July 24, 2018
Written by Helen Chorlton, Senior Programmes Manager (C3, PATA) and Agnes Ronan, Head of Programmes (PATA)
This article originally appeared on ViiV Healthcare. Reposted with permission.
We know that health systems increasingly have the resources to address mother-to-child transmission (MTCT) of HIV; but, in practice, these resources often go under-utilised. If we are to end MTCT, then every HIV positive pregnant woman needs to attend clinic appointments, remain adherent and be supported by her partner, family and broader community. The issue isn’t just a medical one, it’s a societal one; and herein lies the challenge.
Yes, there is more to do but it’s only fair to highlight that there has been significant progress towards ending mother-to-child transmission of HIV in recent years. In 2010, just under 400,000 children were perinatally infected each year and by 2016 this number had dropped to 160,000. However, the global target is 40,000 a year, and the most difficult situations and contexts remain to be solved.
So, where do we start?
The HIV world often talks about a ‘continuum of care’ – ensuring that people at risk of HIV get tested; those who are tested receive antiretroviral treatment (ART); and those on ART achieve and maintain viral suppression. This is simpler described than done given the prevailing attitudes towards HIV and particularly the stigma and discrimination that exists.
In many of these countries where the prevalence of HIV is highest, this continuum is disjointed; with one end not speaking to the other. For example, in some areas where testing is taking place and making in-roads, very few of those testing positive for HIV are being referred to their local clinic to receive treatment.
Community-based organisations are tackling stigma, addressing barriers to testing and outreach with good connecting to funding; while HIV clinics are conducting the testing and treatment, but no single entity is ensuring that funding is being used most effectively or success is being measured, documented and communicated out.
Without a bold and empowered community response, the health system, operating in isolation, will not succeed in breaking down many of the barriers preventing access and retention in programmes – such as HIV stigma and socio-cultural barriers.
It’s clear that in order for populations to reach and sustain record numbers of pregnant women, children and adolescents in care, clinics and the communities they serve must partner with each other.
Together, clinics and communities must sensitize communities to increase uptake, link children and families into care, combat stigma and discrimination, monitor programme quality and build stronger local health systems.
The C3 programme promotes clinic-community collaboration as a key strategy in the elimination of mother-to-child transmissions of HIV. With small improvements in hundreds, or even thousands, of clinic-community collaborations, we can lead to huge overall impacts in improving HIV care.
C3, born out of a partnership between our Positive Action for Children’s Fund (PACF) and action network Paediatric & Adolescent Treatment Africa (PATA), the programme aims to foster partnerships between health facilities and communities, enabling them to deliver improved PMTCT and paediatric HIV services together.
In the last three years, we have worked across nine countries and 36 community-clinic collaborations to witness first-hand how transformative collaboration can be at a local level.
Our key results showed important improvements in clinic-community partnership indicators and an increase in women enrolled in PMTCT services with fewer PLHIV lost to follow-up.
In addition, C3 showed improved relationships between partners and improved perception of each other’s contribution to PMTCT/ paediatric HIV care services according to data from all 36 partnerships)
Key lessons learned to date:
We’re proud to say that C3 has played a significant role in creating a growing community of practice centred around clinic-community collaboration and generated rich and diverse insights and learnings that will directly contribute to achieving improved community engagement; but there’s more to do.
Helen Chorlton, Senior Programmes Manager (C3, PATA)
Agnes Ronan, Head of Programmes (PATA)