Category Archives: Implementation

July 27, 2012 · 4:10 pm

Statement from EGPAF and m2m on WHO’s Option B+ Approach to Protect the Health of HIV-Positive Mothers and Their Babies

WASHINGTON, D.C. – July 27, 2012 – At the XIX International AIDS Conference in Washington, D.C., there has been growing global momentum around optimal approaches to prevent transmission of HIV from mother to child and to keep HIV-positive mothers alive and healthy.

The World Health Organization (WHO) recently encouraged countries to consider accelerating the adoption of one of two options for preventing mother-to-child transmission of HIV (PMTCT) that both include added benefits for and emphasis on the health of mothers. Option B includes the use of triple-drug therapy for the mother during pregnancy and breastfeeding, and Option B+ continues that drug regimen for the mother’s lifetime.

The WHO’s three options – Options A, B, and B+ – all afford similar protection against mother-to-child transmission of HIV, but Option B+ has the greatest potential for health benefits for infected women, and can confer protection against transmission of HIV to an uninfected partner.

There is growing consensus that Option B+ represents an evolving best standard for protecting both mother and child from the effects of HIV. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and mothers2mothers (m2m) support the development and implementation of revised WHO technical and operational guidelines, and will assist the implementation of whichever option is chosen by national governments.

Adoption of Option B+ will require careful study of new and existing operational issues. EGPAF is prepared to use its considerable country presence, technical capacity, and research ability to investigate the operational issues that need to be addressed and understood for optimal implementation of this regimen. Issues that should be studied through operations research include acceptability, adherence, drug resistance, retention, safety, and funding. EGPAF has been an instrumental partner in assisting the WHO and individual countries to implement past guidelines, and will continue to assist as new guidelines are updated.

m2m will support country efforts to implement Option B+ by using its simple and effective Mentor Mother model to promote enrollment and retention in care. Because m2m’s Mentor Mothers provide additional human resources – educating and supporting mothers as they learn to understand, accept, and adhere to lifelong treatment regimens – they can further ease the pressure this new protocol might cause already strained health systems. m2m is prepared to use its trusted presence in communities to ensure that all women, especially those not currently accessing care, are able to benefit from Option B+.

As organizations working to implement the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, we are committed to overcoming any obstacle that prevents us from reaching our goal of ending HIV/AIDS in children and mothers.

There are still large numbers of HIV-positive, pregnant women who cannot access any effective PMTCT services, and so we must ensure that countries are able to accelerate efforts toward universal coverage.

We must also adequately address implementation barriers, such as weak health systems – especially in more rural settings – lack of human resources for health, and a need for significant education and community-based support to promote adherence to lifetime therapy and long-term retention in the health system.

We look forward to supporting countries to overcome these issues as they work toward achieving an AIDS-free generation.

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 About the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF):  The Foundation is a global leader in the fight against pediatric HIV/AIDS, reaching more than 14 million women with services to prevent transmission of HIV to their babies. It currently works at more than 5,400 sites and in 15 countries to implement prevention, care, and treatment services; to advance innovative research; and to execute global advocacy activities in order to bring dramatic change to the lives of millions of women, children, and families worldwide. For more information, visit www.pedaids.org. For live updates and resources from EGPAF at the XIX International AIDS Conference, visit www.EGPAF-IAS.org, and follow us @EGPAF.

About mothers2mothers (m2m):  mothers2mothers (m2m) is eliminating transmission of HIV from mothers to babies and sustaining the health of women and children with its proven Mentor Mother model. Since its inception, m2m has reached more than one million mothers in nine countries. Founded in Cape Town in 2001, m2m is a partner in the United Nations’ Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. Learn more at m2m.org or follow mothers2mothers @m2mtweets.

