Andhra Pradesh (A.P.) is one of the six high HIV prevalence states in India, with all 23 districts categorized as high prevalence. It also has the highest HIV disease burden (21%) in the country. 18 lakhs pregnant women give birth in A.P. per a year. As per 0.77% HIV prevalence, 13,652 estimated HIV positive pregnant women deliver children per year and 4,089 infants are at risk of acquiring HIV without any intervention (30% vertical transmission rate).
75% of deliveries in the state take place at institutions (public-40 %, private- 60%) and the remaining 25% take place in personal homes. By 2008, the state reached 45% of pregnant women with HIV counseling and testing, and identified 25% of HIV positive pregnant women, primarily through the public health sector, with major gap in the private health sector.
To bridge this private sector coverage gap, Andhra Pradesh State AIDS Control Society (APSACS), with technical assistance from SAATHII, initiated PPTCT services in private health facilities through Public Private Partnerships (PPP). The goal of the AP-PPP Program is to prevent mother to child transmission of HIV among pregnant women accessing the private health sector in 15 districts of A.P. This program began in January 2009 and is still operating in order to reach more pregnant women accessing private healthcare facilities.
AP-PPP PPTCT Program Coverage
- Pregnant women
- Counseled and Tested: 306,813
- Positive pregnant women served: 965
- Tested for CD4: 796
- Eligible women put on ART: 203
- Positive deliveries conducted: 762
- No. of live births: 733
- ARV prophylaxis to Mother-baby pairs: 708
- General Clients:
- Tested: 68,470
- Detected positive: 4,550 (6.6%)
Accomplishments untill May 2012
- Established 137 PPP-ICTCs in private sector hospitals of 15 districts
- Trained and sensitized nearly 4,500 healthcare providers on HIV, PPTCT, and universal work precautions
- Established 197 referral sites i.e. private hospitals that are not part of PPP program but are willing to refer HIV positive women to PPP sites for PPTCT services.
- Developed IEC materials including Standard Operating Procedures, tools, and checklists related to various services of ICTC
- So far, 509 out of 518 HIV exposed infants tested negative at 6 weeks, 293 out of 296 tested negative at 6 months and all 169 tested negative for HIV at 18 months (a total of 12 positives have been detected thus far)
- Implemented a NACO certified mobile ICTC van in Nizamabad district to connect ICTC services to hard-to-reach populations and reached 6,025 pregnant women and 20,414 MARPs
- Documented and disseminated “PPP PULSE” newsletters across PPP sites
- Capacities of 138 PPP-ICTCs were built through trainings, periodic supportive monitoring and mentorship visits, and experience sharing meetings which resulted in
- Increase in CD4 testing of positive pregnant women, with ART eligible women initiating ART
- Increase in referrals of positive pregnant women to PPP sites from other ICTCs and private hospitals
- 762 positive pregnant women identified in private hospitals delivered at PPP-private hospitals and government hospitals
- Established linkages between private facilities, District AIDS Prevention And Control Units (DAPCU), and other care, support and treatment services
- Improved documentation at PPP sites and streamlined reporting to the government
The AP-PPP PPTCT Program is funded by Elizabeth Glaser Paediatric AIDS Foundation and Andhra Pradesh State AIDS Control Society