The Program for Prevention of Mother to Child Transmission (PMTCT) was launched in October 2004 and completed in December 2008, being integrated to a great extent into the public health system.

Partner: Ministry of Health, through the County Public Health Authorities in 16 counties: Suceava, Bacau, Galati, Braila, Constanta, Dambovita, Prahova, Olt, Dolj, Timis, Sibiu, Cluj, Bihor, Caras-Severin, Brasov, Hunedoara and Bucharest.

The objectives of the program were as follows:

· To reduce mother-to-child HIV transmission rate;

· To increase competencies of professional networks in the medical field in assisting HIV positive pregnant women and their newborns;

· To ensure equal and non-discriminatory access of HIV positive pregnant women and their newborns to quality medical care and support;

The program for prevention of mother to child transmission was tightly connected in implementation with the program for voluntary counseling and testing addressed to the general population (VCT).

In this respect, in 2004, after evaluation tours done by the coordination team, 17 intervention locations were selected (16 counties and Bucharest). The selection was done in collaboration with specialists from the Public Health Directorate from the Ministry of Health and professionals from the National Institute for Infectious Diseases “Prof.dr. Matei Bals”. The locations were selected following a set of criteria related to material and human resources available at local level, willingness of local medical authorities to allocate the resources to the PMTCT project and prerequisites for sustainability and continuity of the project at the same quality standards as set in the Project Methodology.

Once the implementation locations were selected, Romanian Angel Appeal established 18 Voluntary Counseling and Testing Centers within the local public health authorities and close to the HIV serologic laboratories. For these, 35 nurses were recruited and trained as HIV/AIDS counselors.

The teams of counselors from the 18 centers were trained initially in general counseling for HIV testing, counseling for rapid testing, group counseling and risk assessment. This initial session of residential and on-line training was soon followed by annual sessions (2005, 2006 and 2007) destined for learning abilities for counseling vulnerable groups and group counseling techniques.

Following RAA’s request, 17 local coordinators were named appointed from the local authorities for public health as local program implementation partners.

With financing from The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), the Voluntary Counseling and Testing Centers were fully equipped with the necessary materials, vehicles included, in order to facilitate the implementation in best conditions of the outreach activities in the rural areas or in places far from the county seats. Thus, voluntary counseling and testing services were “brought to the beneficiary” thus ensuring access to HIV testing and counseling for isolated or poor communities. Universal access to services was particularly welcomed by all pregnant women included in the project as well as by their respective partners.

Together with its local partners – local public health authorities and NGOs, Romanian Angel Appeal initiated and developed campaigns to raise awareness about the importance of HIV testing and counseling for pregnant women and their partners.

Taking into account international guidelines, HIV testing and counseling during the first pregnancy trimester was encouraged in all cases so that PMTCT protocol could be applied timely and efficiently. The second HIV testing and counseling were recommended for the third pregnancy trimester.

In addition, we recommended HIV testing and counseling for the pregnant woman’s partner, especially in the cases when, during counseling sessions, they were identified as belonging to a vulnerable group at risk of HIV infection.

For the pregnant women hospitalized in maternities during childbirth, who had not been tested prior to this or were unable to show evidence of testing, RAA provided, through local teams of counselors, rapid tests in 50 partner maternities.

Rapid assessment of HIV status of the pregnant woman allowed for efficient interventions by applying the PMTCT protocol. Moreover, through the Voluntary Counseling and Testing Centers, we provided partner maternities with complete protection materials for C-sections or abortions.

Pregnant women diagnosed with HIV during the program and pregnant women with previous diagnosis in evidence who were receiving therapy benefitted from the PMTCT protocol.

Simultaneously with implementing the PMTCT program, we managed to introduce, as model of good practice, a local group of multidisciplinary intervention in every county involved. The group consisted of professionals from every field – family doctor, infection diseases specialist, obstetrician, family planning specialist, epidemiologist, psychologist, social worker and counselor. Thus, we put the basis of ensuring the access of the HIV positive pregnant woman and her newborn to quality medical care as well as an integrated and multidisciplinary approach of each individual.

In order to implement the program under best circumstances, the RAA coordination team designed the PMTCT Program Methodology in line with international recommendations and the National HIV/AIDS Strategy 2004 – 2007 in the area of prevention of mother-to-child HIV transmission.

The methodology was completed in 2004 but was later re-examined and amended (in 2005 and 2006). Suggestions and recommendations from local partners as well as conclusions and observations from the international evaluator of the program – Dr. Katinka de Vries, expert for WHO, UNAIDS and World Bank, all contributed to the revising process.

The final version of the methodology was endorsed and certified by the Ministry of Health (document no. 46165 / 12.10.2006), the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” of Bucharest (document no. 144/02.10.2006) and is now a very useful working tool for anybody who wants to implement and develop a PMTCT program.

In order to constantly improve the quality of the services provided by the Voluntary Counseling and Testing Centers, RAA designed and put together a set of Monitoring and Evaluation (M&E) instruments for quality assessment. These instruments were also certified and are currently used by the local implementation partners (local public health departments) under the supervision from local RAA coordinators.

Between October 2004 and December 2008, a number of over 120.000 pregnant women have been counseled for HIV testing of which an important portion consisted of women from the rural areas. The newly diagnosed cases of HIV positive pregnant women benefited from referrals to specialized medical and support services.

In order to ensure the sustainability of the MTCT program, following the decision of the Ministry of Health, 17 Voluntary Counseling and Testing Centers were taken over in March 2006 by the local departments for public health (services, staff, specific equipment) while in 2008, the 18th center was integrated into the Institute for Mother and Child Protection (IOMC), Polizu Department of Obstetrics and Gynecology, Bucharest.

The process of integrating the VCT centers into the administrative and financial structures of the local public health departments was long and difficult.

Romanian Angel Appeal’s efforts and the outstanding results obtained in implementing this program represent the basis for the continuation of the activities at the same qualitative standards.

For this, however, effective and efficient collaboration between governmental and non-governmental sectors is vital as well as the involvement of the relevant political stakeholders responsible for woman and child health and for public health.

Complying with current European standards and regulations and keeping the services provided to the pregnant woman and her newborn in line with intervention models internationally recommended are goals that can be reached by medical, economical, social and political factors together.

For more information on the PMTCT Program, please see the Project Report .

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