1. CHAZ Each Community Counts Each Community Counts Community Leadership Spearheading PMTCT Program to Improve Health Outcomes of HIV Exposed Babies, at Nangoma Hospital, Zambia Dr. Dhally Menda MD, MPH, MBA Maternal and Newborn Health Conference for Zambia’s Mothers and Babies 01 st November 2012 www.chazhealth.zm.org

2. CHAZ Background Information “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Formation & Membership Formed in 1970 ( Catholic and Protestant Medical Committees) Interdenominational (Catholic and Protestant) umbrella organisation for 146 CHIS in 10 Provinces: 36 Hospitals & 81 RHCs & 9 Training Schools 29 CBOs Health Services Coverage CHAZ is the second largest provider of health services in Zambia. MoU with the MoH: Grant- Staff Secondment – Essential Drugs PMTCT and ART Sites PMTCT: 61 ART: 51

3. National Strategic Framework HSS in 146 CHIs HIV & AIDS TB Control Malaria Control Sensitizations PMTCT: 13,157 ART: 48,979 Awareness Campaigns MNCH CSS≥ 500 CBOs Mentoring & TA C&T: 361,111 MC: 7,453 CHAZ Health Programmes

4. Background “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Nangoma is a Mission hospital is situated in the rural Central Province ART and PMTCT programs: Initiated in 2006 – Support: GF ATM Catchment: 80,000 & Polygamous society HIV prevalence rate among pregnant women aged 15-40: 9.5%. Home Deliveries (60%) due to: Long distances, Traditional beliefs, Myths and Stigma. – Exposed babies at risk of getting HIV Sensitized the Senior Chief (Shakumbila) and all his entourage on the importance of PMTCT. Lobbied the Chief to have all pregnant women deliver from HF Home Delivery Penalty: Goat Method

5. Method Cont’d “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 To improve the PMTCT outcomes, the Hospital ART/PMTCT Team came up with an HIV Prevention Strategy that embraces all community members. Throughout 2010, the ART/PMTCT team: Recruited mothers to join the Mothers’ Support Groups, to encourage networking and fight against discrimination Recruited Adherence Supporters Workers to help in client (mother/infant pair) defaulter tracing Involved men, through community leaders and hospital staff, to come with their wives for all Antenatal Clinic visits Encouraged HIV +ve pregnant women, living in distant areas from the health facility, to stay at the Maternity Waiting Home, when they enter their 3 rd Trimester of pregnancy. Encouraged all ANC clients to undergo VCT as a couple. Provided ART and/or ARVs Prophylaxis to the mother-baby pair Provided EID.

6. Results “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 The community leadership and members embraced the initiative and took the project to the next level. As a result: HF deliveries increased from 60% in 2008/09, to almost 100% in 2010. Figure 1: Improvement in health facility deliveries

7. Result Cont’d “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Out of the 72 HIV +ve mothers who delivered at Nangoma Hospital: 93% of delivered babies with a negative HIV PCR test. Among the 24 women who delivered at home (no PMTCT intervention), from outside the chiefdom, 20% of their babies had a positive HIV PCR test (P=0.05). Figure 2: Improvement in health facility deliveries

8. Conclusion “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 PMTCT interventions with a strong community involvement have a positive impact on the health outcomes of HIV exposed babies (Avert HIV infection). Involvement of the community through community leadership, can help rural based Health Facilities improve: ANC attendance, Couple Counseling, and Health Facility deliveries

9. Acknowledgment and Thanks “He sent them to preach the Kingdom of God and heal the sick” Luke 9:2 Thank you God bless Acknowledgement: Co-Authors: M.M. Bwalya, P.M. Mulenga, J. Simutowe, M. Zulu, S. Hambilika, K. Sichinga Partners: MoH GFATM Nangoma Hospital Staff Nangoma Community