Web of Positive Living

At the weekly ART meeting, the "Prevention of Mother-To-Child Transmission" (PMTCT) staff reported on the number of children from their program who have been confirmed HIV-positive.

Mothers are given a single dose of nevirapine, to be taken during labor (whether they deliver at home or in the hospital), and children born at the hospital to HIV-positive mothers receive short-course AZT, in an attempt to deter transmission of the virus. Each case that the PMTCT staff reported had a story. Some examples:

• Mothers enrolled in the program for their first birth, but neglected to contact the hospital during a subsequent pregnancy
• Faced with substantial travel costs, some mothers played their (rather, their children's) chances - delivering without PMTCT ARVs
  
• Mothers from a certain village failed to deliver at the hospital, afraid the care-seeking behavior would reveal their status
  

These mothers might bring in their children for testing after 18 months, or only if symptoms present. This delay in determining HIV-seropositivity dramatically decreases the child's chances of survival. Because the drugs (single-dose at birth, followed by a one-week course) are so effective in halting vertical transmission of HIV, every child born HIV-positive to women enrolled in the PMTCT program is deeply troubling.

After talking with hospital staff, we're going to integrate the new SMS network into the hospital's Voluntary Counseling and Testing (VCT) services. As part of their post-test counseling, every client who tests positive will be paired with an HIV-positive CHW with a cell phone. Many of the CHWs we have trained to text are committed members of the HIV-positive community - leaders of support groups, impressively drug-adherent, and people who spread a 'Positive Living' message.

These CHWs, along with their mobiles, will provide HIV-positive individuals a link to hospital services, a way to privately ask questions, and someone to look over their health. It will also provide a means by which to track pregnancies for HIV-positive patients, and follow deliveries for mothers in the PMTCT program.

Above - the fourth group of CHWs. After the training session, Alex and I situated each CHW's ID pin on the map of the catchment area. As promised, new colors appeared - youth counselors and reproductive health volunteers are now connected to the hospital.
At the week's medical meeting, a new category was reported - "SMS Follow-Ups" - for the TB and ART programs.