The state of play
We know that health systems increasingly have the resources to address mother-to-child transmission (MTCT) of HIV; but, in practice, these resources often go under-utilised. If we are to end MTCT, then every HIV positive pregnant woman needs to attend clinic appointments, remain adherent and be supported by her partner, family and broader community. The issue isn’t just a medical one, it’s a societal one; and herein lies the challenge.
Yes, there is more to do but it’s only fair to highlight that there has been significant progress towards ending mother-to-child transmission of HIV in recent years. In 2010, just under 400,000 children were perinatally infected each year and by 2016 this number had dropped to 160,000. However, the global target is 40,000 a year, and the most difficult situations and contexts remain to be solved.
So, where do we start?
Joining the dots: the HIV care continuum
The HIV world often talks about a ‘continuum of care’ – ensuring that people at risk of HIV get tested; those who are tested receive antiretroviral treatment (ART); and those on ART achieve and maintain viral suppression. This is simpler described than done given the prevailing attitudes towards HIV and particularly the stigma and discrimination that exists.
In many of these countries where the prevalence of HIV is highest, this continuum is disjointed; with one end not speaking to the other. For example, in some areas where testing is taking place and making in-roads, very few of those testing positive for HIV are being referred to their local clinic to receive treatment.
Community-based organisations are tackling stigma, addressing barriers to testing and outreach with good connecting to funding; while HIV clinics are conducting the testing and treatment, but no single entity is ensuring that funding is being used most effectively or success is being measured, documented and communicated out.
HIV isn’t one single issue – it’s multiple problems that combine to perpetuate the epidemic. Only by joining forces and fighting on all fronts can we begin to contain it.
Without a bold and empowered community response, the health system, operating in isolation, will not succeed in breaking down many of the barriers preventing access and retention in programmes – such as HIV stigma and socio-cultural barriers.
It’s clear that in order for populations to reach and sustain record numbers of pregnant women, children and adolescents in care, clinics and the communities they serve must partner with each other.
Together, clinics and communities must sensitize communities to increase uptake, link children and families into care, combat stigma and discrimination, monitor programme quality and build stronger local health systems.
That’s where the Clinic-Community-Collaboration (C3) programme comes in…
The C3 programme promotes clinic-community collaboration as a key strategy in the elimination of mother-to-child transmissions of HIV. With small improvements in hundreds, or even thousands, of clinic-community collaborations, we can lead to huge overall impacts in improving HIV care.
C3, born out of a partnership between our Positive Action for Children’s Fund (PACF) and action network Paediatric & Adolescent Treatment Africa (PATA), the programme aims to foster partnerships between health facilities and communities, enabling them to deliver improved PMTCT and paediatric HIV services together.
Three years on ... has it worked?
In the last three years, we have worked across nine countries and 36 community-clinic collaborations to witness first-hand how transformative collaboration can be at a local level.
Our key results showed important improvements in clinic-community partnership indicators and an increase in women enrolled in PMTCT services with fewer PLHIV lost to follow-up.
In addition, C3 showed improved relationships between partners and improved perception of each other’s contribution to PMTCT/ paediatric HIV care services according to data from all 36 partnerships)
Looking into the future: what’s next for C3?
Key lessons learned to date:
- International organisations, development partners, governments, and public and private funders must recognise that sustainable investments at global, national and local level are key to the development and continuation of effective community partnerships and services in order to scale up HIV services. Coordination by funding agencies is necessary to support the comprehensive integration of services required to avoid overlaps and duplications.
- Local governments must, in turn, direct increased financing at a local level to implement methodologies that provide structured capacity-building and district coordination that strengthen and enhance the capacity of communities, and in particular clinic-CBO partners.
- Clinic-CBO programme implementation must commit to a rigorous research agenda to further explore, develop and document more robust clinic-CBO evidence and develop better indicators for community engagement in PMTCT and paediatric HIV treatment. Investment in innovative and accessible platforms and tools to form part of the feedback loop is necessary to ensure timely dissemination, inform policy and facilitate adoption of best practices.
ViiV Healthcare Proud to Support
We’re proud to say that C3 has played a significant role in creating a growing community of practice centred around clinic-community collaboration and generated rich and diverse insights and learnings that will directly contribute to achieving improved community engagement; but there’s more to do.
Helen Chorlton, Senior Programmes Manager (C3, PATA)
Agnes Ronan, Head of Programmes (PATA)