Campaign update: September - November 2006
The Unite for Children Unite against AIDS campaign aims to place children at the centre of the response to the pandemic, and expand interventions in the areas of HIV prevention, treatment, care and protection. The commitment of partners and the involvement of children and young people themselves is key to making a difference in Mozambique.
Prevention among adolescents and young people
The life skills manual used by associations of People Living with HIV/AIDS (PLWHA) has been approved for inclusion in the Pacote Basico Kit developed by the Ministry of Education (MEC). This will strengthen the link between the school curriculum and extra curricular activities. The associations and HIV/AIDS focal points in the Ministry agree on the importance of harmonising key messages with the MEC communication strategy on HIV prevention, and for school principals to accept the activities as part of the school response.
The partnership with PLWHA associations is central to the School Awareness Programme. In 2006, the associations supported the participation of 236,916 primary school children, 46 per cent of whom are girls, in 294 schools in debates, theatre groups and sports activities related to life skills, encouraging informed decisions to prevent HIV infection and delay the onset of sexual relationships. In 2007 the programme will benefit from greater coordination between MEC and civil society organisations.
As part of the World AIDS Day agenda, the First Lady launched the Window of Hope Initiative in Nampula province followed by a dialogue with 300 children. The heightened media awareness on the Window of Hope was initiated by a high level conference organised by the National AIDS Council (NAC) to discuss the Window of Hope with the media, key ministries and development organisations. The initiative, which aims to improve coordination in relation to sexual reproductive health and HIV prevention among adolescents, has been defined by the NAC, together with partners, as the key priority for 2007.
Prevention of mother-to-child transmission
There are currently 142 PMTCT sites, all of which are integrated into existing antenatal care facilities and a broad range of partners are contributing to scale up. A consolidated expansion plan was drafted and is currently being reviewed by the PMTCT Task Force coordinated by the Ministry of Health (MoH).
The Minister of Health issued a “Circular Normativa” to the Provincial Health Departments (DPS), requesting revision of several key aspects of the PMTCT programme, to facilitate expansion and strengthen the quality of services. The DPS have been empowered to approve the involvement of partners in PMTCT. The “opt out” approach for pre-test counselling and testing of pregnant women, which was approved the MoH, is now recommended in both antenatal and maternity services.
The drug regimen for mother-to-child-transmission prophylaxis has changed from single dose Nevirapine to combination therapy, consisting of Azidothymidine (AZT) from 28 weeks of pregnancy. This is combined with single dose NVP during delivery for all mothers and a single dose of NVP combined with seven days of AZT for all children. This regimen is more effective at reducing mother-to-child-transmission and reduces the risk of resistance.
CD4 tests to determine if a HIV positive pregnant woman is eligible for ART, will take place in antenatal care facilities instead of in referral centres. If the woman is found to be eligible, the recommendation is that ART is provided in the antenatal care facility. Enrolling babies born to HIV positive women in medical consultations for children at high risk will be revitalised, and the roll out of PCR tests for HIV infection is recommended.
3,013 children under the age of fifteen were receiving antiretroviral treatment (representing nine per cent of the total numbers of people on treatment) and a total of 13,773 children were enrolled in the day hospitals from a total of 138,371 people enrolled. The target articulated in the poverty reduction strategy (PRSP), and agreed by the MoH, is to have 3,686 children on treatment by the end of 2006.
Children are currently receiving treatment in 55 out of the 113 sites that are providing ART. Many of these sites are brand new and health staff will be trained on paediatric ART in the coming months. Since the MoH instructed the provincial health authorities to accelerate the establishment of treatment sites, there has been a huge expansion of services to rural hospitals and some health centres in Mozambique.
MSF is coordinating the use of PlumpyNut as a replacement food for children in Maputo health centres. This is being linked to the PMTCT programme and has met with good success. Several organisations are interested in the use of PlumpyNut including HAI, UNICEF and Elizabeth Glaser.
Partners will support the MoH in developing guidelines on the use of PlumpyNut as a replacement food and identifying where it will be introduced. PlumpyNut distribution to HIV positive children is ongoing in eight day hospitals and expansion is planned for 2007. As part of the general nutrition rehabilitation programme, MoH has requested assistance to roll out community based treatment of severe malnutrition using PlumpyNut.
In 2007, partners will focus on how best to support quality training of health staff, as well as building linkages with child health services, community support including home based care and mothers support groups. Communication will also be a focus in the coming year, with social mobilisation activities to increase awareness of paediatric AIDS and the services available for HIV positive children, as well as to improve understanding and compliance with treatment. The MoH target for 2007 is to have 10,000 children on treatment.
Protection and support for children affected by HIV/AIDS
A total of 1,030,000 children have now been registered with an additional 250,000 expected to be registered by the end of 2006. Training materials, jointly developed by the National Directorate for Registries and Notaries and the National Institute of Communication supported the training of 748 registration agents and 366 social mobilisation activists.
As part of their training, registration agents also benefited from a session on HIV prevention held by RENSIDA partner organisations. Registration activities are still ongoing in the central and southern provinces of Mozambique, and social mobilisation activists are raising awareness among communities and families on the importance of birth registration. Particular attention was paid to the registration of orphaned and vulnerable children, with over 90,000 orphaned children registered so far in targeted districts.
Joint efforts from the Ministry of Women and Social Action, PEPFAR and partners have resulted in 170,000 children being reached with at least three out of six basic services- health, education, nutritional and food support, financial support, legal and psycho-social support. In addition, as of November 2006, the Provincial Directorates of Women and Social Action had reached approximately 100,000 children in seven provinces with psycho-social support and home visits. As part of the next steps for 2007, the monitoring and evaluation system of the Ministry will be strengthened to ensure the children identified by civil society partners are being reached.
Partners have developed a flexible system to improve delivery of basic materials including hygiene products, water purification kits, school uniform and materials and mosquito nets to households caring for the most vulnerable orphaned and vulnerable children. In November, 1500 kits of basic materials were pre-positioned in the provinces of Tete and Sofala in coordination with the provincial level OVC Technical Working Groups for immediate distribution through the National Institute of Social Action (INAS) and civil society organisations partners. The materials will reach the most vulnerable children including child-headed households.