Supporting the Department of Health (DoH) since the early days of its roll-out, Anova offers direct and technical support at a facility level and interacts with key role-players at multiple levels within the DoH and other stakeholders. Over 80 000 pregnant women come through the eMTCT programme annually, and we consistently achieve below 2% perinatal transmission at six weeks.
Regular training of healthcare workers is central to this support, allowing the programme to remain sustainable. Some of the training processes we support include Nurse-Initiated Management of Antiretroviral Treatment (NIMART), District Integrated Course on Maternal Health, Nutrition and Young Child Feeding in the Context of HIV; Integrated Management of Childhood Illness and Family Planning. We also provide training for facility and programme managers and in-service training at the facility level. Part of this training also covers updating healthcare workers on new guidelines.
We also run practical simulation scenarios for healthcare workers to measure competence in clinical management around eMTCT, focusing specifically on paediatric care. More recently, our paediatric team has supported the District to start the roll-out of the KidzAlive model. This model trains and mentors clinics, hospitals and community organisations to provide structured services to children and caregivers.
Part of our facility level activities includes clinical, systems and data management support, largely by our technical/clinical advisors, nurse mentors and data quality teams. We currently have a high uptake of HIV testing in pregnant women, ART initiation in those who are HIV-positive and testing of their infants at birth and later. Our current focus is on maintaining this performance, and tackling the remaining gaps in the programme.
Viral load monitoring a key focus
Viral load monitoring in pregnant and postnatal women is our main focus. We are working with the DoH to come up with strategies to improve on this. We use a data-driven approach to our facility support. Routine data from DHIS and TIER.Net allows us to target specific facilities and programme areas, to ensure our support is directed at the correct problem at the correct time.
Expanding paediatric and adolescent HIV and TB care
Supporting the Johannesburg Health District, Anova and other partners (Wits RHI, Right to Care, HIVSA and CARe) are collaborating on a Paediatric and Adolescent scale-up project. The project aims to improve current paediatric and adolescent HIV and TB care, to increase the number of children diagnosed, initiated on treatment and retained in care to improve outcomes in this vulnerable age group. Anova works with DoH, Wits RHI, Right to Care, HIVSA and CARe on the project.
Several approaches have been implemented within the project, including increasing interest in HIV testing through an index-client approach, use of a screening tool to motivate for HIV-testing, increasing awareness for testing at paediatric and adolescent entry points and placement of counsellors to support facility testing.
Clinical support for managing HIV-positive children and adolescents has been central to the project, facilitated by the implementation of paediatric focused NIMART mentoring at six sites across the Anova-supported sub-districts. Initiation of young babies and children has also been expedited by using National Health Laboratory Service (NHLS) data to support clinics in identifying HIV-positive children early and ensuring they are initiated onto treatment. We also support the completion of the HIV-positive Baby Tool, which helps to identify gaps in eMTCT implementation. Within the project, a psychosocial team have started support groups for young people living with HIV, as well as counselled many caregivers to be able to support their children better.