|African Regional Meeting on Pilot Projects for the Prevention of Mother-to-child Transmission of HIV, Gaborone (UNAIDS, 2000, 58 p.)|
|SESSION 3: SHARING OF COUNTRY EXPERIENCES|
Kenya also shared its experience of infant feeding. The National AIDS and STD Control Programme estimates the HIV seroprevalence in the adult population in Kenya to be 13.9%; however, there are regions in the country with a prevalence of 20-30%. The current population of Kenya is 29 million people with about 50% aged less than 15 years. The seroprevalence among antenatal mothers varies from 3% in low prevalence areas to 35% in high prevalence areas.
The sites chosen for the Kenya PMTCT project are Homa Bay in Nyanza province, Karatina Hospital in Central Province and Kenyatta National Hospital in Nairobi Province. The percentages of pregnant women testing positive at the sentinel sites in these regions are 29%, 17% and 16% respectively.
At each of the sites breastfeeding is universally practiced and other feeds are introduced early to the majority of infants.
To support PMTCT project implementation, a baseline knowledge, attitudes and practices survey was conducted in November 1998 with the following major findings:
· stigmatisation of HIV-infected persons by health workers and communities was common at all sites
· alternatives to breast milk are used when a mother dies (cows, goats and camels milk and soya products); formula milk, however, was not given as one of the choices.
· accurate knowledge on infant feeding was low among both communities and health workers (exclusive breastfeeding and complementary feeding)
· health workers expressed a need for training in infant feeding
· misconceptions are common regarding HIV transmission
· the socioeconomic status of the rural communities was low, with poor sanitation and hygiene
· there was a lack of both knowledge about and access to VCT services
· women are not empowered to make decisions
The presenter explained where the project is now:
· An integrated training package has been developed and used to train 30 trainers of trainers who, in turn, have trained 180 health workers at two sites
· Supplies have been received and delivered to most of the sites
· Health facilities are being improved to meet the needs for confidential counselling
· All data collection tools have been developed, including modification of the ANC card
· IEC materials development has followed the process of formative research, analysis, design of materials and production of drafts, which have been pre-tested in all three sites. Materials cover the themes of introducing PMTCT, VCT, stigma reduction, marketing of health facilities, support groups, individual counselling and awareness creation on primary prevention of HIV transmission.
· Kenya is ready to recruit the first client on the first of June 2000
Lessons learnt to date include:
· Slow implementation reduces the high motivation of the health workers and communities
· The implementation of the pilot project is likely to increase general awareness of the options available to mothers and will lead to an increase in client load. This is important given that the sites experience staff shortages.
· There is a need to study and develop interventions to meet the psychosocial care and stimulation of the baby who will not be breastfed
The way forward:
· The pilot project is taking advantage of the newly constituted National AIDS Control Council to advocate for increased resource allocation and for government to take a more active role in project implementation and monitoring.
· The project will undertake a cost analysis study that will inform on the various costs to the implementers as well as to the mother and to the community. This will provide important information for scaling up.
· A study on alternatives to breast milk at community level is planned.