Rapid upscaling of prevention of mother-to-child HIV transmission (PMTCT) in Cameroon, West Africa

Tih Pius Muffih, MPH, PhD¹, George Ndikintum¹, Godlove Nkuoh¹, Joseph Nkfusai¹, Thomas K. Welty, MD, MPH¹, Edith R. Welty, MD¹, Janet Kayita, MD, MPH², and Marc Bulterys, MD, PhD³. (1) AIDS Education and Prevention Program, Cameroon Baptist Convention Health Board, PO Box 9, Nso, Northwest Province, Kumbo, Cameroon, 237-776-4781, PiusTih@aol.com, (2) Institute for HIV/AIDS, Family Health International, 2101 Wilson Blvd. Suite 700, Arlington, VA 22201, (3) Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Mailstop E-45, 1600 Clifton Road, Atlanta, GA 30333

Despite the availability of donated nevirapine (NVP) for PMTCT in developing countries, only a small proportion of HIV-positive mothers receive prophylaxis. In February 2000, the Cameroon Baptist Convention Health Board began a PMTCT program in two referral hospitals in rural Cameroon with support from the Elizabeth Glaser Pediatric AIDS Foundation. Through December 2003, a total of 344 health care workers were trained to implement PMTCT at 92 health facilities, ranging from large hospitals to small clinics in remote villages in 6 of Cameroon’s 10 provinces. A training manual (http://womenchildrenhiv.org) and two videos were developed (in English and French): one for educating antenatal patients as part of group pre-test counseling, and the second to train health care workers (order from http://www.hcpartnership.org/mmc). Each site performs serial rapid HIV tests and same-day post-test counseling, thereby reducing cost and improving follow-up. Through December 2003, we counseled 38,131 pregnant women. The acceptance rate of HIV testing was 93%. HIV-1 seroprevalence among pregnant women tested varied widely by facility, ranging between 2% and 18% (mean 10.5% in 2000, 9.9% in 2001, 9.5% in 2002, and 7.7% in 2003). Group training of health care workers to integrate PMTCT into antenatal care, use of rapid HIV tests, same-day post-test counseling, and ongoing support are the keys to rapid and efficient upscaling of PMTCT services. Integration of PMTCT into routine antenatal care is crucial to achieving high test acceptance rates. Funding organizations should support collaboration of NGO and governmental programs to rapidly upscale PMTCT services in resource-limited settings.

Learning Objectives:

1. Define essential components of successful programs for prevention of mother to child HIV transmission (PMTCT) in resource-poor settings.

2. Identify tools to help upscale PMTCT programs in such settings.

3. Discuss the role of PMTCT as the gateway to community-wide HIV testing and counseling, prevention, and destigmatization, and the care and treatment of AIDS.

4. Describe the use of antenatal seroprevalence as a surveillance tool to monitor the HIV epidemic.

At the conclusion of the session, the participant in this session will be able to

1. Describe two factors that lead to high acceptance rates for antenatal HIV testing.
2. Explain how PMTCT programs can be a gateway to prevention and treatment of HIV/AIDS
3. Discuss the use of HIV seroprevalence data as a surveillance tool in resource-poor settings.

Keywords: HIV/AIDS, International Health

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The Cameroon Baptist Convention Health Board (CBCHB) is a faith-based organization that administers two hospitals, 21 intergrated health centers, and 40 primary health centers. CBCHB has been a leader in HIV/AIDS prevention in Cameroon and works collabor
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation

HIV/AIDS: Have We Found the Right Prevention and Treatment Strategies?

The 132nd Annual Meeting (November 6-10, 2004) of APHA