PMTCT Outcomes Enhanced by Psychosocial Support and Education for Mothers June 19, 2012 Johannesburg, South Africa

m2m Goals Reduction in early and late transmission of HIV Reduction in maternal mortality associated with HIV Improved RMNCH Empowerment of women Reduction in stigma associated with HIV

m2m Overview Operating for over 10 years Trains and employs women living with HIV from local communities to provide PMTCT peer education and support Serves pregnant women, new mothers & their male partners Employed more than 4,000 Mentor Mothers since m2m’s founding Employs 1519 staff, in 609 health facilities in 7 countries

Key findings from m2m 2010 and 2011 client cohorts

Gestational age at 1 st visit by country: most women present late for care n=3474 n=751 n=983 n=10435 n=1624 n=308 n=669 N=18244

Uptake of any ARV during pregnancy, by country, 2010 and 2011 Cohorts * UNICEF. (2011). Children and AIDS: Fifth stocktaking Report, Geneva: UNICEF, UNAIDS, WHO & UNFPA. *53% Uptake in Low to Middle income countries 2011: n=771 n=724 n=3568 n=11123 n= : n= 1313 n=991 n= 2059 n=4217 n=898

m2m clients receiving more psychosocial support report higher uptake of ARV during pregnancy m2m Kenya*m2m Lesotho** *X 2 =399.09, p<.001 **X 2 =71.33, p<.001 n-=781 n=499 n=871n-=164 n=127 n=242

Coefficients and odds ratio from logistic regression of uptake of any antenatal ARV amongst m2m clients in 2011 BS.E.95% C.I. for EXP(B) LowerOdds ratiosUpper Disclosure Not yet disclosed* 1 Disclose to anyone 1.14** Done CD4 test No*1 Yes.66** Came as a Couple No*1 Yes Knowledge of Male partner status No*1 Yes.39** Gestational at 1st visit 1 st Trimester* 1 2 nd Trimester.38** rd Trimester 1.32** Number of m2m antenatal visits 1 m2m visit* 1 2+ m2m visits.27** m2m visits.83** m2m visits 1.39** *Reference category R Square=.17 (Cox & Snell),.25 (Nagelkerke) **P<.001

High Disclosure rates amongst clients receiving psychosocial support in 2010 and 2011 Cohorts 2011: n=1579 n=1250 n=5763 n=17200 n=4225 n= : n= 1133 n= 2366 n= 4069 n= 4947 n=2573 n=15088

*Uptake of PCR testing amongst m2m clients higher amongst those enrolled earlier in psychosocial support… m2m client type overall pattern…m2m Country differentials… *Fishers exact test for differences within countries, p<.001 n=12842 n=7200

*Infant PCR test positivity is lower amongst m2m clients enrolled earlier in psychosocial support… Country Program Enrolled to m2m after delivery N (%) TotalEnrolled during pregnancy & post delivery N (%) Total Kenya124 (12) (4)1306 Lesotho20 (12)1647 (3)247 Malawi14 (23)601 (7)40 South Africa163 (11) (3)1031 Swaziland57 (10)57412 (4)278 Uganda28 (9)3234 (3)157 Zambia27 (10)2619(9)98 *m2m overall433 (11%) (4%)3157 *Fishers exact test for differences between clients enrolled during pregnancy vs. enrolled post delivery p<.001

Discussion m2m evidence shows that retention in psychosocial care improves outcomes “Dose response” importance of psychosocial visits=health facility dose Disclosure key to uptake and adherence of services Earlier enrolment and follow through in psychosocial services improve outcomes Challenges Late presentation of women for antenatal care Implications for retention and initiation in care Retention is challenging given inter-health facility movements in health systems

m2m services: integrated in facilities, promote referrals generate demand for PMTCT services, treatment, and care to keep mothers alive stigma reduction diminishes demand-side barriers to ARV uptake Demand Creation and Retention

Retention Initiatives Let’s SOAR (Strengthening Outcomes by Analyzing Results): enables site staff to understand data/improve program Active Client Follow Up (ACFU): active client follow-up improves client retention in PMTCT cascade through phone calls, SMSes, and/or home visits

1) Daily site-level data collection 2) Quarterly data review and action planning 3) Improve client health! HOW we ‘SOAR’

m2m Program Department 16 Thank you!