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close this bookAfrican Regional Meeting on Pilot Projects for the Prevention of Mother-to-child Transmission of HIV, Gaborone (UNAIDS, 2000, 58 p.)
View the document(introduction...)
View the documentZambia
View the documentCote d’Ivoire
View the documentZimbabwe
View the documentRwanda
View the documentKenya
View the documentSouth Africa
View the documentUganda
View the documentTanzania
View the documentHonduras
View the documentBotswana
View the documentDiscussion and lessons learned


Honduras shared its general experience in getting started. Between 1985 and October 1999, a total of 14,230 HIV-infected persons and 11,021 AIDS cases have been reported. In 1997, 0.7% of pregnant women in Tegucigalpa were HIV-infected. In 1998, the seroprevalence in prenatal care clinics in San Pedro Sula was 3.6%. From 1987-1992, 105 children with perinatal-acquired HIV/AIDS cases were seen. Between 1993-1998, 514 children were diagnosed with HIV infection.

The main objectives with regard to MTCT include:

· to implement a pilot programme in Tegucigalpa and San Pedro Sula for two years that will reduce MTCT by 50% in non-breastfeeding women and by 35% in breastfeeding women, without increasing infant morbidity and mortality, nor impairing infant growth;

· to develop institutional capacity to combat MTCT.

The target population in the two cities is 56,355 pregnant women, of whom 80% attend prenatal care. It is hoped to reach half of these women in the first year. The pilot will include twelve health centres and two hospitals in the capital city, Tegucigalpa, and four health centres and three hospitals in San Pedro Sula.

The basic intervention package will include:

· IEC activities
· short-course AZT
· provision of prenatal multivitamins
· obstetric measures
· counselling on infant feeding
· provision of breast-milk substitutes for women who decide to use it
· growth and development monitoring of the child (monthly)
· testing of infants
· family planning services
· psychosocial support

Four main areas of weakness and/or where major implementation questions have arisen:

· IEC:

· for health workers (counsellors, doctors): information workshops, training, distribution of information, in a continuous process, on the theme of MTCT and the pilot programme;

· for pregnant women: information in health centres, posters, on the themes of HIV transmission and prevention, HIV tests;

· for HIV-infected pregnant women: counselling, leaflets, on the themes of prevention of transmission and the pilot programme.

· Delivery Care:

· confidentiality vs. identification of HIV-infected women in hospitals;

· deliveries in septic (semi-isolation) ward for asymptomatic HIV-infected women;

· rooming-in and infant feeding in the case of Caesarian-section;

· AZT treatment during delivery.

· Tests for HIV status:

· rapid tests: these are very expensive when bought locally, and there is no experience in their use in the public sector and especially in health centres;

· polymerase chain reaction (PCR) testing: it would be desirable to have early diagnosis in new-borns, but PCR testing is very expensive.

· Psychosocial support:

· counsellors exist in the health centres;

· self-help groups needed, and first contacts have been established.