PMTCT Updates

08/05/2024 1
Presentation Outline
• MTCT of HIV
• Risk of MTCT of HIV without intervention
• ANC
• HTS
• Syphilis
• HEI follow Up
• Triple elimination
• Different formats
• Indicators
• Five year eMTCT strategy
• PIP
08/05/2024 2
MTCT of HIV
• Mother-to-Child transmission of HIV (MTCT) is the transmission of HIV
from an infected mother to her baby. It can occur during:
Pregnancy
Labor and childbirth
Breastfeeding
• Implementing the four-pronged approaches can reduce the risk of
transmission of HIV to less than 5% in breast-feeding infants, and to less
than 2% in non-breast-feeding populations.
• Promotion of safer sexual practice among sero-discordant couples;
• provision of ART for HIV positive partners and Pre-Exposure Prevention
(PrEP) for negative partners

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Risk of MTCT of HIV without intervention
Timing Transmission rate
without intervention

During pregnancy 10- 25%

During labor and delivery 35-40%
Overall with breastfeeding 35-40%
up to 6-24 Months
Note: Rates of transmission vary because of differences in population characteristics
such as maternal CD4+ counts, RNA viral load, exclusivity and duration of
breastfeeding

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ANC

• Minimum of eight contacts is required

• diagnostic tests
 Hg. or HC, blood group, and Rh
 Urine analysis: Dipstick, microscopy/gram stain
 Tests for HIV, syphilis and HBV.
• Ultrasound : One ultrasound scan before 24 weeks of gestation (early
ultrasound)
Estimate gestational age,
detection of fetal anomalies
 multiple pregnancies,
placentation
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HTS
The following population categories are also eligible for retesting:
• Members of sero-discordant couples
• FSWs (Female sex workers) and other MARPs
• History of multiple sexual partner
• History of STIs during this pregnancy
• Injectable drug users
• History of potential exposure to HIV
• Pregnant women with OIs defining illness
• Occupational exposure or sexually assaulted client

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HTS
• Partner test
• HIV self test
• Sero-discordant (PrEp)
Care and treatment
• First line Choice- TDF/3TC/DTG Alternative TDF/3TC/EFV
• ART should be rapidly, preferably same day, (within an hour for
laboring mother).
• cervical cancer screening .Post-partum woman can be screened for
cervical cancer 3 months after she gave birth.

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HIV Exposed infants

Components of HEI Follow up

Physical examination
Exclusive breast feeding
Provide dual (AZT+NVP) prophylaxis for the first 6 weeks and continue
NVP for the next 6 weeks.
DNA/PCR test at 6 wks and 9months and confirmatory anti body test after
18 months.
Growth and developmental monitoring
Immunization
Nutritional assessment
OI Prevention (CPT,TPT)
Registration and reporting
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TB/HIV

• Daily dose of INH (300mg) for 6months (6H) For screen negative
• Start ART in all TB patients living with HIV as soon as possible
within 2 weeks following initiation of anti-TB treatment.
• In case of TB-HIV confection, the dose of DTG should be 50mg BID.
• To minimize the challenges that are associated to sputum based
diagnostic tests, urine based rapid TB diagnostic tests are
recommended to detect TB in PLHIV with Advanced HIV Disease.
(Alere lipoarabinomannan (LAM) assay)

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Syphilis

• All pregnant women should be screened for Syphilis at the first

antenatal care contact.
• Penicillin G is the drug of choice for all stages of syphilis.
• In infants with confirmed congenital syphilis or an infant who are
clinically normal, but whose mothers had untreated syphilis,
inadequately treated syphilis (including treatment within 30 days of
delivery) or syphilis that was treated with non-penicillin regimens,
treat the infant with aqueous benzyl penicillin or procaine penicillin.

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Four Prongs

Primary prevention of HIV, Syphilis and Hepatitis B.

Prevention of unintended pregnancy
Prevention of MTCT transmission of HIV, Syphilis and Hepatitis B
Care, Support and treatment for positive clients, and families.

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 Triple Elimination Strategy
• Triple elimination refers to elimination of MTCT of HIV, syphilis and Hepatitis at
national, regional, district and community levels.
• Similarity of the control interventions necessary to prevent the transmission of both
infections in pregnancy makes it feasible to establish an integrated approach
• Elimination is defined as reduction to zero of the incidence of disease or infection in a
defined geographical area.
• Considering the challenges in our health care system, the goal for EMTCT initiatives is to
reduce MTCT to a very low level, so that it is no longer a public health problem (<50 per
100,000 live births).
• Alternatively, elimination of MTCT of HIV is defined as:
transmission rate of <2% for non-breastfeeding and
<5% for breastfeeding infants (WHO, 2007 b, WHO 2014).
Goal: eliminate new pediatrics HIV infection due to MTCT and congenital syphilis by
2020 and keep their mothers alive.
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 08/05/2024 13

Basics of HBV and MTCT

• HBV is prevalent in Ethiopia and based on few studies it has a prevalence of 8-12%.
• Hepatitis B Virus (HBV) is a DNA virus, which causes acute and chronic hepatitis that could
range from asymptomatic carrier states to fulminant liver failure
Chronic HBV infection
• Defined as, persistence of hepatitis B surface antigen (HBsAg) for six months or more after
acute infection with HBV.
HBV is transmitted by:-
• Blood and/or body fluids(saliva, menstrual, vaginal and seminal fluids) from infected
individuals,
• Use of contaminated traditional and medical equipments.
• Mother to child
• HBV is extremely infectious (about 100 times as infectious as HIV and 10 times more
infectious than Hepatitis C).
08/05/2024 14