Contacts:

Michelle Milford Morse, mothers2mothers; Phone: 323-969-0445; us@m2m.org

Robert Yule, Elizabeth Glaser Pediatric AIDS Foundation; Mobile: 202-390-9540; ryule@pedaids.org

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Filed under Community, EGPAF, Global Plan, IAC 2012, Implementation, Pediatric Treatment, PMTCT, Research

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July 26, 2012 · 12:54 pm

Canadian International Development Agency and EGPAF Partner to Increase Uptake of MCH Services

By Robert Yule

This week the Canadian International Development Agency (CIDA) and EGPAF announced a new partnership to promote increased use of services for maternal and child health (MCH) and prevention of mother-to-child transmission of HIV (PMTCT).

On Monday, EGPAF gave a presentation at the IAC’s Canada Booth introducing our work to support national PMTCT programs, and the types of interventions that will be used through the ACCLAIM project with CIDA.

Read below for a joint press release from CIDA and EGPAF about this partnership:  

 

New ACCLAIM Program Will Help Expand MCH/PMTCT Services in Swaziland, Uganda, and Zimbabwe

Washington, D.C. – At the XIX International AIDS Conference, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) today announced a new partnership to improve progress toward elimination of pediatric HIV/AIDS. The project, Advancing Community-Level Action for Improving MCH/PMTCT (ACCLAIM), seeks to increase demand and retention in maternal and child health and prevention of mother-to-child transmission of HIV (MCH/PMTCT) services. The project is supported by the Canadian International Development Agency (CIDA), which has pledged CAD $10 million over a four-year period to fund the partnership.

The ACCLAIM Project will focus on changing community norms and attitudes about key health behaviors related to HIV, maternal and child health, and gender through targeted community-based interventions. The project will also use research to assess the behavioral and operational outcomes of selected community-based interventions and their relative effectiveness.

The program will help expand services in Swaziland, Uganda, and Zimbabwe, and will focus on three key interventions:

  • Engagement of Community Leaders: Training and capacity-building to generate increased demand for MCH/PMTCT services through development of Community Action Plans
  • Community Days: Semi-annual days of information, communication, and activities to generate awareness
  • Peer Support Groups: Men’s groups and MCH classes to increase and improve MCH/PMTCT behaviors.

CIDA’s contribution is part of the Canadian HIV Vaccine Initiative, a collaboration with other Canadian federal departments and the Bill and Melinda Gates Foundation. As work towards the development of a safe, effective, affordable, and globally-accessible vaccine continues, HIV prevention efforts must also continue, and CIDA is focusing efforts on the prevention of mother-to-child transmission of HIV.

This work will emphasize the need to scale up prevention of mother-to-child transmission programs and reach more HIV-positive pregnant women with simple and highly-effective – yet underutilized – interventions. It will also support operations research to analyze and overcome existing barriers to delivering prevention of mother-to-child transmission services.

“The Canadian International Development Agency has demonstrated a strong commitment to improving the welfare of women, children, and communities affected by HIV and AIDS,” said Charles Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation. “We are proud to work with CIDA on this partnership, which will ensure that more mothers and children have access to essential prevention of mother-to-child transmission services by strengthening community support for those living with HIV and AIDS.”

“Canada is taking action that is saving the lives of women and their children,” stated Minister of International Cooperation, Julian Fantino. “Through our partnership with the Elizabeth Glaser Pediatric AIDS Foundation, we are working to protect women and children from HIV and prevent the transmission of HIV from mothers to their infants.”

While virtual elimination of pediatric HIV/AIDS has been achieved in high-income countries like the United States and Canada, much more needs to be done to protect women and children from HIV in the developing world. Each day, 900 children are needlessly infected with HIV, primarily in sub-Saharan Africa. With the proper medicines and PMTCT services, the risk that a mother with HIV will transmit the virus to her baby can be reduced to virtually zero.

It is critical to link vital facility-based PMTCT services with communities, many of which are rural and far from even the closest clinics. The EGPAF/CIDA partnership will address the need for community-level engagement and support for women, children, and families affected by HIV/AIDS.

