services overall. This strategy is implemented in 19 health sites and communities.
The strategy combines community mobilization and participation, promotion of services, use of the Traditional Birth Attendant (TBA) and CHW to ensure free provision of a holistic package of mother and child services at community and institutional levels as well as adherence to treatment. This is coupled to a subsidy program for a prepaid MCH package that covers transportation fees for monthly visits, fees for lab tests, incentives for TBA and the cost of delivery in the health clinics while putting an emphasis on quality of care.
Results and lessons learned: More pregnant women have benefited from this support and have completed their prophylaxis. They have become an advocacy group for other HIV+ pregnant women.
Significant improvement has been noted also not only regarding PEPFAR objectives for PMTCT but for other management and monitoring systems.
Key Recommendation: A strategy for PMTCT to succeed needs to be adapted to each environmental situation and provided within an integrated and holistic package to avoid stigma and discrimination that can drive directly to failure.