PMTCT at DifferentLevels of Care:The Uganda ExperiencePMTCT at DifferentLevels of Care:The Uganda Experience
Dr. Saul Onyango
National PMTCT Coordinator
Ministry of Health
1
1
2
Background…Background…
MTCT is 2nd major mode of transmission ofHIV in Uganda
Major mode of transmission of HIV to children(>95%): Approx. 25,000 infected babies eachyear
Accounts for up to 25% of all new infections inthe country
PMTCT is a major intervention for preventionof HIV infection particularly among children
Priority intervention in the NSF and HSSP II
2
3
PMTCT ProgrammePMTCT Programme
Started as a pilot intervention in 2000
Targeted 7 sites within 5 districts, withregional balance
Government and NGO health facilities
Aim to learn:
◦Integration within existing system
◦Impact of intervention on family andcommunity
3
4
The PMTCT InterventionsThe PMTCT Interventions
HIV counselling and testing
Comprehensive antenatal care, Improved careduring labour & delivery
Post natal care and follow up for mother & baby
Anti-retro viral drugs for HIV+ mothers andtheir babies
Counselling on appropriate infant feeding forHIV+ mothers
Promotion of community & male partnersupport
4
Households /Communities/ Villages
HC II
HC III
Referral Facility(HC IV or Hospital)
Regional ReferralHospital
National ReferralHospital
HC II
HC II
HC II
HC III
5,000
20,000
100,000
2,000,000
Health Sub-District(HSD)
NationalPopulation
District:500,000
National Health System
5
National Health System…
HC II (2008 facilities)
◦Ambulatory services
HC III (955 facilities)
◦Preventive, promotive & curative services
◦Basic laboratory & maternity care
HC IV (161 facilities)
◦2nd level referral services for HSD, includessurgical & obstetric emergency care
Hospitals (113 facilities)
◦Comprehensive services
6
Antiretroviral Drugs for PMTCT
1. Basic Regimen
This is applicable in situations where:
there is no capacity for HIV disease staging
HAART is not available
it is not feasible to refer a woman duringpregnancy for further HIV disease evaluation
the woman gets to know her HIV status at 38weeks of gestation or later
7
Antiretroviral Drugs for PMTCT…
2. Combination Regimen
This is applicable situations where:
the woman presents for antenatal care before28 weeks of gestation
there is no capacity for HIV disease staging.
it is not feasible to refer the woman for furtherHIV disease evaluation
she is not eligible for treatment by the WHOstaging
HAART is not available but the woman iseligible for treatment on WHO staging
8
Antiretroviral Drugs for PMTCT…
3. HAART
This is applicable in situations where:
the woman presents for antenatal care from 14weeks of gestation onwards
clinical evaluation for WHO disease staging wasperformed and she is stage 3 or 4
investigations have been done to confirmeligibility for treatment: full blood count, CD 4cell counts and other laboratory assessments.
use of HAART is recommended such as inWHO clinical stage 2 with a CD 4 count of<350
9
10
Practical ApplicationPractical Application
Basic package:HC II facilities
Intermediate package:HC III facilities
Comprehensive package:HC IV facilities & Hospitals
Challenges
Human resources for health
◦Category of professional cadres
◦Absolute numbers of professional cadres
◦Competence (capacity building)
Logistics and supplies management
◦National
◦District and health facility levels
Infrastructure
11
12
FinallyFinally
12
