Country Programs: Prevention of Mother-to-Child Transmission of HIV

Since 1999, the U.S. Agency for International Development has been committed to helping the millions of women living with HIV/AIDS to reduce the likelihood of transmitting the virus to their infants. USAID focuses on a comprehensive approach to preventing mother-to-child transmission (MTCT) which includes improvement of antenatal services, HIV voluntary counseling and testing, short-course antiretroviral prophylaxis for HIV-infected pregnant women, counseling and support for safe infant feeding, and strengthened health, family planning, and safe motherhood programs. USAID, in coordination with other U.S. government agencies, has combined these elements into a comprehensive package of MTCT interventions in:

Guyana
Haiti
Ethiopia
Kenya
Mozambique
Namibia
Nigeria
Rwanda
South Africa
Tanzania
Uganda
Zambia

Guyana—The U.S. government plans to expand an MTCT pilot project that began with eight sites in 2001 to 32 sites by 2004. These clinics will serve 5,000–8,000 people in all 10 regions of the country and provide antiretroviral therapy to 350–500 people at three sites by 2004 and 2,250 people by 2008. Strengths of this plan include a highly detailed and comprehensive implementation plan, a forward-looking approach to the problem of limited human resource capacity, inclusion of the maternal and child health system, and the resolve to remedy the currently fragmented system of care.

Haiti—The MTCT pilot program is part of a larger five-year national strategy to fight HIV/AIDS in Haiti. The U.S. programs will provide nationwide access to voluntary HIV counseling and testing and MTCT services. USAID and CDC are supporting the creation of a nationwide network of clinical service and reference centers, as well as providing a range of care including voluntary HIV counseling and testing, reproductive health, tuberculosis, and selected AIDS care, including MTCT services. The key strategy is to strengthen and expand the presence of voluntary HIV counseling and testing at points of access in the health care delivery network, while establishing MTCT services in a tiered approach in clinical settings.

Ethiopia—The Government of Ethiopia has a nascent HIV program, including MTCT services. The U.S. government programs have established partnerships with various civilian and military hospitals and a number of international implementing partners to roll-out a “center of excellence” approach to MTCT programming. This approach—building on the limited existing infrastructure—will serve as a model for future scale-up. Given the vast expanse of the country, initial sites will be primarily in urban areas where there are higher numbers of women receiving services.

Kenya—U.S. government sites have adopted an approach to counseling and testing where providers assume women want services unless they decline when asked. This opt-out approach has improved uptake significantly. Kisumu district has achieved an 80 percent acceptance rate of pregnant women offered MTCT services and sites using opt-out routine testing have increased uptake of counseling and testing from 57 percent to over 80 percent. Over 30 new U.S. government sites have started services since June 2003.

Mozambique—The U.S. government MTCT strategy for Mozambique is designed to accomplish two central tasks. The first is to increase the number of MTCT sites in the country from 11 to 25 by 2004 and add one MTCT Plus site, which provides antiretroviral drugs for mothers and other HIV-positive family members. The second task is to support the Ministry of Health by financing the staffing of key positions in their ministry, completing and distributing appropriate MTCT manuals and training materials, and to train up to 600 ministry staff in MTCT at the central, district and service delivery levels.

Namibia—The goal, at the request of the Ministry of Health and Social Services, is for the U.S. government to strengthen MTCT, MTCT Plus, and antiretroviral therapy services at the national level and at specific public and faith-based health facilities. Current U.S. support includes assistance training, program management, monitoring and evaluation at the national and regional levels, CDC assistance to six government health facilities, and USAID assistance to five ministry-supported faith-based health facilities.

Nigeria—The U.S. government HIV/AIDS program in Nigeria focuses on establishing a network model of care. The Ministry of Health is planning programs to provide antiretroviral therapy in 25 states, and the U.S. government is supporting work in four. In these select states they are establishing four centers of excellence, each with two to three satellite clinics and two to four community service organizations. CDC is principally funding training, service delivery, and the establishment of a monitoring and evaluation system at the centers of excellence. USAID is working on behavior change communication at satellite centers, and with local non-governmental organizations to develop community service organizations.

Rwanda—In 2003, a total of 21 U.S. government-supported sites—seven of which were new—assured basic MTCT services including nutrition counseling, family planning, and improved maternity services. To support quality improvements, the “collaborative approach” was introduced, bringing together 18 sites already offering MTCT services to provide a forum for sharing lessons learned, problem-solving, and addressing issues of replication and scale-up. Several teams were created to discuss ongoing issues relevant to MTCT and a communications capacity assessment has been completed at all 18 sites. In addition, research to identify appropriate strategies to increase nevirapine acceptance at antenatal clinics is currently being conducted.

South Africa—The goal of the national program is to “reduce mother-to-child HIV transmission by improving access to HIV testing and counseling in antenatal clinics, improving family planning services to HIV positive women, and implementing clinical guidelines to reduce the transmission of HIV during childbirth and labor.” The national program has expanded rapidly in the last year, with the provinces of KwaZulu Natal, Gauteng, and the Western Cape achieving almost universal coverage of MTCT services. The U.S. government is taking a lead role in developing an integrated MTCT communication strategy, developing an MTCT and infant feeding training curriculum, establishing a regional training center in the Eastern Cape, providing training and staff development, expanding MTCT services, and providing community-based care and support.

Tanzania—The U.S. government is supporting the Tanzanian Ministry of Health’s goal to expand MTCT services to all 21 regions of the country by 2006. The approach of the U.S. government in Tanzania is to strengthen the existing health infrastructure to integrate MTCT services into routine reproductive and child health services. The goals include providing high quality services to as many pregnant women as possible, integrating MTCT services into routine reproductive and child health services, and collecting data to document the impact of these services. Activities will be coordinated through the MTCT Secretariat, located in the Ministry of Health.

Uganda—The U.S. government strategy is to support the Ministry of Health in the scale-up of the national MTCT program through the identification of critical gaps and challenges. U.S. government efforts have identified and facilitated partnerships with private providers, non-governmental organizations and faith-based organizations to assist the ministry in this process. To accomplish this, USAID and CDC have focused on strengthening the capacity of the national MTCT program to lead, monitor, evaluate, and to improve capacity in training, staffing, counseling, behavior change communications, laboratory infrastructure, facilitating community outreach and mobilization, and strengthening the logistics and delivery system for MTCT-related commodities.

Zambia—USAID and CDC are working in close collaboration with the Central Board of Health’s Reproductive Health Advisor and district health teams to ensure further expansion of MTCT services in country. The government has developed an MTCT strategy and implementation plan, which seeks to integrate MTCT services into existing maternal and child health services. To achieve planned national expansion of MTCT sites to all provincial centers and further to antenatal facilities in all 72 districts, the U.S. government is working with national and international partners. Funding for MTCT in Zambia is a collaborative effort with financial support coming from the World Bank, UNICEF, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, in addition to the U.S. government.

February 2004

USAID's Efforts to Prevent Mother-to-Child Transmission of HIV

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