SUMMARY:

mothers2mothers (m2m) will implement activities to improve the effectiveness of prevention of mother-to-

child transmission (PMTCT) in HIV programs. Services are carried out through facility-based, peer

education and psychosocial support programs for pregnant women, new mothers and caregivers, all living

with HIV and AIDS. There are four components of the program: curriculum-based training and education

programs; psychosocial support and empowerment services; programs to increase uptake for counseling

and testing; and bridging services linking PMTCT treatment and care to antiretroviral treatment (ARV) and

other health services. The primary emphasis areas are human capacity development (training) and local

organizational capacity building. The target population is people living with HIV and pregnant women.

BACKGROUND:

m2m is a South African-based international NGO established in 2001 to help enhance and support publicly-

funded PMTCT programs through peer education and psychosocial support for HIV-infected pregnant

women and new mothers. With PEPFAR's support, m2m will increase the effectiveness of PMTCT services

through a comprehensive program of facility-based, peer education and psychosocial support for pregnant

women, new mothers and caregivers living with HIV and AIDS. m2m addresses issues of stigma through

group counseling, support groups, and linkages to income generation. All activities have been and will

continue to be coordinated with local PMTCT service providers and their partners, and will also be carried

out in conjunction with provincial, district and municipal health authorities. The programs have the active

support of the Departments of Health for KwaZulu-Natal, Mpumalanga and Western Cape provinces and

will be integrated into their healthcare structures. Current m2m programs are located in over 90 healthcare

facilities in four provinces in South Africa as well as in Lesotho. With funding from the PEPFAR New

Partners Initiative, m2m will initiate service provision in Kenya, Rwanda and Zambia in 2007/2008. With FY

2008 funding, m2m will enhance the existing South African program sites and improve infrastructure, while

adding significant numbers of facilities in these provinces. By the end of FY 2007 m2m will be active and will

have launched sites in one of the following three provinces: Northwest, Limpopo, Gauteng. In the remaining

two provinces, preparation during FY 2007 will have laid the ground work for implementation and site start-

up so that these sites will be ready to launch as early as possible in the following year. With the work of FY

2007 as a foundation for expansion, in FY 2008, m2m will continue to build the program and increase

service provision in new provinces and with new partners who offer antiretroviral care and treatment

services. By the end of FY 2008, m2m will have established service in up to 200 sites throughout seven

provinces in South Africa.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Human Capacity Development and Training

PEPFAR funding will be used to support the delivery of a cascade of curriculum-based training for m2m

mentors and education programs designed to improve PMTCT outcomes through education and training of

pregnant women and new mothers with HIV and AIDS. The training curriculum that is given to m2m staff

provides guidance about PMTCT and ARV treatment tied to maternal and infant health, with the objective of

encouraging women living with HIV (PLHIV) to take responsibility for their own health, their child's health,

and the health of their partners. Additional critical subjects covered in the training include disclosure, safer

feeding options, family planning, nutrition, couples counseling, and prevention guidance for these PLHIV

and their partners ("Prevention with Positives"). An intensive two week training course is given to all m2m

Site Coordinators (SC) and Mentor Mothers (MM), all of whom are PLHIV. Training for Site Coordinators

includes an additional week of management training (3 weeks of training total). m2m staff, in turn, provide

curriculum-guided education and support (individual and group) to mothers in PMTCT programs during

antenatal care, post-delivery recovery, and at their return to clinics after delivery. Annual training is given to

all staff, inclusive of new staff and retraining for existing staff. m2m does not provide formal training on

direct PMTCT service provision for healthcare providers, including doctors and nurses. With FY 2008

PEPFAR funding, m2m will add a complement of trained PMTCT care providers (SCs and MMs) to

supplement the resources of frequently overburdened local healthcare providers in 3 new provinces. m2m

will also use funding to continue to support existing sites and open new sites. Simultaneously, the program

will also hone the skills and knowledge of existing healthcare staff in PMTCT related care and support. The

lasting impact of these activities will make a significant contribution to the sustainable development of the

capacity of local organizations. Through expanded partnerships with providers of ART, m2m will also be

able to train the staff of these organizations and have an impact on ARV care and treatment service

providers.

ACTIVITY 2: Service and Mentoring

PEPFAR funding will be used to provide individual and group psychosocial support and empowerment

programs for pregnant women and new mothers with HIV and AIDS to help them with issues including

stigma and discrimination, disclosure, reducing risky behavior ("Prevention with Positives") and pediatric

support. Nutritional support and guidance is also part of the programs. A related activity focuses on

providing specific support programs for the MMs and SCs ("Care for Caregivers"), contributing to their own

physical and emotional well-being as well as that of their clients. One objective of both group and individual

support is specific knowledge transfer around the many issues women living with HIV and AIDS faces in

navigating the PMTCT process. Another outcome is empowering the women to focus on and take

responsibility for the health of their babies, and their own health. By encouraging behaviors that can help

mothers sustain their well-being, the programs aim to reduce the potential that their children could become

Orphans and/or Vulnerable Children (OVC). While m2m does not provide formal referrals for healthcare,

MMs are well informed about where services are available and they inform women about how to access

both medical and social services. The program addresses the reality of the high rates of violence against

women in the communities served, as well as the specific ties between HIV and domestic violence. They

provide tactical as well as emotional support aimed at helping women confront this issue and reduce their

likelihood of becoming targets and victims. Women who come to the program are also giving information

about income generation projects in their area and are encouraged to participate in such programs.

ACTIVITY 3: Counseling and Testing

Working in close partnership with local health and government programs, m2m will facilitate the integration

Activity Narrative: of MMs and SCs into the antenatal intake process at both the community and facility levels. In this role, they

will focus on increasing counseling and testing uptake by serving as committed advocates, working with

women like themselves and drawing on their training and their own personal experience. Through this

program, the MMs and SCs also provide significant support for Pediatric Counseling and Testing during

home visits by advocating for pregnant women to return to clinics post-delivery to test their infants,

supporting the women in the post-delivery period, and providing referrals of babies to testing and treatment

programs.

ACTIVITY 4: Linkages and Referrals

This activity provides linkages and referrals in various forms including creating a bridge between PMTCT

services and other health and empowerment services. In active collaboration with local and provincial health

officials, PEPFAR funding is used to link ante/post natal women to programs providing wellness care for

themselves and their infants, and to refer women and infants with AIDS-defining conditions to ARV therapy

programs. With FY 2008 funding, m2m will expand partnerships with service providers of ARVs in order to

become fully integrated into HIV and AIDS care and treatment programs throughout South Africa. Working

at sites where ARV treatment is provided, m2m will be able to assist in the process of steering pregnant and

post-delivery women in need of referral for ARV care and treatment to these services.

The above results contribute to the PEPFAR 2-7-10 goals by increasing the number of women cared for by

PMTCT programs; by improving prevention (PMTCT) outcomes, thus reducing the number of infected

children; and by increasing the number of pregnant women, new mothers, and infants receiving treatment

by providing a referral system from PMTCT to ARV services.