PMTCT

When Mearege gets really sick, her husband leaves town. Bedridden and in the care of her parents, Mearege gets tested and learns she--and her daugther--are HIV-positive. Through the support of mother mentors, trained by the Ethiopia Network for HIV/AIDS Treatment, Care and Support Program (ENHAT-CS), Mearege finds solace, guidance, and healing -- and decides to have another child.

Mearege is one of many HIV-positive women in Ethiopia whose lives have been transformed, with the support of ENHAT-CS. Says Mearege:

I was able to have a healthy child because I followed up with the mentor mothers and applied their teaching...

Presented by ENHAT-CS in partnership with the National Network of Positive Women Ethiopians, this video is made possible by the generous support of the US President's Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID).

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{Photo credit: Maeghan Orton/Medic Mobile}Photo credit: Maeghan Orton/Medic Mobile

For more than a decade, health teams in over 40 countries have improved their performance using MSH’s Leadership Development Program (LDP) and the latest version, Leadership Development Program Plus (LDP+), which improves public health impact and scale-up. During the same period, there has been a tremendous expansion of information and communication technologies (ICTs) in health and mHealth interventions, particularly using mobile devices. This past year, two MSH-led projects—the Prevention Organizational Systems AIDS Care and Treatment (Pro-ACT) project in Nigeria and The Leadership, Management & Governance (LMG) Project—collaborated with LMG partner Medic Mobile to pair the LDP+ with a mobile application to systematically capture, collate, and report LDP+ results in near-real-time.

{Photo credit: Mark Tuschman, Kenya.}Photo credit: Mark Tuschman, Kenya.

On the eve of the 20th International AIDS Conference (AIDS 2014), Rachel Hassinger, editor of MSH’s Global Health Impact Blog, spoke with Dr. Scott Kellerman, global technical lead on HIV & AIDS, to discuss his latest research on prevention of mother-to-child transmission (PMTCT) of HIV and pediatric HIV & AIDS. Kellerman and colleagues will be attending AIDS 2014, July 20-25, in Melbourne, Australia. (Read more about the conference.)

RH: What is the state of HIV & AIDS globally?

[Scott Kellerman]Scott KellermanSK: We are at the threshold of a sea change. In the beginning, our HIV prevention tool box was sparse. We could offer extended counseling and condoms, and impart information, but not much else. Behavioral change was the cornerstone of tackling the epidemic. It worked sometimes, but, not consistently.

Now biomedical advances are propelling treatment as prevention—even what I call “treatment IS prevention”.

 {Photo credit: Genaye Eshetu/MSH}Almaz Haile, Yeshi Derebew, Jember Alemayehu, and Teberih Tsegay receive 2014 REAL AWARDS.Photo credit: Genaye Eshetu/MSH

Four Ethiopian HIV-positive mothers received 2014 REAL Awards for their outstanding contributions to the fight against HIV, particularly prevention of mother-to-child transmission of HIV (PMTCT), at a ceremony in Addis Ababa, Ethiopia, on April 10, 2014. Created by Save the Children and the Frontline Health Workers Coalition, the REAL Awards are designed to develop greater respect and appreciation for health workers and the lifesaving care they provide globally, as well as in the United States. 

Meet Tsegay, Haile, Alemayehu, and Derebrew

After breaking their silence and confronting the stigma faced by people living with HIV in Ethiopia, and envisioning that no child be born with HIV from their town, the four mothers—Teberih Tsegay, Almaz Haile, Jember Alemayehu, and Yeshi Derebew—received training on PMTCT and began working in late 2010 as mother mentors at Korem Town’s health center of Tigray Region.

 {Photo credit: Genaye Eshetu/MSH.}Teberih Tsegay, Almaz Haile, Jember Alemayehu, and Yeshi Derebew, of Korem Town, Ethiopia.Photo credit: Genaye Eshetu/MSH.

Knowledge is power, so the saying goes.

No one understands that more than Teberih Tsegay, Almaz Haile, Jember Alemayehu, and Yeshi Derebew, of Korem Town, Ethiopia, who have used their knowledge to save the lives of babies in their community. "Some years back there was no one to teach us, so we gave birth to HIV-positive children. But now we can teach others so no child will be born with the virus," said Jember.

