The document summarizes Swaziland's efforts to accelerate its PMTCT program. It describes the high HIV prevalence rates among pregnant women in Swaziland. While ANC access and skilled birth attendance are high, PMTCT uptake was only 67% in 2007. The comprehensive PMTCT package and lessons learned around integration and capacity building are discussed. Key ongoing challenges include prevention of unwanted pregnancies, follow up counseling for HIV-negative women, and ensuring access to commodities and expanded services. The national strategic plan aims to reduce mother-to-child transmission rates and increase coverage of ARV prophylaxis and early infant diagnosis. Strengthening linkages between programs and expanding partner support are part of the proposed way forward.

1. ACCELERATION OF PMTCT IN
SWAZILAND
BY
INNOCENT MAHLUBI HADEBE
HIV/AIDS PREVENTION COORDINATOR
(NERCHA)
SWAZILAND.

2. LAYOUT
• BACKGROUND
• ANC AND HIV
• PMTCT COMPREHENSIVE
PACKAGE
• PMTCT UPTAKE
• CHALLENGES
• SOLUTIONS / WAYFORWARD

4. BACKGROUND
• Population 1,018,449, 000
• National HIV prevalence (15-49) population
26%
• HIV prevalence ≥2 yrs population –19%

5. ANC AND HIV
• HIV prevalence rate among pregnant
women 42%
• Deliveries per annum 43,001
• Pregnant women accessing ANC - 97%
• Delivery by skilled attendant - 74 %
• MMR - 589/100 000

6. HIV INFECTION TRENDS AMONG ANC
CLIENTS IN SWAZILAND SINCE 1992
1992-2008

7. NEONATES AND UNDERFIVES
• Neonatal Mortality 85/1000
• Under five mortality 120/1000
• Children in need of ART 4,529 (2007
spectrum projections)
• Children receiving ART by end of October
2008 – 2759 (61%)

8. CHILD MORTALITY
ESTIMATES 1986-2007
140
120
106
89
99 85
78
72
1986 PHC 1991 DHS 1997 PHC 2006-07 SDHS
Infant Under-five

9. PMTCT COMPREHENSIVE
PACKAGE
PMTCT implementation started in 2003
• PMTCT comprehensive package includes:
– HIV testing and counseling
– Provision of family planning and counseling
– Identification and management of STIs
– Screening for TB
– Prophylaxis – CTX
– ARV- including HAART
– Infant feeding counseling
– Provision of continuum of care (Intrapaturm, postpartum, child
welfare including EID)
– Linkages and referrals

10. PMTCT UPTAKE
• 138 out of 172 health facilities
providing ANC provide PMTCT
• 67% success rate (2007)
• Adopted the new WHO PMTCT
guidelines for ARV drug prophylaxis
recommend giving HIV infected
pregnant women. – SACD minimum
standards

11. LESSONS LEARNT
• Political commitment (MOHSW full support)
• Improved implementation through integration of PMTCT
in sexual and reproductive health programmes
• Integration of PMTCT in MCH has improved maternal
and child health care services in MCH
• Capacity building of health workers has improved service
uptake
• Availability of resources – human and basic supplies
• Integration of monitoring indicators in the existing
registers and patients cards (e.g. ANC, CWC)

12. CHALLENGES
• Prevention of unwanted pregnancy among HIV infected
women (low uptake of FP services)
• Primary prevention of HIV infection among women testing
HIV negative during pregnancy (follow-up counseling on HIV
prevention).
• Periodic shortage of basic commodities (HIV testing kits,
ARV drugs, OI drugs – (issues in procurement and supply
management for drug and laboratory supplies)
• Limited access to care and treatment (CD4 testing, DNA
PCR, ART) due to lack of decentralization of services.
• Limited mechanisms for linkages and referral between
programmes at facilities levels and community.
• Infant feeding in the context of HIV and EID (meeting
AFASS and prevent malnutrition)

13. WAY FORWARD
NSF 2009 -2014 Outcome level results:
• % HIV infected infants born of HIV +
mothers is reduces from 21.5% in 2007 to
5% by 2014
• % of HIV positive pregnant women who
received a course of ARV prophylaxis to
reduce MTCT is increased from 65% in
2007 to 90% by 2014

14. WAY FORWARD (CONT)
• Integration of FP in chronic HIV care and ART
• Continue counseling HIV negative on HIV prevention at every postnatal
visit
• Expand access to early HIV infant diagnosis and Treatment (all health
facilities to provide service)
• Conduct Integrated HIV trainings (e.g. IMCI) through in-service
trainings at the training institutions
• Advocate for transportation of specimens to lab (CD4 and DBS).
• Improve coordination of partners and programs relevant to
implementation of services
• Establish quality improvement for PMTCT and Paediatric AIDS care
• Improve commodity procurement and supply systems

15. WAY FORWARD (CONT)
• 80% HIV+ women have assess to dual
contraception
• 60% of health facilities offer both PMTCT
and ART services
• % of health facilities providing minimum
package of PMTCT increased from 78% in
2008 to 95% in 2014

16. WAY FORWARD (CONT)
• Increase the proportion of HIV exposed
children below 12 months receiving
virological tests from 30% to 50%
• Increase the proportion of HIV exposed
children receiving CTX 55% to 70%

17. PARTNERS
• WHO
• UNICEF
• UNFPA
• USG – EGPAF and ICAP, Clinton Foundation,
Baylor – COE NGOs
• M2M
• Global Fund, MSF)
• Support from partners (HR, technical, financial
equipment and supplies, clinical support, etc)

18. NGIYANIBONGA!
I
THANK
YOU!