The global impacts from this project will be:

  • An evidence base for packaged interventions to improve demand, access, retention, and participation in PMTCT programs at the community level;
  • Documentation of challenges and lessons learned from community-focused PMTCT-MCH interventions;
  • The opportunity to implement community interventions across different contexts, with greater involvement of men in PMTCT programs; and
  • The opportunity to contribute to literature on the effects of capacity building of local leaders on HIV/PMTCT outcomes.

Bringing interventions to communities will help ensure uptake and retention in life-saving PMTCT and MCH services, and the healthy survival of mothers, children, and families.

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About The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF):

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a global leader in the fight against pediatric HIV and AIDS, and has reached more than 14 million women with services to prevent transmission of HIV to their babies. The Foundation currently works in more than 5,400 sites and in 15 countries to implement prevention, care, and treatment services; to further advance innovative research; and to execute global advocacy activities in order to bring dramatic change to the lives of millions of women, children, and families worldwide. For more information, visit www.pedaids.org and www.amothersfight.org.

About the Canadian International Development Agency (CIDA):

The Canadian International Development Agency (CIDA) is Canada’s lead agency for development assistance. CIDA’s aim is to manage Canada’s support and resources effectively and accountably to achieve meaningful, sustainable results. It also engages in policy development in Canada and internationally, enabling Canada’s effort to realize its development objectives.

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Filed under EGPAF, IAC 2012, Implementation, MCH, Pediatric Treatment, PMTCT, Public-Private Partnerships, Research, Swaziland, Uganda, Zimbabwe

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July 23, 2012 · 3:18 pm

“Eliminating pediatric AIDS and keeping mothers alive from an implementation perspective” – Satellite Session on best practices, programmatic barriers and bottlenecks in the field

By Alex Ekblom

On Sunday, EGPAF, mothers2mothers (M2M) and Johnson & Johnson (J&J) hosted a satellite entitled “Eliminating pediatric AIDS and keeping mothers alive from an implementation perspective – best practices, programmatic barriers and bottlenecks in the field.” This was a four-part/panel series of presentations moderated by John Donnelly, a journalist from GlobalPost.

EGPAF Swaziland’s Caspian Chouraya

The first part had to do with country-level approaches around building capacity of HIV service implementers, which highlighted Kenya’s mentor mothers approach (where HIV-positive mothers are trained to coordinate access to and retention in care among other HIV-positive mothers), EGPAF-Zimbabwe’s experiences in reducing costs of all-level health care worker training by reduction in time of training and facilitators (saving $185.00 per participant), and SAATHI’s experience in engaging the private sector to increase local PMTCT capacity (including collaboration of 17 NGOs to increase private site coverage, which has reached 1.2 million women with PMTCT care).

The second panel focused on supporting continuity of care and featured m2m’s work on mother mentors in retaining women through use of smartphones and SMS reminders, and NASCOPs implementation of a courier system to shorten turnaround time for early infant diagnosis of HIV.

The next panel was centered around how to create demand to increase uptake of PMTCT. Examples included the use of m2m mentor mothers, who increase quality of care to clients by relieving health worker burden/task shifting, EGPAF-Zambia’s integration of syphilis and HIV testing (through innovations in rapid testing) and the use of 8 steps to roll out effective integration, and EGPAF-Lesotho’s implementation of integrated health services and the use of Family Health Days, or mobile health services which offer a variety of testing and treatment options for HIV, opportunistic infections.

EGPAF Zambia’s Susan Strasser

The final panel focused on data use and highlighted m2m’s “let’s SOAR” initiative, which included a quarterly data review component, where site coordinators could review daily recorded data and assess areas for needed improvement, EGPAF-Swaziland’s data collection and review mentorship activities, EGPAF-Rwanda’s implementation of an excel macro tools to issue feedback to supported facilities through reports of facility and district data (from which facilities could see where improvements were needed), and EGPAF-Tanzania’s experience implementing quality improvement initiatives to strengthen pediatric care.