Seeing the toll HIV had taken on their communities—but empowered with knowledge and skills to stop its further spread—the four women began working with the Korem Health Center as Mother Mentors in 2010. They teach HIV-positive pregnant women and their husbands about the steps necessary to keep their babies safe from the virus.

Remarkably, since they began their work three years ago, only one child has been born HIV-positive in Korem Town.

{Photo credit: Warren Zellman}Photo credit: Warren Zellman

I remember attending the Durban international AIDS conference in 2000, my first. That was the one where everything was going to turn around and we were going get a handle on the epidemic. Nelson Mandela spoke at that one, in a hall that was the size of three football fields. And the crowd was joyous, raucous, the noise was deafening and it was one of the most memorable days of my life. 

Before Mandela took the stage, a choir made up of kids—none more than 9 or 10 years of age and many much younger—took the stage to sing tribute to the great man and those of us gathering there.

It was charming and sweet. Everyone had a huge grin on their faces. And then I realized that this group of kids was special, maybe overheard someone nearby or perhaps the MC say that this, “was THAT group.” All were infected with the virus, and as I watched these gorgeous children singing so strong, moving and smiling and clapping with everyone, I knew, knew inside, that they probably wouldn’t live much longer.

 {Photo: Lourdes de la Peza}Keziah Samaila from Township Clinic, left, and Joy Otuokere, right, from Zuba Health Center, singing during the LDP+ training in Gwagwalada, Nigeria.Photo: Lourdes de la Peza

This post originally appeared on USAID’s IMPACT blog. USAID is observing World AIDS Day this year by celebrating ten years of HIV and AIDS work under PEPFAR.

More than 85,000 infants in Nigeria are at risk of HIV transmission from their mothers every year. While the number of HIV-positive pregnant women who receive antiretroviral treatment (ART) is increasing, robust efforts to improve coverage are needed if national targets (PDF) for prevention of mother-to-child transmission of HIV (PMTCT) are to be met in 2015.

 {Photo credit: MSH}Kenyan youth holds AIDS education pamphlet.Photo credit: MSH

The Kenya National AIDS and STI Control program (NASCOP) under the Ministry of Health (MOH) disseminated preliminary results of the Kenya AIDS Indicator Survey (KAIS) 2012 on September 10, 2013. The dissemination conference was attended by all major stakeholders in the HIV and AIDS response in Kenya, including Management Sciences for Health (MSH).

The second such report, the KAIS 2012 (PDF) provides national data in comparison with the first survey in 2007.  Overall, huge improvements have been made, despite the remaining challenges and the gender, age group and geographical disparities that have persisted.  Adult HIV prevalence dropped from 7.2 percent in 2007 to 5.6 percent in 2012. The total number of people living with HIV is now estimated at 1.2 million, down from 1.4 million in 2007. Among children 18 months to 15 years, the prevalence was estimated at less than one percent (0.9 percent), which translates into about 104,000 children living with HIV in 2012. 

{Photo credit: Reavis/MSH, Malawi}Photo credit: Reavis/MSH, Malawi

The World Health Organization (WHO) made waves at the International AIDS Society conference in Kuala Lumpur when it issued revised guidelines for HIV treatment. The new guidelines—WHO’s first major update since 2010—recommend an earlier start to treatment, from a CD4 threshold of 350 cells/mm3 to 500 cells/mm3. While most patients don’t show symptoms of disease at these higher CD4 counts (a measure of immune system strength), the new guidelines responded to evidence that an earlier start improves long-term clinical outcomes and that ARV treatment dramatically reduces patients’ likelihood of transmitting the virus to sexual partners.

MSH: Saving lives and improving health in 2013.{Image credit: MSH.}Image credit: MSH.

We have seen some remarkable gains in global health in 2012. Yet millions of women, children, and men still die from preventable causes. As we pause and reflect on 2012 and look ahead to the new year, I invite you to read and share some of our favorite blog posts from the year.

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