In Inhambane province in Mozambique, the HIV prevalence rate has increased worrisome: from 8.6% in 2009 to 14.1% in 2015 (IMASIDA). To avert this increase, the Kusingata programme aims to increase quality of HIV services and create demand of it by pregnant women and children.
Kusingata means ‘support’ or ‘warmth’ in local language, referring to a support approach to families and children living with or affected by HIV. It is rooted in traditional systems of the communities in Inhambane. The programme makes use of these community structures for referrals to testing and treatment; individual support through home visits; support groups and community dialogues. Implementation of a community scorecard, a social accountability tool at health facility level, quality of HIV services will be improved from a user-perspective. To assure intrinsic motivation of clients, field staff and health care providers will receive training on motivational interviewing.
Kusingata is designed by a consortium of two Mozambican organisations N’weti and Mahlahle, who joined forces with the Dutch research institute KIT. This unique blend of expertise allows the consortium to have profound knowledge of the community context, as well as assuring to incorporate latest international evidence and establish a strong research component.
Kusigata aims to contribute to children and mothers living with or affected by HIV living healthier lives and reach their full potential. Expected outcomes are:
1) A higher percentage of women are on treatment before a (first) pregnancy
2) A higher percentage of children exposed to HIV receive an early infant diagnosis or access community-based testing services
3) A higher percentage of women start HIV treatment through PMTCT services earlier in pregnancy
4) Higher ART initiation and retention rates of children and pregnant and lactating women living with HIV
Children and pregnant women
Mozambique is facing a generalized HIV epidemic, with a national prevalence rate of 13.2%. There is a higher prevalence rate among women (15.4%) compared to men (10.1%) (IMASIDA) and 48% is currently on treatment (UNAIDS). The major gaps regarding prevention, treatment and care of children living with HIV and PMTCT are:
- Never-pregnant, young women living with HIV are less often on ART compared to older women. Among the HIV positive pregnant women on treatment, 53% started upon entry to antenatal care (PEPFAR);
- On average, pregnant women make their first antenatal visit at 20 gestational weeks. Starting ART late in pregnancy increases the risk of vertical transmission;
- The 12-month retention rate is lower for pregnant women than for people living with HIV who started treatment: 61% against 70%;
- Only 50% of HIV-exposed infants are tested at early stage (UNAIDS) due to women not being in PMTCT care or who have fallen out of it.