Prevention of Mother To Child Transmission of HIV
Implementing a prevention of Mother to child transmission of HIV program in private health care sector. The program provides antenatal and HIV prevention counseling to pregnant women, interventions for HIV infected mothers to reduce transmission to child and linking the family to further care and support services
A propos de vous
Section 1: About You
Prénom
ritu
Nom
parchure
URL du site Web
Organization
Prayas
Pays
Inde, MM
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
Non
Section 2: About Your Organization
Nom
Prayas
Site Web
Téléphone
91-2025441230
Adresse
Amrita Clinic, Athavalae Corner Building, Sambhaji Bridge Corner, Karve Road Corner, Deccan Gymkhana, Pune, 411038
Pays
Inde, MM
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Your idea
Name Your Project
Prevention of Mother To Child Transmission of HIV
Country your work focuses on
Inde, MM
Describe Your Idea
Implementing a prevention of Mother to child transmission of HIV program in private health care sector. The program provides antenatal and HIV prevention counseling to pregnant women, interventions for HIV infected mothers to reduce transmission to child and linking the family to further care and support services
Website URL
Innovation
What makes your idea unique?
PMTCT (prevention of mother to child transmission of HIV) coverage in India is as low as 20%. Most of the PMTCT initiatives are in public health care sector. In India more than 30% pregnant women seek care in private sector. However, there are very few private sector initiatives for PMTCT.
PRAYAS PMTCT program is an important effort to bridge this gap. It is India’s one of the largest private sector initiatives. It has pioneered the concept in the state of Maharashtra.
We have provided services to more than 1130 HIV infected pregnant women since 2002. While the national PPTCT program still uses single dose nevirapine for mother and baby (which is known to be less efficacious than combination ARV regimen), we have been successfully using combination anti-retroviral medicines for mother and child as per WHO guidelines. The uptake of cascade of PMTCT services in our program is quite high, enabling us to achieve transmission rates as low as 5%.
Do you have a patent for this idea?
Non
Impact
This Entry is about (Issues)
What impact have you had?
Our PMTCT program started in 2002. It is currently operational in 10 districts of Maharashtra at 47 private health care facilities. Till date more than 158445 pregnant women received antenatal counseling, 119394 women were screened for HIV, 1130 HIV infected pregnant women were provided PMTCT services. Mother to child transmission rate is around 5%.
Our project introduced concept of pretest counseling at private health care facilities and nurtured it through consistent periodic trainings (for counselors and doctors). To make it resource easy, we prepared innovative IEC material for the beneficiaries (booklets, cards etc), and also for the doctors and counselors.
In last 7 years we have trained more than 3000 doctors to increase their capacities to provide care to HIV infected pregnant women and reduce sigma and discrimination. With these strategies we could reach out to large number of women quite rapidly while keeping cost per woman served to the minimum.
Problem
With a population of around 120 million it is estimated that Maharashtra would have roughly 3.6 million pregnancies annually. With HIV prevalence of 0.5%, annually there would be 18000 pregnancies in HIV infected women.
As per NFHS 3 report approximately 40% pregnant women access health care services in private sector in Maharshtra. Applying this information we can estimate that approximately 7200 (40%) HIV infected pregnant women would access care in private sector. Without any interventions 1800 children would get the infection.
However, there are very few private sector initiatives for PMTCT. In private sector care is almost exclusively denied to HIV infected women barring a few honorable exceptions. The knowledge level about PMTCT interventions is poor among the private health care providers.
There is, therefore, an urgent need for PMTCT initiatives in private sector. Training and sensitization of health care providers from this sector is important.
Actions
We are trying for wider outreach; at the same time aim for cost effective models of service delivery. This is done by establishing referral systems to reach out to HIV infected pregnant women, expanding outreach in rural areas and encouraging equal ownership of health care facilities in program implementation.
We have developed user friendly educational material for doctors and counselors (such as film on universal precautions, handbook on PMTCT, ready reckoner charts etc) and conduct training programs for different health care providers.
We have developed trimester specific ANC cards which give specific take home messages about antenatal care to every pregnant woman attending the clinic. We have also developed a card which gives information about HIV testing and PMTCT. In the private health care set up, where uninformed HIV testing is almost a rule, such IEC material ensures that the woman receives at least minimum essential information.
