pmtct in humanitarian settings: lessons learned and recommendations art patient files from a flooded...
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PMTCT in Humanitarian Settings:Lessons Learned and Recommendations
ART patient files from a flooded clinic in Mozambique drying in the sun © MSF
Alice Fay*Save the Children
Sarah KarminUNICEF
Gabriel MuneneUNHCR
Heidi Becher Independent Consultant
Video
Background
Problem Burden of HIV high in many risk prone, emergency affected and fragile
settings Shortcomings in emergency preparedness Gaps and barriers in addressing HIV and PMTCT in humanitarian
settings (natural disasters, armed conflict /civil disturbance)
Consequences Women and infants lose access to ARVs for PMTCT Initiation, continuation and scaling up of PMTCT programmes is affected
Objectives
1. Synthesize lessons learned and develop recommendations from PMTCT programmes implemented in humanitarian settings
2. Develop a “How to Guide” from lessons learned on ways to implement PMTCT programmes in humanitarian settings.
Methodology
1. Literature review – peer reviewed and grey literature
Search strategy and results- Search terms and time frame: all 4 prongs of PMTCT, reproductive
health & humanitarian contexts between 2003 - 2014 - Sources: Pubmed and Popline, agency websites and unpublished
documents shared by agencies
Documents included- Related to PMTCT or ART in humanitarian settings
2. Key informant interviews
58 semi-structured telephone interviews- Humanitarian and development NGOs- UN agencies- Organisations of people living with HIV - Donor agencies
Focus on 3 levels
• Preparedness
• Service Delivery
• Individual level
Preparedness
Preparedness and contingency planning mitigate the impact of a shock on PMTCT programmes
Develop a contingency plan- Analyse how regular programmes could be affected by an emergency- Prepare to minimise the risk of disruption of access to PMTCT treatment- Task shifting, task sharing, buffer stockEx: pre- seasonal flooding, signs for increased risks of violence
Absence of contingency planning can lead to treatment interruptions with risk of treatment failure and ART resistance- CAR 2013/2014 complex emergency
- Mozambique 2013 floods, Gaza province: 50% estimated ART interruption in Chokwe district
Service delivery
Facility-based services Pre-position buffer stocks; use NGO buffer stock Redistribute drugs in case of localised shortage Access ARVs for temporary health facilities from the
national system (Re)-open PMTCT/ARV providing services as soon as
possible Integrate ARV dispensing in camp health facilities
Mobile and community services Mobile outreach teams and mobile clinics for ARV
dispensing Home dispensing at pre-arranged meeting points Dispensing ARV through other patients Facilitate transport Integrate patient education into community programming
Individual
Patient education Physical tracing Patient networks House to house and community information
campaign Information at camp registration point Radio, TV messages Public messaging during mobile clinics,
immunisation campaign, food distribution, etc. Mobile phone tracing
Consider: context, size of cohort, available and most efficient means of communication
Combined methods seem to reach best coverage.
Context-specific priority setting
Impact of shock Preparedness Alternative service delivery method
ü Transport routes for drug supply impassable
ü Facility becomes
inaccessible (flooded, looted, etc.)
ü Patients access to health
facility impossible ü Patients flee to other areas
ü Order buffer stock in advance
ü Secure drugs and patient
registers in flood safe location (.e.g. 2nd floor)
ü Provide extra supply of
ARVs to patients in advance ü Provide patient passports
& inform patients about alternative treatment sites in advance
ü Set up temporary health facilities in accommodation sites affected population
ü Supply temporary health
centres with all commodities needed from district buffer stock
Recommendations
Integrate preparedness and contingency planning into regular PMTCT/ART programming and include PMTCT/ART in general national disaster preparedness plans
Ensure drug and commodities supply in humanitarian settings
Take leadership and support coordination to assure that PMTCT/ART is included in emergency response from the very start in generalised HIV epidemics
Make rapid funding available for PMTCT/ART response in humanitarian emergencies
Organise and adapt service delivery for rapid response in humanitarian settings
Adapt monitoring system for patient cohorts in humanitarian settings
Thank you