Community Innovation in eMTCT Learnings from Positive Action for Children Fund Durban July 2016

Who are we? An initiative of ViiV Healthcare 157 partnerships (current) + capacity building eMTCT and paediatric HIV focus Smaller community groups (avg grant about £15,000 p.a.) Capacity building support

In 21 priority countries, since 2009... 60% drop in new infections Huge Progress In 21 priority countries, since 2009... 60% drop in new infections 1.2m infections averted amongst children Significant reduction in children infected perinatally over 270,000 -> 110,000 p.a. Children on treatment 15% -> 51% Source: UNAIDS Press Release; June 2016 (http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/june/GlobalPlan2016)

How leaky a cascade? Primary prevention Low awareness, lack of understanding, poor sex education, lack of power & rights, cultural & religious beliefs... Preventing unintended pregnancies Low awareness of F.P, lack of power & rights, unwillingness of men to accept condom use, willingness to accept disclosure from partner PMTCT Late presentation at clinic, loss to follow-up Supporting Mothers Job’s done?, have to think beyond health, women spend time in community

Plugging remaining leaks Primary prevention Low awareness, lack of understanding, poor sex education, lack of power & rights... Preventing unintended pregnancies Low awareness of F.P, lack of power & rights, unwillingness of men to accept condom use PMTCT Late presentation at clinic, loss to follow-up Door-to-door outreach Edutainment Community testing Working in schools Clinic Referrals Working with community leaders – raising awareness, changing by-laws Supporting Mothers Job’s done?, have to think beyond health

Plugging remaining leaks Primary prevention Low awareness, lack of understanding, poor sex education, lack of power & rights... Preventing unintended pregnancies Low awareness of F.P, lack of power & rights, unwillingness of men to accept condom use PMTCT Late presentation at clinic, loss to follow-up Edutainment Working in schools Clinic Referrals Door-to-door outreach Supporting Mothers Job’s done?, have to think beyond health

Plugging remaining leaks Primary prevention Low awareness, lack of understanding, poor sex education, lack of power & rights... Preventing unintended pregnancies Low awareness of F.P, lack of power & rights, unwillingness of men to accept condom use PMTCT Late presentation at clinic, loss to follow-up Tracking people Counselling & support Accompanying people to clinic Ensuring births happen in facility Follow-up during breast-feeding & EID Supporting Mothers Job’s done?, have to think beyond health

Plugging remaining leaks Primary prevention Low awareness, lack of understanding, poor sex education, lack of power & rights... Preventing unintended pregnancies Low awareness of F.P, lack of power & rights, unwillingness of men to accept condom use PMTCT Late presentation at clinic, loss to follow-up Ensuring continued access to care Livelihoods – nutrition & financial (Savings, IGAs) Risk reduction Schooling Counselling & peer support Supporting Mothers Job’s done?, have to think beyond health

Partners working across continuum Primary prevention Preventing Unintended Pregnancy PMTCT Supporting Positive Mothers & Families Applications/Projects Volume of Life Concern Mai Khanda Pride Community Health Organisation Kabangwe Case Studies Addis Hiwot Rehabilitation & Reintegration Association PATA C3 Partners

Life Concern, Malawi Driving access to and uptake of PMTCT by strengthening existing healthcare infrastructure, promoting male involvement and encouraging broader community participation. Fall in home deliveries, progress on access to and uptake of testing services has been impressive: in just 10 months, 813 couples were tested for HIV – compared to just 41 couples at baseline.

Pride Community Health Organisation, Zambia Support Safe Motherhood Action Groups. These groups have facilitated couples counselling, identifying pregnant women who are yet to attend clinic. Increases in male participation, Number of pregnant women attending their first antenatal care appointment has tripled.

Addis Hiwot Rehabilitation & Reintegration Association, Ethiopia Use mobile technology to provide home-based counselling, support, follow up and tracing those lost to follow up. Between 2012 and 2015: The number of pregnant mothers attending all ANC appointments rose from 457 to 692 p.a. The number of lactating mothers who attended post-natal care visits near doubled, increasing from 142 to 263 p.a.

Kabangwe, Zambia Focused on getting men to engage and take their women to clinic Baseline 183 out of 486 (38%) women lost to follow-up during pregnancy Within 5 months, 18% retained in care (male partner initiated visits)

Mai Khanda, Malawi Women’s groups led by volunteer facilitators, identifying and solving problems specific to the local context. Simultaneously, groups participate in income generating activities with profits used to fund bicycle ambulance, emergency transport funds and medical supplies to support safer births. One group raised over 300,000MWK.

Micro x Many = Big Effects!! 1.8 million reached 270,000 referred into the health system (for PMTCT care, ANC, and testing primarily) 167,000 births in facility 210,000 tests 20,000 testing positive Source: October 2015. PACF Reporting 2010-2015.

Selected Learnings At a micro - level, huge impacts Some things better than others Communities can optimise investments made in health systems Communities ensure people treated holistically, health not separate from rest of life

For more info: positiveactionforchildren@viivhealthcare.com Thank You For more info: positiveactionforchildren@viivhealthcare.com