Results
The aim of our program is not only to provide secondary prevention by providing ARV prophylaxis to HIV infected pregnant women but also to increase primary prevention among un-infected women through comprehensive antenatal counseling. Linking HIV infected pregnant women to further care and support is also one of the important objectives of the program. In low prevalence settings such as India, to reach an HIV infected woman, a wider outreach with testing and counseling is needed. So even if costs per antenatal woman reached may be very low, cost per HIV infected woman provided PMTCT services is quite high. With the above mentioned strategies we expect to achieve wider outreach through most cost effective models of service delivery.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Following strategies would be important for our project to be successful over next few years.
1. Continue to establish referral networks for reaching out to HIV infected pregnant women
2. Reaching out to health care providers from private sector and sensitize them towards issues of HIV care in general and PMTCT care in particular
3. Developing innovative IEC material for the same
4. Exploring possibilities of partnership between public and private health care sector and configuring ways to make it sustainable and effective
5. Monitoring and analysis of data in order to understand the emerging issues
What would prevent your project from being a success?
For any program to achieve its goals, financial back-up is the primary requirement. Lack of adequate resources, co-operation from government, and paucity of committed and experienced project staff would be some of the challenges that may prevent our project from being a success in future.
How many people will your project serve annually?
Plus de 10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Oui
Viabilité
A quel étape votre projet en est-il ?
En place depuis plus de 5 ans
Votre organisation est-elle une
organisation à but non lucratif
Is your initiative connected to an established organization?
Oui
If yes, provide organization name.
Prayas
How long has this organization been operating?
Plus 5 années
Does your organization have a Board of Directors or an Advisory Board?
Oui
Does your organization have a non-monetary partnerships with NGOs?
Oui
Does your organization have a non-monetary partnerships with businesses?
Non
Does your organization have a non-monetary partnerships with government?
Non
Please tell us more about how these partnerships are critical to the success of your innovation.
Partnership with local NGOs is important for wider expansion of the program services and establishing referral systems in order to reach out to HIV infected pregnant women. Partnership with government is crucial in the same context.
What are the three most important actions needed to grow your initiative or organization?
Actions needed to grow the initiative
• Establishing strong referral networks for reaching out to HIV infected pregnant women
• Exploring possibilities of partnership between public and private health care sector
• Capacity building of existing staff in issues of program management and publications (important if we want to make impact on national policies)
The Story
What was the defining moment that you led to this innovation?
‘The only thing worse than knowing your child is HIV infected is to know that it could have been avoided’. In 2000, when we came across this famous sentence by Elizabeth Glazer, we completely agreed with the truth in it as we were going through the same experience at that time.
Prayas has a well recognized clinical and counseling center for HIV infected adults and children catering services for past many years. Around the time of late 90’s, the treatment costs were very high. We lost many of our young patients during that time, for the want of ART. Facing the morbidity and mortality among these little ones was very difficult. More than 90% of these had acquired infection from their mother. Their sufferings could have been prevented if their mothers had received proper interventions during the pregnancy. This realization made us want to work on this issue. During the same time we had an opportunity to be a part of PMTCT initiative in India, which was supported by Elizabeth Glazer Pediatric AIDS Foundation (EGPAF). Thus from 2002 onwards we started with PMTCT program in private health care sector in Maharashtra. The program that started with 4 health care facilities from one district has now been expanded considerably.
Tell us about the social innovator behind this idea.
There is no single innovator behind the idea. PRAYAS health group has been working in the field of HIV since 1994. It has always tried to respond to emerging needs by keeping a feel of the pulse of the evolution of the epidemic. As explained above around the year 2001 we were facing this problem of very high mortality and morbidity among children with HIV. Even though ART had become available it was beyond of reach of most families. So we felt that along with trying to arrange affordable ART for these children we should also try and put in our efforts in preventing pediatric HIV. We were providing prophylaxis to HIV infected pregnant women since 1996 (since the time its efficacy was established in the scientific literature) but such cases were only sporadic. We planned a programmed intervention and were fortunate to have the support of EGPAF around the same time. We would say that it was a collective response from our team.
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Email from Changemakers
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Commentaires
Thank you for your entry. There are many others on this site with similar ideas to yours on how to prevent the spread of HIV from mothers to children. The link below is one of my favorites and my be of interest to you.
justmilk.org
The HIV nipple shield is a device designed to prevent mother-to-child transmission of HIV through breast feeding. The invention is a breast milk ‘filter’ in the form of a textile disk impregnated with a microbicide that is incorporated in a modified nipple shield. The invention can inactivate HIV in breast milk without greatly disrupting breast feeding.
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