1. PMTCT /Paediatric AIDS Program: Karamoja Experience Achievements and Challenges Presentation during Children and AIDS Retreat Mountain of the Moon Hotel Fortportal September 2009

2. Background Projected population = 1,060,900. Estimated pregnant women = 41,713. HIV prevalence 3.7% (MoH; 2005, Sero behavioural survey). Number of pregnant women expected to be HIV+ = 1,543 (at 3.7% prevalence).

3. Background cont.. Number of ANC sites = 37 Number of PMTCT sites = 34 (90% ANC coverage) Implementing partners CESVI (Abim and Kaabong district) IRC (Kotido, Moroto and Nakapiripirit district) CUAM (all the 5 districts).

4. 2009 AWP Inputs (Cash and supplies) Total direct disbursement to the district stands at 124,642,650 (32%); Planned amount in AWP 396,922,200. 3 district have submitted their second funding request. Supplies that included drugs for prophylaxis (ARVs, Cotrimoxazole), HIV test kits, Mama kits, gloves, cotton wool, Vacutainer tube needles and holders etc). Received 2 vehicles and 8 motor cycles to support programme implementation.

5. Out puts (Jan – July 2009) 131 health workers skills in Paediatric HIV testing and DBS collection enhanced through training. 160 HIV exposed babies tested through PCR and 32 (20%) tested positive.

6. Out puts (Jan – July 2009) cont. 58 Health Workers (Nakapiripirit 14, Kotido 10, Moroto 21 and Kaabong 13) trained and their skills on PMTCT HIV counseling and testing improved.

7. Out puts (Jan – July 2009) cont. Counseled and tested 16,235 pregnant women through static and outreaches in hard to reach areas. Enrolled 239 out of 333 HIV positive women into the PMTCT.

8. Out puts (Jan – July 2009) cont. 900 members of the VHTs (Abim and Kaabong) have been oriented on PMTCT. VHTs participating in raising awareness on PMTCT among communities and mobilising pregnant women to attend static and outreach ANC clinics. Scale up to other districts (Moroto, Kotido and Nakapiripirit)

9. Out puts (Jan – July 2009) cont.. Community mobilized through MDD to influence and change their behaviour and attitude towards safer sexual behaviours and HIV testing with emphasis on pregnant women and their partners

10. Out puts (Jan – July 2009) cont. Following up HIV positive mothers and their babies through home visiting. Challenged by high mobility pattern in search of food.

11. Out puts (Jan – July 2009) cont Improved data reporting from the health units. Utilization and validation remains a challenge with discrepancies seen between PMTCT and HMIS reports. Minimal stock outs of supplies reported. This is attributed to buffer stocks supplied by UNICEF. Streamline the reporting, requisitions and delivery from NMS which remains challenging.

12. Regional Performance (Jan – July 2009) IndicatorKaramoja ANC sites37 PMTCT sites34 Estimated pregnant mothers41,713 Pregnant mothers tested16,235 Mothers tested +ve333 Mothers given ARVs239 Babies given ARVS135

13. District performance (Jan – July 2009) IndicatorAbimKaabong KotidoMorotoNakap PMTCT sites53 6118 Estimated pregnant mothers 2,67515,830 9,40813,80011,335 Pregnant mothers tested 2,646 98% 2,723 17% 3,778 40% 4,218 31% 2,870 25% Mothers tested + ve8625 789648 Mothers given ARVs 6112 498235 Babies given ARVS 337 4814

14. Challenges Low ANC attendance and institutional deliveries; difficulty in dispensing ARVs to new born babies? Role of VHTs/TBAs. Understaffing vs competing priorities. Lack of Psychosocial Support. (no NGOs supporting PHA networks especially livelihood for women and OVCs). Lack of EID and CD4 testing facility in the region resulting in long results turnaround time. Mixed feeding among HIV positive mothers compounded by poor follow up.

15. Lessons learnt Increasing incidences of GBV emerging from disclosure of HIV status. Need for mitigation measures. Involvement of PHAs have not been exploited in sensitization of communities and fighting stigma. VHTs is a critical structure in communities mobilization and awareness raising. Family centred approach to clients enhance disclosure, initiation on ART and adherence.

16. Priority areas up to Dec 2009 Counseling and testing, provision of ARVs to +ve mothers, EID. (static and outreaches including home based counseling and testing). Community mobilization to raise awareness and increase service utilization by use of VHTs, drama, radio programs etc. special emphasis on Male participation. Follow up and referral of HIV positive pregnant women and their children for both PMTCT and comprehensive ART services. Supply chain (timely requisition to NMS of ART drugs to avoid stock out). Programme monitoring, supervision and evaluation through field monitoring visit, review meeting, data validation.

17. PMTCT sites by district Moroto district 1. Moroto hospital 2. Kidepo HC III 3. Lotome HC III 4. Lokope HC III 5. Iriiri HC III 6. Matany Hospital 7. Nadunget HC III 8. Tapac HC III 9. Lopei HC III 10. Kangole HC III 11. Moroto Army HC III Kotido district 1. Kanawat HC III 2. Kotido HC IV 3. Kacheri HC III 4. Kotido CoU HC III 5. Rengen HC III 6. Nakaperimoru HC III Abim district 1. Abim hospital 2. Rwamuge HC III 3. Morulem HC III 4. Nyakwai HC III 5. Alerek HC III

18. PMTCT sites Nakapiripirit district 1. Tokora HC IV 2. Nabilatuku HC IV 3. Amaler HC III 4. Namalu HC III 5. Nakapiripirit HC III 6. Lolachat HC III 7. Lorengedwat HC III 8. Amudata Hospital Kaabong district 1. Kaabong hospital 2. Karenga HC IV 3. Kalapata HC III

19. Welcome to a Manyata

20. Thanks Alakara Noi