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Strengthening Community and Health Systems for Quality PMTCT: Applications in Kenya, Nigeria, South Africa, and Ethiopia

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This 12-page report by Pathfinder discusses experiences as well as recommendations based on programmes for prevention of mother-to-child transmission (PMTCT) of HIV. According to the report, barriers to implementing programmes for PMTCT in resource-limited settings fall into common biomedical, behavioral, and structural categories. In addition to a lack of access to quality PMTCT services at the clinic level, community-level factors such as stigma, adverse gender dynamics, low support for HIV testing, antenatal care (ANC), and skilled birth attendance, and poor linkages between communities and their facilities all pose challenges to improving PMTCT outcomes. Since 2002, Pathfinder has implemented PMTCT programming globally, using lessons learned to inform implementation of their global PMTCT strategy. This technical brief discusses implementation experience in four African countries, providing recommendations for future efforts to more holistically advance improved PMTCT outcomes in resource-limited settings.

Pathfinder's PMTCT programmes are designed to work from a systems perspective to see the larger picture in which mother-to-child transmission occurs, while allowing flexibility for adaptation at the implementation level. To support long-term positive health outcomes, the strategy addresses health system and community factors that drive poor HIV and maternal and newborn health (MNH) health outcomes. At the health systems level, the global strategy works to reduce stigma within facilities and institutionalise rights-based care through quality service standards that emphasise full integration with MNH services, provider-initiated opt-out testing, risk reduction, male involvement, on-going care for mother and infant, and support for safe breastfeeding. At the community level, the strategy places particular emphasis on mitigation of the drivers of HIV vulnerability and barriers to PMTCT service uptake. This includes working to empower women, supporting them to create enabling environments for their and their families’ health and security throughout the PMTCT continuum. In Africa this has included community and health system collaboration in Nigeria, addressing adverse gender dynamics in Kenya, improving quality through dedicated service delivery models for youth in South Africa, and expanding coverage through engagement of frontline workers in Ethiopia.