1. AIHA’s Pilot Project in Odessa: A Comprehensive MTCT Prevention and Intervention Program Zoya Shabarova American International Health Alliance

2. AIHA Strategic Framework to Prevent Mother-to-Child-Transmission of HIV in Odessa
“Plus-pMTCT-Plus”
First “Plus”: prevention of HIV among women of reproductive age and family planning for women with HIV
pMTCT: Prevention of mother-to-child transmission of HIV
End “Plus”: Follow up care and support for families

3. Ukrainian Context for MTCT Strategy
Prenatal HIV screening is widely available
Prenatal, perinatal and postnatal coverage is almost universal
High percentage of HIV+ women are IDUs; high percentage of infants are born addicted to drugs
Replacement feeding can be carried out by HIV infected mothers without major risks and obstacles
Because numbers of identified HIV infected women is still limited, it is still affordable to provide pMTCT interventions
The current, relatively low number of MTCT cases provides a window of opportunity to prepare the health care system to cope with the emerging problem

4. AIHA MTCT Pilot Project Goals
Reduce the incidence of HIV in women of reproductive age, increase the early identification of HIV+ pregnant women (Plus-pMTCT)
Prevention of MTCT during pregnancy, delivery and postpartum (pMTCT)
Provide follow up care and support to infants, mothers and families to ensure that children born to HIV+ mothers grow up in a sustainable, nurturing environment (pMTCT-Plus)
Prevent occupational exposure to HIV among healthcare workers
Create a model that is adaptable to other sites and a teaching laboratory to facilitate dissemination and replication (scaling up)

5. MTCT Project Strategic Partners in Odessa
Odessa Oblast Clinical Hospital
Odessa State Medical University
Odessa Oblast AIDS Center
Odessa Oblast and Odessa City Health Administrations
Boulder Community Hospital
University of Colorado’s Health Sciences Center
Children’s Hospital of Denver
International Donors Organizations and NGOs (MSF, UNICEF, PATH, Odessa PLWA NGOs)

6. Coordination of USAID Donor and Inter-Donor Efforts in Odessa
USAID Donors
JHPIEGO Family Planning Trainings including counseling component , Odessa Oblast Hospital
AIHA Consultation Training and Pre- and Post- HIV Testing Counseling workshop, May 2002, Kiev. Attended by all AIHA Women Wellness Centers (WWC) and PHCs including OOH
PATH VCT training, , Odessa
Inter-Donor
MSF: Provide Nevirapine, infant formula, C-section delivery kits for OOH and develop laboratory capacity; cooperation on Satellite Clinic development at OOH
UNICEF: Developed training materials on pMTCT in collaboration with OSMU and OOH

7. Main Components of AIHA’s Odessa Pilot Project
Develop a comprehensive strategy and establish widespread community support for key components.
Creation of a “center of excellence” at a designated healthcare facility (OOH).
Restructuring of health care delivery system: effective communication and referral system between health institutions, effective allocation of limited resources.
Development and implementation of relevant, evidence-based practical guides, informational brochures, and patient charts among others.
Training of healthcare professionals.
Assure high quality of care at designated health care facility (OOH).
Provision (including substantial donations) of essential medical equipment and supplies.
Coordination of activities with other donor organizations (MSF, UNICEF, PATH) and Odessa PLWA NGOs.

8. Project Milestones (1)
A catalogue of reference documents was developed (practical guides for healthcare workers, patient’s charts, and patient education materials).
A clinical training program was initiated in Denver in April 2002.
MTCT supplies and equipment were delivered to the Odessa Oblast Hospital.
A case management Monitoring and Evaluation PMTCT database was developed (in MS Access), data entry is in progress; preliminary results are available.
A MTCT training course curriculum for Odessa HCWs was developed.
Odessa Oblast Health Administration issued an order requesting HCWs from all women's consultations to participate in the MTCT training course (May 2002).
Odessa Oblast Health Administration issued an order in May 2002 that all HIV-positive pregnant be referred for prenatal care and for delivery to OOH.

