UNICEF support for pilot projects in sub-Saharan Africa

The Botswana Programme for the Prevention of Mother-to-Child Transmission of HIV Programme has a high level of commitment from the Government and is the leading programme in Africa that has yielded positive results in the short time it has been operational.  In Botswana, a National Reference Group, including UNICEF and WHO, began planning a prevention of MTCT programmes in 1997. Studies were subsequently conducted to find out the acceptability of VCCT among pregnant women and cost-effectiveness of a national programme providing VCCT, AZT and breastmilk substitutes.

A major finding was that the Information, Education, and Communication strategy promoting PMTCT had to be retooled and upgraded so that women and their partners and families know more about the programme before reaching the clinic and in order to increase advocacy for the programme, especially from community and traditional leaders.  It was found important not only to communicate PMTCT interventions to seropositive women, but, since the majority of people will test seronegative, it was equally important to counsel HIV-negative women on how to protect themselves and their partners from becoming infected UNICEF and WHO have assisted with training health workers, assessing the capacity of health facilities to deliver the interventions, and establishing AZT and breastmilk substitute management policies. The Government has committed $3.6 million a year to MTCT prevention. Implementation began in all government health facilities in Francistown and Gaborone in April 1999 and is expected to benefit 550 women a month, of who over 200 are likely to be HIV-positive. To date, 3,000 women have received MTCT counselling , but less than half decided to accept the MTCT intervention, largely because they decline to undergo HIV testing.

 

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In Cote d'Ivoire, UNICEF helped to secure Turner Foundation funding for an Interim Project to assess the feasibility of delivering PMTCT interventions through routine mother/child health services, and has developed training materials and methods for health workers.   Between October 1998 and April 1999, 3,800 pregnant women were counselled and 3,500 tested--13 per cent tested HIV-positive --in four facilities in Abidjan: a university clinic, a public health facility and two community health centres.

Another 4,500 women were counselled from April to December 1999 under a project of the Fond de Solidarite Therapeutique International. UNICEF is using the Turner funding to introduce PMTCT interventions in other sites in Cote d'Ivoire covering about 6,000 pregnant women. The UNICEF Interim Project is the basis for implementing the UNICEF pilot programme on the reduction of MTCT of HIV in Cote D'Ivoire.  The need for a comprehensive Information, Education, and Communication strategy targeting the pregnant women themselves, the communities in which they live, the health workers, and the decision-makers in health care has been identified.

 

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In Kenya, assistance is being given to integrate MTCT prevention activities into existing health services in a range of urban and rural settings.  UNICEF is funding the development of guidelines and training materials on counselling and breastfeeding, training health facility staff, strengthening national capacity for production of IEC materials, and assessing health facility capability, among other activities. The pilot project will benefit up to 300 women a month, of which a third are expected to be HIV-positive. UNICEF is working with a pharmaceutical company to register AZT in Kenya, and with USAID on implementation of the project.

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In Rwanda, UNICEF has been working with the government since early 1998 to plan the MTCT pilot project. With Turner Foundation support, the pilot project started in April 1999 and is being implemented in three sites-a health centre in Kicukiro, an NGO health centre, government health centre and central hospital in Kigali and the public health centre at the university hospital in Butare.  About 1,500 women are expected to attend antenatal classes and about 25 percent are likely to be HIV positive with an 80 percent rate for taking AZT. To date, 1122 women attended antenatal care; 781 of them accepted voluntary testing; 181 tested HIV-positive and 73 of them received AZT by the end of December. UNICEF has helped to procure supplies and equipment, and to train health and laboratory personnel.

 

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In Tanzania, the PMTCT pilot project is being implemented through five national referral hospitals, Muhimbili Medical Centre in Dar es Salaam, Kilimanjaro Christian Medical Centre, Bugando Medical Centre, Mbeya Referral Hospital and Kagera Regional Hospital.

With funding secured by UNICEF from the Turner Foundation, the pilot will benefit some 1,600 mother/child pairs. In addition to conducting the assessment of project sites, UNICEF has assisted with the development of national infant feeding guidelines, updating of HIV counselling training and obstetric care guidelines, developing an effective monitoring and evaluation framework to track the impact of interventions and the use of antiretroviral drugs, and preparing a communication strategy. Additionally, UNICEF also contributed to consensus-building around the guidelines; producing training materials; training of core trainers; conducting a sensitisation seminar for hospital staff; providing a training course for counsellors and health service providers; and an intensive training for counsellors. UNICEF is currently reviewing the possibility of increasing AZT availability.

 

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In Zimbabwe, UNICEF and UNAIDS have helped with securing Turner Foundation funding for the pilot, a situation analysis and preparation of HIV and infant feeding guidelines. The pilot project began in early 1998, in ten primary health care clinics and two referral centres in the three largest cities in Zimbabwe, and aims to enroll 2,700 women. UNICEF supported procurement of HIV test kits, training for health workers in VCCT, childbirth procedures, giving short course AZT, and national HIV and infant feeding guidelines were launched. There is still a very low uptake of VCT due to stigma, fear of lack of confidentiality, and some reluctance on the part of health workers to make VCT more readily accessible. Also, more health workers need to be trained as counsellors and a communications strategy and IEC materials have yet to be developed. 

 

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In Zambia, UNICEF has provided technical assistance to enable the national MTCT Working Group to review feasible interventions, identify pilot project sites, finalise policies on infant feeding and distribution of formula, and develop and implement communication guidelines and training modules.Turner Foundation funds have been secured and the project has been launched in close collaboration with other UN partners.

The pilot is being conducted in primary clinics linked to hospitals in three sites-the University Teaching Hospital in Lusaka, a provincial hospital in Mbala, and a mission hospital in Monze-and will reach 1,200 women, of whom 400 are expected to be HIV positive.