Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothers alive

Leaders from around the world attending the 2011 High Level Meeting on AIDS committed to work towards the elimination of new HIV infections among children by 2015 and reducing AIDS-related maternal mortality. This is to be accomplished through the implementation of a new Global Plan* for scaling up comprehensive prevention of mother-to-child transmission of HIV
(PMTCT) programmes. The Global Plan calls for broader thinking and action both within and outside the formal health-care delivery system. An important feature of the plan is its emphasis on community engagement as an integral part of the scale-up strategy.

Despite the widely-recognized importance of communities, much of the PMTCT guidance focuses on antiretroviral drug prophylaxis during pregnancy and facility-based interventions. This review was commissioned by the Joint United Nations Programme on HIV/AIDS (UNAIDS) to help address the information gap around the essential and complementary role of communities. In particular, this study sought to identify and share promising practices that can strengthen programmes and facilitate efforts to stop HIV transmission to children and enable their mothers to remain healthy.

The methods used in this study included literature review and key informant interviews. “Community engagement” was defined broadly to include participation, mobilization and empowerment, while excluding activities that involve communities solely as the recipients of information
or services. A “promising practice” was defined as a practice for which there is documented evidence of effectiveness in achieving intended results and some indication of replicability, scaleup or sustainability.

The promising practices identified through this research are organized below in terms of their primary intended outcome. The study describes each practice, provides documented examples, and summarizes the lessons learnt.

Improving the supply of PMTCT services:

• extending the workforce through community cadres (e.g. community health workers, mentor mothers, lay counsellors, traditional birth attendants);
• strengthening linkages with community- and faith-based organizations to promote and provide PMTCT services;
• monitoring PMTCT programmes through civic participation using a rights-based approach.

Increasing the uptake of PMTCT services:

• empowering communities to lead social and behaviour change communication around PMTCT;
• providing peer support through individual counsellors and in support groups;
• engaging communities to maximize their assets and address financial barriers to PMTCT.

Creating an enabling environment for PMTCT scale-up:

• advocating and supporting activism for PMTCT and the right to health;
• promoting policies and strategies that support PMTCT and community engagement.