9. Project Milestones (2)
Five abstracts based on project results were published in the XIV International AIDS Conference abstract book, six articles were published in the special volume containing the extended versions of the abstracts and five posters were presented.
MOH decided to use Odessa PMTCT M&E database as the basis for the development of national MTCT M&E database.
UNICEF asked AIHA to demonstrate the PMTCT M&E database during the UNICEF sponsored PMTCT Study Tour for CARK policy makers.
Satellite Clinic was opened for HIV+ people at the OOH in June 2003 (in collaboration with MSF).
The Odessa PMTCT Training center was opened in June In September , based on WHO/GTZ mission assessment visit, Odessa PMTCT Training center was chosen by as the element of WHO Knowledge Hub, focused on PMTCT.
Two abstract were published in Abstract book of 2nd IAS conference on HIV pathogenesis and treatment and two posters were presented at the conference in Paris.
Odessa model was the element of the PMTCT review in Ukraine conducted by WHO, UNICEF, Ukrainian MOH and international organizations. Two Odessa experts participated in this review in Kiev and Dnepropetrovsk.

10. Project Monitoring and Evaluation
Purpose of M&E:
to ensure that implementation is progressing as planned, to examine activities and determine the degree of achievement in meeting set objectives
Two types of results:
Replicable management tools (practical guides, information brochures, charts, etc.)
Clinical

11. MTCT Practical Guides
Purpose: Provide improved practice guidelines for OB/GYNS,
neonatalogists, pediatricians, family physicians, nurses, midwives, social
workers and lab technicians on various aspects of treating HIV+ patients.
Family Planning for Women with HIV
Prevention and Treatment of STIs
Treatment of STIs in HIV+ Pregnant Women
Infection Control Practices
Voluntary Counseling and Testing in Prenatal Care
Prenatal Care for HIV+ Women
Prevention of MTCT During Delivery
Infant Feeding for Babies Born to HIV+ Women
Pediatric Care for Infants Born to HIV+ Mothers
Primary Health Care for HIV+ Patients
PMTCT among women who are IDUs

12. Other MTCT Products for Dissemination
1. Questionnaires
Purpose: Assess knowledge of HIV/AIDS and MTCT of healthcare
workers in maternity houses and pediatric settings. Questionnaires have also
been developed for parents and guardians of children born to HIV infected
mothers and for HIV+ pregnant women.
2. Information Packages
Purpose: Disseminate information among women of reproductive age and HIV+
women on HIV prevention, pregnancy and HIV testing, HIV, newborn and infant
Care.
3. Patient Charts
Purpose: Collect and maintain information about HIV infected women and
Infants.

13. Monitoring of Clinical Results
Within “Plus-PMTCT-Plus” approach, PMTCT can be considered as a cascade of program intervention to stop the transmission of HIV from mother to child, integrated into the MCH and PHC schedule (UNAIDS, 1999; UNICEF, UNAIDS, WHO, 2001).
The MCH schedule provides a basis for monitoring and evaluating the PMTCT project clinical results. Cascade of interventions is based on the best available evidence, adapted to regional situation.

14. Main M&E Indicators MTCT rate in OOH.
Number of HIV positive women who was registered for prenatal care before the 2 trimester of pregnancy (delivery at OOH).
Number of HIV positive pregnant women who had PMTCT counseling at OOH.
Number of cases where the HIV positive status was known before delivery in OOH.
Number of HIV positive pregnancies appropriately treated for PMTCT at OOH.
Number of HIV positive deliveries appropriately handled for PMTCT at OOH.
Number of babies, exposed to HIV, appropriately treated for PMTCT at OOH.
Number of HIV positive women and their babies who received family oriented follow up care at OOH Satellite Clinic.
Number of health care professionals, trained for PMTCT, in Odessa region.

15. Selected PMTCT Project Preliminary Data

16. Future Directions
Replication of Odessa PMTCT Model in other regions in Ukraine and the NIS
Development of comprehensive model of care and treatment to women with HIV and HIV infected children
Further development of the Odessa PMTCT Training Center as “Teaching Laboratory” on PMTCT for the NIS region