Written by Molly Schmalzbach
I spent the past year in South Africa working at mothers2mothers, an organization that helps to prevent mother-to-child transmission of HIV (PMTCT). I have been looking forward to learning about the newest developments in the prevention of pediatric infections at the XIX International AIDS Conference – AIDS 2012. On Sunday, July 22, several organizations – the Elizabeth Glaser Pediatric AIDS Foundation, mothers2mothers (m2m), and Johnson & Johnson – presented on “Eliminating Pediatric AIDS and Keeping Mothers Alive from an Implementation Perspective – Best Practices, Programmatic Barriers, and Bottlenecks in the Field.” These implementing partners, working in 10 high-burden countries, highlighted some of the programmatic challenges and exciting innovations in the areas of: building capacity for country ownership, supporting continuity of care, creating demand and increasing uptake, and using data for program improvement. I was thrilled to see the success of these initiatives shared with such a broad audience.
When I visited an m2m site at a PMTCT facility in the township of Khayelitsha last August, I saw firsthand that overcrowding and understaffing are significant obstacles. In this session at AIDS 2012, Agness Mkweu, an m2m Site Coordinator from Malawi, shared how m2m’s innovative approach allows for task shifting to Mentor Mothers in the facility, taking the load off of doctors and nurses. m2m employs mothers living with HIV, like Agness, as mentors and trains them to provide education and psychosocial support to pregnant women and new mothers going through the PMTCT program. Doctors and nurses see Mentor Mothers as an important resource in the facility. Jackline Odongo, an m2m Site Coordinator from Kenya, explained to the audience how serving as a Mentor Mother not only empowers these HIV+ women, but also helps to reduce stigma around HIV/AIDS in communities because these women are seen as role models.
When I worked at m2m last year, I supported several projects aimed at improving program quality through better retention of mother-baby pairs and data usage for action planning. I was able to see the progress made on some of these initiatives at this conference session. Shungu Gwarinda, m2m’s Country Director for South Africa, described how loss to follow-up in the PMTCT cascade is a critical issue because women are not getting the treatment and care they need. m2m is now scaling up a pilot called “Mother Baby Pair Tracking” that tracks clients throughout an inter-facility referral system and actively follows up with them if they miss an appointment. Mother Baby Pair Tracking is currently transitioning from a paper-based system to using smart phones, which will further enhance client outcomes by providing instant access to client data and reporting results.
Admire Chirowodza, m2m’s Program Evaluation & Operations Research Technical Specialist, explained the importance of involving people living with HIV not only in consultation for strategy planning, but also in monitoring and evaluation of program data. He presented an initiative called “Let’s SOAR” that offers m2m site staff the opportunity to review the data that they have been collecting on a quarterly basis. At these meetings, site staff are able to compare their data with that of other sites, identify problem areas, and formulate action plans to improve results. Next steps with this project will involve the application of technology for data capture.
The innovations discussed in this conference session are addressing critical challenges regarding implementation in these high-burden countries of sub-Saharan Africa and India. It remains to be seen whether they will be scaled up in time to reach the goal of virtual elimination of mother-to-child transmission by 2015, as the UNAIDS Global Plan sets out to do.