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Africa Regional PMTCT and IYCF Program

(abridged)

Project Duration: 2002–2006


The LINKAGES Africa Regional PMTCT and Infant and Young Child Feeding (IYCF) Program was established in 2002 in response to multiple requests from African countries for technical assistance in integrated infant feeding in the context of HIV/AIDS and PMTCT. The project’s pioneering work in Zambia between 1997 and 2004 to introduce HIV counseling and testing and apply national infant feeding guidelines in antenatal clinics was studied elsewhere in Africa as a feasible and sustainable strategy in low-resource settings because it reduced the risk of mother-to-child transmission and improved care for all mothers and infants regardless of HIV status The skills, tools, and materials that emerged from LINKAGES/Zambia helped over a dozen countries begin to overcome the challenges of IYCF in the context of PMTCT.

Program Design

The Africa Regional Program endorsed the integration of optimal IYCF counseling into mother and child heath (MCH) clinic and community PMTCT services. The goal was to help women weigh the risks and benefits of infant feeding methods and choose the best option for their situation. The components of the LINKAGES approach were:

1. Advocacy for updated and applied national PMTCT and IYCF policies and guidelines

2. Assessment of clinic and community services and referral systems, staffing, training needs, care-seeking behavior, household food security, sanitation, stigma, gender issues, HIV/AIDS and PMTCT knowledge and attitudes, IYCF practices, and replacement feeding options

3. Training of health providers, community health volunteers, and partner staff in PMTCT and IYCF counseling and on-the-job mentoring through existing or improved supervisory systems

4. Support for improved MCH services (labor, delivery, post-natal, family planning, and child health) to reduce the risk of mother-to-child transmission of HIV

5. Behavior change communication (BCC) strategic planning, training in BCC methodologies, materials development, and media campaigns to promote appropriate PMTCT and IYCF messages

6. Community involvement in supporting mothers and their IYCF choice, strengthening community counseling and referrals to clinics, and monitoring community results

7. Enhanced data management , including capacity building to collect data within the health management information system and feedback on how to improve behavior change and service demand

Program Implementation and Recommendations

From 2002 through 2006, the Africa Regional Program collaborated with national, regional, and international partners to promote and facilitate PMTCT policies and programs and build capacity to integrate optimal IYCF into existing maternal and child health (MCH) and community PMTCT services. Technical assistance was grounded in extensive field experience. Program staff included African technical specialists in HIV/AIDS, infant feeding, training, BCC, and monitoring and evaluation.

LINKAGES found that attention to the following considerations can facilitate uptake of PMTCT services and practice of optimal infant and young child feeding:

  • Emphasizing nutrition in all phases of PMTCT programs and linking PMTCT to other child survival interventions, family planning, and care and support of people with HIV/AIDS
  • Promoting PMTCT and IYCF as services for couples and families, not only for women
  • Providing on-site and hands-on training in breastfeeding, safe replacement feeding demonstrations, and communication and negotiations skills and then mentoring, supervising, and monitoring the trained health providers and community health workers
  • Training private sector as well as public sector health providers in IYCF counseling
  • Training community health workers in optimal maternal nutrition, IYCF, and BCC strategies to relieve some of the burden on facility-based PMTCT health providers
  • Organizing regular meetings between health providers and community health workers to monitor the community component of PMTCT programs
  • Raising awareness of the dangers of mixed feeding through advocacy, health education, counseling, and media messages
  • Engaging recognized community volunteers, men, and older women to promote IYCF in the context of PMTCT
  • Encouraging communities to establish infant feeding and PMTCT support groups