Delegates brought interesting questions into the discussion. One of which was how can we better prioritize the “keeping their mothers alive” portion of the global plan. It’s an important point for upcoming work on elimination of MTCT.

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Filed under EGPAF, Global Plan, Implementation, India, Kenya, Lesotho, MCH, mHealth, Pediatric Treatment, PEPFAR, PMTCT, Rwanda, Swaziland, Syphilis, Tanzania, Zambia, Zimbabwe

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· 1:20 pm

“Together We Can” – EGPAF Zimbabwe Satellite Session on Eliminating New Pediatric HIV Infections through Public-Private Partnerships

By Alex Ekblom

On Sunday, the Zimbabwe team hosted their satellite, “Together We Can: Achieving Virtual Elimination of New Pediatric HIV Infections in Zimbabwe by 2015 Through Strategic Public-Private Partnerships”, which featured introductory remarks from Chip Lyons, and presentations from Nick Hellman, Agnes Mahomva, Auxilia Muchedzi, Batsi Chikwinya, Caroline Zinyemba, Angela Mushavi, Theresa Ndoro of OPHID and Peter McDermott, Managing Director of CIFF.

The satellite focused on Zimbabwe’s pediatric HIV context (151,000 children are living with HIV in Zimbabwe), engagement in the national pediatric HIV elimination agenda in Zimbabwe, and key innovations that will be rolled out to achieve this goal.

Angela presented on national strategies, including implementation of a results-based management system,  integration of health services, implementation of a multi-disciplinary approach, supportive engagement with people living with HIV, and how to strengthen human resource capacity, supply chain management, and lab capacity. Angela underscored the need for community involvement to achieve elimination.

Agnes presented on the recent rapid coverage expansion of PMTCT services  (especially in the accelerated coverage of more efficacious drug regimens) through a variety of approaches, including use of district focal persons, implementation of point-of-care CD4 testing, and mass communications on PMTCT. She indicated that meaningful partnerships with other NGOs and government agencies are instrumental in achievement of this national goal.

Batsi discussed implementation of the district focal person and how EGPAF trained 30 nurses to support districts to roll out increased coverage of PMTCT.

Auxilia presented on the national roll-out of 50 point-of-care CD4 machines, which (based on a quasi-experimental study of the intervention) have effectively increased testing of HIV and enrollment in care.

Carol focused her presentation on a national communications strategy deployed by EGPAF, in collaboration with the Ministry of Health and Child Welfare in Zimbabwe, which has included a training of 30 journalists on PMTCT, and newspaper and radio announcements on the importance of engagement in PMTCT.

Peter McDermott presented on a donor perspective focused on strengthened cost/data analyses. He indicated that what we should aim to not just change policy and practice in one geographic location for the better, but to build a body of knowledge around good HIV programming for global policy and practice change. He highlighted what it will take to eliminate pediatric HIV, which includes strengthened HR, M&E, task-shifting, record-keeping, and addressing  gaps  in the PMTCT cascade.

Nick discussed EGPAF strategies in achieving virtual elimination of pediatric HIV and highlighted challenges. The discussion portion of this satellite brought about interesting remarks, including how stigma is being addressed, how adolescents are being approached, what will happen with district focal persons after 2015, first ANC attendance and how it has been affected by the communications strategies, and issues around loss to follow-up.

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Filed under Advocacy, Countries, EGPAF, Global Plan, IAC 2012, Implementation, Pediatric Treatment, PMTCT, Public-Private Partnerships, Zimbabwe

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July 22, 2012 · 1:11 pm

Upcoming EGPAF Session: Overcoming Barriers to Implementing Global Plan

By Robert Yule

Join EGPAF, mothers2mothers, Johnson & Johnson, and our other partners at this upcoming session on overcoming implementation barriers to the Global Plan.

