The Small Projects Foundation

Making meaning. Taking action. Changing lives. 

Kistefos HIV/AIDS Action

The Small Projects Foundation

Making meaning. Taking action. Changing lives. 

Kistefos HIV/AIDS Action

This PMTCT and paediatric ART support programme, funded by Kistefos in Norway has been in place in Port St Johns, OR Tambo District, since 2009.

We focus on
– PMTCT
– Provision of antiretroviral treatment to pregnant women, mothers & children
– Capacity building of nurses and CHWs on PMTCT and ART provision
– Gardening programme
– Health systems strengthening
– Community mobilization

Achievements

– We have arranged employment & stipends for 70 Community Healthcare Workers who were not yet absorbed by the Eastern Cape Department of Health

– 96 CHWs completed the training modules required for them to attain their Ancillary Health Care (AHC) qualification.

– 6 763 gardens planted, from which an estimated 44 844 people are being fed

– We hold regular community meetings & PLAs

– We conducted a PLACE Survey to evaluate the impact of the awareness & behaviour change component of the programme.

– Three clinic committee members from each of 17 project clinics were trained on their roles & responsibilities

– We trained one nurse (clinics could not send two nurses due to their workload) and three clinic committee members from each clinic on the balanced score card for clinic service quality improvement. The nurses and clinic committee members also developed balanced score cards for their clinics.

– We achieved a MTCT rate of 3%, with some clinics having a zero rate of transmission.

– One of our greatest victories has been the improved number of male partners of HIV positive pregnant women who have been attending the antenatal clinic with the women and have been testing for HIV.

– Our programme has mobilised 76% of the community members in project clinic catchment areas (99 390 of 130 000 population of the area).

– There has been an improvement in the early detection of HIV infection in pregnant women & therefore an improvement in the provision of PMTCT to HIV positive pregnant women.

– Early detection of HIV infection in their babies has been achieved.

– 15 073 pregnant women were tested for HIV during the project.

– Mapping & allocation of patients to CHWs per village has been done in all clinics.

Note Worthy

Since our programme has been so successful, we have attracted interest from the South African National Department of Health, EU, EC Provincial Department of Health and the OR Tambo District Municipality. Since then, we have extended our work into Nyandeni, Quakeni and Mhlontlo as the Kistefos Phase II programme.

 The programme was established in 2009 with funding from Kistefos in Norway.

Kistefos Phase 2

The new programme, which was also funded by Kistefos, Norway, is currently underway and replicating the methodology and work of the Kistefos/Isilimela HIV/AIDS Action Programme into three new health sub-districts:
Nyandeni
Mhlontlo
Quakeni
 in the OR Tambo District Municipality over a 30 month period.

Our aim is to make a meaningful impact in combating HIV/AIDS by providing services to disadvantaged communities. We make sure that these services are integrated into the existing, under-resourced and fragmented health services.

We engage communities by creating an enabling environment for behaviour change. Part of this is building the competencies of individuals, communities and organisations to provide prevention, care, treatment and support in a sustainable manner. We do this to save the lives of adults and children.

Kistefos Phase II will continue to support 48 new clinics and three hospitals, 450 villages and provide the ability to combat HIV/AIDS and TB to over 

480 000 people.

Achievements

HIV Testing of children under five years
6.5% (1 673) children have been tested and 108 children found to be HIV positive & put onto treatment.

Children under 15 years on treatment for HIV
7 685 children are being treated for HIV & provided with support. There are currently some HIV and sexual and reproductive health counselling services for adolescents in Mhlontlo and Qaukeni, but none in the Nyandeni sub-district.

PMTCT Programme:

– 1 134 patients are defaulting (for more than one month) PMTCT programme pregnant woman and mothers were identified and 53% have been traced and brought back onto treatment.

– 805 patients have been lost to follow-up (more than three months) PMTCT programme mothers were identified and 47% of these women have been traced and brought back onto treatment.
– It is crucial that we trace non-adherent HIV positive pregnant women and mothers. We are improving file & patient management systems at clinics and extending this to improve defaulter tracing. We are also developing an App to enable cellphone notification of community health workers to find and support patients to revisit the clinic and adhere).

– We have an impressive total of 2 939 pregnant women on the PMTCT programme.

Antenatal care services

– 8 374 pregnant women have accessed antenatal care.

– 3 761 of these women attended within 16 weeks (45%).

– 4 731 of these women attended within 20 weeks (56.5%)

These results are a lot better than the district average of 45%.

– 201 of 8 374 pregnant women were tested for HIV (97.9%).
– 1 331 of these 8 201 pregnant women tested positive for HIV (16.2%) at first ANC visit were put onto treatment.
– 3 033 pregnant women who tested negative at first visit were re-tested at 32 weeks gestation and 139 tested positive for HIV and were put onto treatment (4.6%).
– 588 male partners were counselled and tested for HIV.

Exclusive breastfeeding

We counselled 5 009 mothers on exclusive breastfeeding.
& 3 108 of these women are now exclusively breastfeeding (62%).

Six day post-natal check-up

3 001 mothers & their babies came in for their 6th day post-natal check-up.

Six week HIV test on babies
1 992 babies were tested for HIV (only 68.6%). We are working hard to ensure that all HIV exposed babies are tested at birth or by six weeks for HIV.

Of these, 51 babies were HIV positive (2.5%).

This total of 51 HIV positive babies is made up of a percentage of 0.87% for Qaukeni, 3.79% for Mhlontlo and 6.3% for Nyandeni. There is still much work to be done in Nyandeni and improvement is needed also in Mhlontlo to decrease this Mother to Child transmission of HIV.

Test on babies six weeks after weaning from breast feeding

– 132 babies were tested, of which 40 were HIV positive (33.3%). These are babies identified as ill or needing testing and who must have been exposed to mixed-feeding.

This shows that we need to do intensive work to prevent mixed feeding. This includes educating & supporting mothers to exclusively breastfeed, and we are developing training material for this work.

Our target? Get at least 80% of mothers exclusively breastfeeding (our current rate is only 62%).


Test of HIV exposed babies at 18 months
708 babies were tested at 18 months of whom 36 were positive (5.1%, down from 7.2%).


Estimated MTCT

The MTCT of HIV is therefore estimated to be 7.6% down from 9.2% (2.5% plus 5.1%).


New babies who were initiated onto ART were 88 of 127 (30 plus 37 plus 36) equals 69%. All HIV positive babies need to be initiated on ART (preferably within 2 weeks of diagnosis).


TB treatment
3 220 children were tested for TB of whom 772 tested positive for TB (23.97%).

– 760 of these children with TB were placed on treatment (98%).
– 16 of these 772 children defaulted on TB treatment but 13 were traced (81%).

Gardens established

– 2 022 gardens are in place of which 726 are newly established.

SA Government CHWs recruited or engaged

– Total number of CHWs in this area: 1 303.

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