Reducing the transmission of HIV to unborn and newborn babies through better health education (PMTCT)
With an estimated 5.7 million HIV- and AIDS-positive residents, South Africa is believed to have highest prevalence of the disease in the world. Women and children are among the hardest hit, with an estimated 3.2 million women and 280,000 children infected.
Among children, up to 90 percent of infections are due to mother-to-child transmission that occurs during pregnancy, labor, delivery or breastfeeding. But there’s hope: With the right intervention and compliance, the rate of mother-to-child transmission during pregnancy may drop as low as 2 percent.However, women trying to access prevention services – and stick to complex treatment regimens – often face significant obstacles. For instance, while more than 50% of South African women need access to services for the prevention of mother-to-child transmission (PMTCT), the shortage of health workers is a major impediment. Meanwhile, delivery mechanisms remain weak, and the focus on clinical interventions, while important, offers scant support for new mothers confronting psychosocial issues such as disclosing their HIV-status to family members who may react negatively.
Preventing AIDS in South Africa: m2m training and outreach
m2m began operations in 2001, seeking to supplement traditional health care services by training and employing local HIV-positive mothers as community-based mentors. Partnering with more traditional staff, these women could provide critical peer education and psychosocial support to HIV-positive pregnant women and new mothers. When m2m first started operations, the range of available PMTCT interventions was limited.
Since then, new treatments and approaches have emerged, offering better protection of mothers’ health for a longer period, while virtually eliminating the risk of HIV transmission from mother to child and improving child survival prospects. However, this expansion has further stretched already overburdened health care systems. Moreover, many of the women who seek treatment continue to confront cultural, literacy and socioeconomic barriers that limit their access to health services and adherence to PMTCT regimens.
To better help these women and ensure consistent delivery of accurate information, mothers2mothers recently revised its training materials with the support of the Michael & Susan Dell Foundation. The new curriculum includes expanded technical content about early infant diagnosis and infant follow-up; reproductive health and family planning; and couple and family issues such as disclosure of HIV status and partner testing. Illustrative cards, which use simple drawings to depict key concepts, play a central role in this revised curriculum. Used to help train mentor mothers working in the field, each card illustrates critical behaviors on one side, while highlighting priority talking points on the other. This approach increases student comprehension and dialogue, while also reinforcing trainers’ ability to deliver consistent, accurate information. Education cards also dramatically reduced the time required for effective training, leaving each staff member as much as 30 additional minutes per day to devote to client interactions. Mentor mothers responded very positively to the cards and expressed a strong desire to use them when counseling clients directly.
The impact of enhancing training for mentor mothers in PMTCT
Given the positive impacts of card-based training for mentor mothers, m2m staff plan to develop cards for use in the field. The cards will help better illustrate complex topics, stimulate more discussion, and provide additional professional credibility for m2m staff in delivering difficult messages to the HIV-positive mothers they counsel. Moreover, they will help m2m achieve another of its core goals: Standardizing the delivery of up-to-date information across all the centers which it serves.Given the program’s growth, this last goal is critical: m2m continues to scale its efforts to reach more women and children, with m2m South Africa expanding its programs from 119 sites in 2007 to 350 sites in 2011. Data captured for a recent month show that m2m staff logged 137,424 total encounters. As part of its effort to continually refine the effectiveness of these encounters, m2m is also tracking, document and analyzing what factors positively influence HIV-positive women to engage with PMTCT services. The program will use its findings to ensure that all its trainings support mothers in preventing transmission of HIV to their babies as effectively as possible.
Data from April 2010. Total encounters is a count of all m2m visits including 1-on-1 and support group interactions