This fast-paced session – moderated by Global Post’s John Donnelly – will feature people working on the front lines of program implementation from high-burden countries and representing various implementing organizations. Each presenter will raise a specific challenge, explain how it was addressed, describe the result, and share what is being done next.

The audience will have the opportunity to interact with presenters for further discussion of implementation barriers and solutions.

“Eliminating Pediatric AIDS and Keeping Mothers Alive from an Implementation Perspective – Best Practices, Programmatic Barriers, and Bottlenecks in the Field”
Sunday, July 22, 1:30 – 3:30 PM
Mini Room 1

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Filed under Global Plan, Implementation, India, Kenya, Lesotho, Malawi, PMTCT, Rwanda, South Africa, Swaziland, Tanzania, Zambia, Zimbabwe

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· 7:59 am

Upcoming EGPAF Session: Strategic Public-Partnerships to End Pediatric HIV/AIDS in Zimbabwe

By Robert Yule

Join EGPAF and our partners this morning at a satellite session to talk about exciting progress in ending new HIV infections in children in Zimbabwe - and how public-private partnerships are helping us get there.

“Together We Can: Achieving Virtual Elimination of New Pediatric HIV Infections in Zimbabwe by 2015 through Strategic Public-Private Partnerships”
Sunday, July 22, 11:15 AM – 1:15 PM
Session Room 5

 

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Filed under Implementation, Public-Private Partnerships, Zimbabwe

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July 20, 2012 · 5:00 pm

A Focus on Children before AIDS 2012 Begins

By Robert Yule

In recent years, before International AIDS Society (IAS) conferences even begin, there are two events that place a special focus on the effects of HIV/AIDS on children:

The symposium, Children and HIV: Closing the Gap – Ending Vertical Transmission through Community Action, opened today at the Georgetown University Conference Center, with a keynote address from U.S. Congresswoman Barbara Lee. The symposium brings together service providers, donors, researchers, advocates, and policy leaders – all to share data and discuss best pratices for children and families.

EGPAF, a member of CCABA, is presenting throughout the symposium, including talks by staff from the     U.S., Switzerland, Tanzania, and Zimbabwe. EGPAF topics on preventing mother-to-child transmission of  HIV (PMTCT) include:

  • Country-level efforts to scale up and integrate community support with medical services
  • Improving the continuum of care by promoting male involvement
  • Mobilizing community engagement through capacity building of media practitioners
  • Strengthening district capacity for rapid PMTCT scale up in Zimbabwe using the District Focal Person Approach

CCABA has produced a  great roadmap on pediatric and PMTCT-related sessions at AIDS 2012, and will be hosting their own session on Wed, July 25 on community involvement that EGPAF will be participating in.

EGPAF also has a strong presence at the 4th Annual International Workshop on HIV Pediatrics. The abstract-driven workshop shares the latest scientific data and discusses how to implement advances in PMTCT and pediatric treatment in the field.

Both the symposium and the workshop conclude on Sat, July 21, but will help drive the discussion of HIV and children and families throughout AIDS 2012.

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Filed under Community, Implementation, Pediatric Treatment, PMTCT, Research, Switzerland, Tanzania, U.S., Zimbabwe

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· 3:23 am

CDC’s Kevin De Cock on U.S. Leadership Fighting Pediatric AIDS

In advance of AIDS 2012, EGPAF hosted the following guest blog by Dr. Kevin M. De Cock – the U.S. CDC’s Director of the Center for Global Health - about U.S. leadership in preventing mother-to-child transmission of HIV globally:

Dr. Kevin De Cock, U.S. CDC

By Kevin M. De Cock MD, FRCP (UK), DTM&H

From July 22 to 27, Washington, D.C. will host the XIX International AIDS Conference, welcoming more than 20,000 attendees from around the world, representing hundreds of HIV/AIDS organizations and diverse backgrounds.  

