Preventing vertical transmission in the private sector:
The majority of pediatric HIV infections are transmitted vertically, from HIV positive mothers to their children. The risk of such transmission is in the 20%-45% range. It can be reduced to 2-5% through Prevention of Parent to Child Transmission (PPTCT) interventions that follow national guidelines for lifelong Anti RetroViral Therapy (ART) for pregnant women who are HIV+. [Option B+ is the current WHO and Gov't of India recommendation, in which ART is to be initiated regardless of immune status as measured by the CD4 count.]
The full cascade of PPTCT interventions includes HIV counseling and testing to all pregnant women at first antenatal care (ANC) visit, provision of life-long antiretroviral therapy (ART) to all HIV-positive pregnant women regardless of immune status, promotion of institutional delivery, provision of antiretroviral prophylaxis to all infants born to HIV-positive mothers, from birth up to 6 weeks at the minimum, and Early Infant Diagnosis (EID) at 6 weeks and 6, 12 and 18 months.
The national program has experienced gaps in reaching women who seek antenatal, delivery and postnatal care in the private sector. Country-wide, 27% of women who deliver institutionally do so in private hospitals, and this percentage is significantly higher in states, such as Andhra Pradesh, Telangana, Maharashtra, Gujarat, Kerala and Tamil Nadu. Private hospitals are required to offer HIV tests during routine ANC screenings. However, there remain substantial challenges reaching the private sector, convincing providers to use standardised diagnostics and treatment protocols. There is a strong need to support the private health system in bridging these gaps, ensuring adherence to the national PPTCT guidelines, and reporting of positive cases to the government.
SAATHII has been working with the private sector since 2002. As of October 2015), it entered into a partnership with The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to further scale up the engagement through enabling and strengthening public-private partnerships. Titled Project Śvetana, this scale-up covers Andhra Pradesh, Delhi, Goa, Gujarat, Jharkhand, Karnataka, Kerala, Maharashtra, Odisha, Puducherry, Rajasthan
Ensuring retention in the PPTCT cascade:
Women who seek maternity and post-natal care in private health facilities, and are diagnosed positive, nevertheless may visit government facilities to get their HIV screening results confirmed or avail of the anti-retroviral therapy available in government ART Centers. Attrition has been observed in all of the following steps:
- From single test to confirmatory diagnosis
- Confirmatory diagnosis to ART initiation
- Delivery to initiation of Nevirapine prophylaxis for the infant
- Uptake of 6 week, 6 month, 12 month and 18 month infant diagnosis
While such attrition occurs in PPTCT programs globally, ensuring retention in case is particularly challenging in the context of women seeking services across private and public sectors. The m-Maitri intitiative offers one potential solution to reducing attrition in the cascade.