1. Decentralization of Option B+ services and implications for task shifting Dr Franck Fwamba N’kulu National AIDS & STI Control Programme Democratic Republic of Congo ICASA 2015

2. DRC context prior to Option B+ 1.SITUATION: – Limited health facilities offer HIV services to pregnant women – Majority of the population is poor with high fertility rates – High cost of transportation – Antiretroviral therapy (ART) driven by physicians – Most pregnant women attend primary healthcare clinics (PHC) run by nurses 2.OPTION B+ RESPONSE – Decentralisation of ART to PHC level – Task shifting for ART services – Many more facilities offering PMTCT services – Strengthening supervision activities 218th ICASA, Harare

3. Decentralization of Option B+ services 1.Objective: Increase access to HIV services for pregnant women and their families 2.Strategy: Strengthen capacity of Primary Health Care facilities to provide HIV services Strengthen health systems Strengthen community – facility linkages 318th ICASA, Harare

4. Strengthen capacity of Primary Health Care facilities to provide HIV services Since 2013 1.Strengthen the capacity of the province to provide PMTCT services at PHC level – Train nurses and other health workers at Zone de santé (health district) and health facility levels – Introduce monthly facilitative supervision at facilities – Introduce data-driven planning at all levels (health zone, health facilities and provincial levels) – Train HCWs in stock management of commodities 418th ICASA, Harare

5. Health System Strengthening Enabling environment Introduce task shifting policy - initiation of ART and management by nurses Revise national guidelines and training manual Adopt combined ART treatment for pregnant women Revise data collection tools & national ME system Introduce PMTCT indicators in the report and data driven planning at all levels 518th ICASA, Harare

6. Health system Strengthening (cont…) Train HCP and management on data-driven planning and ensuring quality of services Introduce facilitative supervision approach for HCP 618th ICASA, Harare

7. Community – facility linkage Inventory CBO and support groups Train HCP on community – facility linkage Train CBS and groups on community-facility linkage, tracing of and support to women + and their families Train community health workers on two-way referral of HIV infected pregnant women and their families 718th ICASA, Harare

8. Results SUMMARY All health facilities in six health district in Katanga Province have introduced HIV services at PHC level (public and private sector) Over 90% of pregnant women tested for HIV at all health facilities Nurse prescribe and follow pregnant women on ART Health system strengthened to ensure the provision of HIV services to HIV infected pregnant women and HIV exposed children 818th ICASA, Harare

9. Health facilities providing PMTCT 918th ICASA, Harare

10. Who initiates ART? 1018th ICASA, Harare

11. Timing of HIV testing 1118th ICASA, Harare

12. Challenges Viral load measurements for pregnant women and breastfeeding mothers not available Loss to follow up and weak adherence to treatment 1218th ICASA, Harare

13. Scale up lab plan(VL & EID) Lab situation, The end 2014Lab situation, the end 2017 13 PNLS, Plan extension CV et EID en RDC, 2015 18th ICASA, Harare

14. Opportunities, 2 The new program to strengthen the community system 1418th ICASA, Harare