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
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.
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
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.
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