 The U.S. Centers for Disease Control and Prevention (CDC) and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) partner with many of these organizations combatting HIV/AIDS through PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. 
 
PEPFAR is the largest public health program ever mounted for an individual disease, and is celebrating almost a decade since it was established. Now more than 7 million people worldwide are receiving antiretroviral therapy (ART) for HIV. The conference offers opportunity to assess progress in the fight against HIV/AIDS, review research advances and priorities, and recommit to meeting HIV/AIDS specific targets that we have collectively endorsed.
 
It was in the late 1980s that research in the U.S. and other countries such as the Democratic Republic of Congo laid the foundation for our understanding of mother-to-child transmission of HIV. Approximately one-quarter of children born to HIV-infected mothers acquired the infection themselves, with other research subsequently showing that prolonged breastfeeding contributed an additional 14% transmission risk.
 
Overall, up to 40% of children born to and breastfed by mothers living with HIV would become infected. And yet, alternatives to breastfeeding were not realistic options for most African mothers for reasons of poverty, stigma, and the fact that lack of breastfeeding exposed infants to higher risk of malnutrition and other lethal infectious diseases. 
 
The history of research on mother-to-child transmission of HIV and its prevention offers the clearest example of how domestic and global HIV/AIDS work have interacted and benefited from integration, and how research has led to specific program implementation. Communicating this relationship is an overarching contribution of International AIDS Conferences. 
 
In the early 1990s, the groundbreaking ACTG 076 trial showed that prophylactic zidovudine given to the mother during

Photo: EGPAF/James Pursey

pregnancy and labor and delivery, and postnatally to the infant, prevented HIV transmission by two-thirds. The trial initiated an avalanche of research on prevention of mother-to-child transmission in and tailored to low-income settings, the benefits of which we are reaping today. 

Opinion is growing that the World Health Organization’s “Option B+” – under which HIV-infected women start combination ART on detection of pregnancy and stay on it for life – will be an important tool to meet our ambitious goal of virtual elimination of mother-to-child transmission of HIV by 2015.
 
In 2010, 35% (42% in sub-Saharan Africa) of pregnant women in low- and middle-income countries received HIV testing and counseling, and the estimated coverage of antiretroviral drugs for prevention of mother-to-child transmission of HIV among pregnant women was 48%.  In 2011, 57% of pregnant women living with HIV in low- and middle-income countries received effective antiretroviral drugs to prevent transmission to the child.
 
Despite this progress, much remains to be done. Only 28% of exposed infants worldwide received an appropriate test for HIV infection in the first two months of life in 2010, with 22% coverage of ART for infected children. In 2011, treatment coverage for ART in infected children rose to 28%, yet treatment coverage among children is still substantially lower than the estimated 57% coverage among adults living with HIV.
 
The U.S. Administration’s Global Health Initiative has refocused attention on the health of women and children. Now we have unrivalled opportunity for synergy and integration – harmonizing programs for maternal and child health, HIV/AIDS, and family planning for the greater good of women and children’s well-being. 
 

Photo: EGPAF/Jon Hrusa

Re-commitment to the worthy goals of an AIDS-free generation would be a good outcome of the XIX International AIDS Conference. The targets are to reduce the number of children newly infected with HIV by 90% by 2015, reduce mother-to-child transmission of HIV to below 5% everywhere, and reduce maternal mortality related to HIV by 50%. 

 
Looking back to the dark days – when AIDS was a death sentence, life expectancy was declining in southern Africa, under-five mortality was rising because of AIDS, and hopelessness prevailed – the 2012 International AIDS Conference should be an occasion of pride, re-engagement, and forceful determination to achieve what was once thought impossible: an AIDS-free generation
 
To learn more about EGPAF’s collaboration with the CDC on global HIV treatment and PMTCT programs, click here.

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Filed under Countries, Democratic Republic of Congo, IAC 2012, Implementation, Pediatric Treatment, PEPFAR, PMTCT, Research, U.S.

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