Overview of Implementation of LLAPLa in Tanzania Dr MD Kajoka Na+onal PMTCT Coordinator TANZANIA
Presentation Layout Background Roll out of Life Long ART to pregnant and Lacta+ng women Achievements Challenges Future Plans
Background Information Total popula+on (year of es+mate):45 million (1) Annual number of expected pregnancies: 1.8 million (2) Adult HIV Prevalence: 5.1% (3) HIV prevalence among pregnant women; 5.4% (4) Es+mated number of HIV+ Pregnant women: 100,000 (5 Propor%on making at least one ANC visit; 96% (6) Maternal Mortality Ra+o: 454/100,000 (6) Infant Mortality Rate: 51/1,000 (6) Under Five Mortality Rate: 81/1,000 (6) MTCT rate 15% (2013) Key (1) Na%onal Popula%on Census 2012, (2) Na%onal projec%ons, (3) Tanzania HIV and Malaria Indicator Survey 2012, (4) Na%onal ANC HIV surveillance 2010, (5)Spectrum Projec%ons, (6) Tanzania Demographic and Health Survey 2010
Fundamental shift in thinking? PMTCT = SD- NVP (L&D) Short course AZT (ANC + L&D) OpIon A or OpIon B (ANC, L&D, postpartum) Maternal treatment + infant follow- up? (overlapping treatment and MNCH con+nuum)
CoordinaIon: Ministry of Health and Social Welfare PMTCT/C&T - TWG: MoHSW - RCH, UN, USG partners, EGPAF, CHAI, NACOPHA, TACAIDS, MUHAS, MSD, Private Sector, Co chaired by PMTCT Co/ C&T Sub teams 1. Guidelines and Model of care 2. Community interventions 3. Advocacy and resource mobilization 4. Logistic and Supply Chain 5. Monitoring and evaluation 6. Policy and guidance Regional PEPFAR PMTCT IPs, RHMTs, CHMTs Health FaciliIes
Life Long ART to Pregnant and Lactating Mothers (LLAPLa) Roll-out Guidance for the roll- out of LLAPLa (OpIon B+) Goal: 100,000 HIV+ pregnant & Lacta+ng women on treatment by June 2014 Strategy: All sites that see > 30 HIV+ Pregnant & Lacta+ng women per year will be priori+zed Regions priori+zed according to their HIV burden
The roll-out of LLAPLa Each of the regions were given specific target to reach for HIV posi+ve pregnant and lacta+ng mothers The roll out was carried out in two phases o Phase 1: Nine (9) regions started October 2013 o Phase 2: The remaining 16 regions started February 2014
The roll-out of LLAPLa Circular was released by the Ministry to mark the start of LLAPLa Advocacy at na+onal, regional and district levels to authori+es Review of guidelines and Training package Refresher training to PMTCT and CTC service providers Ader training follow up to all facili+es in+a+ng LLAPLa
Logistic and Supply Forecas+ng, quan+fica+on was done using the agreed targets Procurement via VPP Global fund Smart push was done to all Health Facili+es ini+a+ng LLAPLa
Monitoring and Evaluation Recording and repor+ng Harmoniza+on of ART tools (ART register, CTC 1 and CTC2 cards, etc) repor+ng as one The new integrated system is capturing both pregnant and lacta+ng women Established infant card that links the baby to the mother Supervision and mentoring Intensifica+on of monitoring and supervision first to high volume sites
Service Delivery Nurses ini+ate ART at RCH clinic Couple counseling is done at RCH clinic HIV posi+ve male partner are enrolled into care and treatment All pregnant and lacta+ng mothers receive ART at RCH Cases that requires more ahen+on are referred to CTC for management Decentraliza+on for pediatric care from CTC is ongoing
Community Interventions Comprehensive Maternal and Newborn Community strategy is on use : Community health workers are trained to follow up Pregnant /lacta+ng women in the community Home based care providers will also be oriented on MNCH issues
Progress LLAPLA. Graph showing PMTCT site Coverage 5000 4500 4603 4832 4914 Number of PMTCT sites 4000 3500 3000 2500 2000 1500 1000 3626 1165 Number of ANC sites offering PMTCT 500 0 Baseline (2009) 0 2011 2012 2013 Year
Achievements Ownership, and accountability at all level fostered through na+onal and local authority emtct campaigns championed by poli+cal leaders Increasing coverage of ART for pregnant and lacta+ng mothers Scale up of EID services with B plus plajorm Health Facility countrywide coverage to be ahained by December 2014 Declining trend of MTCT rates
Challenges Mixed M&E system during transi+on period from op+on A to B+ Adherence and reten+on Consistent availability of commodi+es (Logis+cs) Limited space in RCH clinic
Future Plans To strengthen Mother baby pair follow up through peer support approach Empowering communities for behaviour change towards facility utilization Promote other adherence improving interven+ons (support groups, mobile phone technology) Scale up Point of Care machines to the lower levels, increase viral Load machines Adoption of the consolidated guidelines (2013)