Screening of pregnant women for HBV

• All pregnant women should be tested for hepatitis B surface antigen

(HBsAg) at least once and as early as possible particularly in settings with

a ≥2% HBsAg seroprevalence in the general population.
08/05/2024 15

HBsAg TESTING IN PREGNANT WOMEN

(using RDT or laboratory-based imm unoassay)

HBsAg + HBsAg –

HBV DNA VIRAL LOAD OR HBeAg (if HBV DNA is unavailable)

AND ASSESS FOR CIRRHOSIS

HBV DNA HBV DNA Presence of

<200 000 IU/mL ≥ 200, 000 IU/mL cirrhosi s
(≥ 5. 3 log10 or HBV DNA
or IU/mL) >20 000 IU/mL +
HBeA g negative, or HBeA g persistently
positive, abnormal A LT
without cirrhosis without cirrhosis

N O MATERN AL START MATERNAL START LONG-

TEN OFOVIR TEN OFOVIR T ERM
PROPHYLAXIS PROPHYLAXIS MATERNAL
(fr om 28 w eeks of T ENOFOVIR
pr egnancy until at T REATMENT AND
DEFER LONG- least bir th) MONI TOR (as per
T ERM National H BV
MATERNAL REASSESS FOR treatment
T ENOFOVIR LONG-TERM guidelines)
T REAT MEN T BUT MATERNAL
MONI TOR AND T ENOFOVIR
REASSESS T REAT MEN T
(as per N ational AFTER DELI VERY
H BV AND
tr eatment MONI TOR (as per
guidelines) N ational H BV
guidelines)

HEPATITIS B BIRTH DOSE VACCINATION OF THE

INFAN T FOLLOWED BY 3 DOSES OF VACCINE

HBIG (if av ailable) FOR INFANTS BORN TO HBsAg POSITIVE MOTHERS

(especially if H BeAg positiv e or w ith high H BV DN A)
 Treatment monitoring of pregnant and breastfeeding women
Monitoring viral suppression with viral load testing for newly HIV positive pregnant
mothers :
at 3months of ART initiation,
at 34-36 weeks of GA or delivery at the latest,
followed by three months after delivery and
then every 6months.
For those who are already on ART with previous VL test conducted more than three
months back repeat VL test at 1st ANC contact /PMTCT visit, at 34-36 weeks of
gestational age (or at the latest at delivery) and 3 months after delivery and every six
months thereafter until MTCT risk ends
Whenever possible, use same-day point-of-care testing for viral load testing of pregnant
and breastfeeding women to expedite the return of results and clinical decision-making.

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 Viral Load Result Categories
Viral suppression:
A viral load that is undetectable, equal to or less than 50 copies/ml.
Low-level viraemia
-one or more viral load results that are detectable (more than 50 copies/ml) but equal to
or less than 1000 copies/ml.
Virological failure:
-Viral load above 1000 copies/ml based on two consecutive viral load measurements in 3
months, apart with enhanced adherence support following the first viral load test

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 Treatment monitoring algorithm

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DSD Models

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MCH _DSD Model

• Mothers living with HIV and their infants are important target
population for differentiated service model (DSD).
• There are various models of care used to support MCH/HIV services.
• Some of the DSD models in Ethiopia includes
 family planning service integration to HIV care,
 Point of care (POC) EID testing for HEIs and VL testing for
mothers
 provision of 3 month ARV dispensing for HIV positive
pregnant and breast feeding women during COVID 19
pandemic

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PMTCT cards, forms, registers
• Integrated Antenatal, Labor, Delivery, Newborn, Postnatal care chart
• HIV exposed infant follow up card
• ART Intake form
• HIV/ART chronic care follow up form
• Transfer out form
• PMTCT Dashboard
• PMTCT facility performance indicators follow up form
• Continuous quality improvement tool (CQI)
• ANC Register
• L&D Register
• PrEP Register
• PMTCT Register for Health Centers and Hospitals (mother baby pair cohort register)
• Postnatal Register

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PMTCT cards, forms, registers
• Family Planning Register
• DNA PCR specimen tracking logbook
• PMTCT appointment & LTFU Tracking logbook
• Index test testing (ICT line listing register)
• High viral load register
• Retest for verification register
• CD4 request forms
• DNA PCR request forms
• Viral load request form
• Monthly HMIS reporting forms
• PMTCT Cohort reporting form
• PMTCT SOP
• PMTCT Cohort wall chart
• PMTCT job aid
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PMTCT Indicators

1.Percentage of pregnant and lactating women who were tested for

HIV and who know their result (Four data element)
Number of pregnant women tested and know their result during
pregnancy
Number of pregnant women tested and know their result during
labor& delivery
Number of lactating women tested and know their result during the
post partum period
Number of women who knew their HIV status before the current
pregnancy (on ART)
2. Number of women tested positive for HIV (Newly identified and
already known)
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 PMTCT Indicators

3. Percentage of HIV Positive pregnant and lactating women who

received ART at ANC+L&D+PNC for the first time and who get
pregnant while on ART
Number of HIV Positive pregnant who received ART at ANC for the first
time
Number of HIV positive Pregnant women who received ART to reduce
the risk of mother to child transmission during L&D for the first time
Number of HIV positive lactating women who received ART to reduce
the risk of mother to child transmission during PNC for the first time
Number of HIV-positive women who get pregnant while on ART and
linked to ANC

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 PMTCT Indicators---
4.Percentage of HIV infected women using a modern family
planning method.
Number of HIV infected women aged 15-49 reported the use of
any method of modern family planning
5. Percentage of partners of pregnant, laboring and lactating
women tested for HIV during the reporting month.
Number of partners of pregnant, laboring and lactating women
tested for HIV whose test result is HIV negative
Number of partners of pregnant, laboring and lactating women
tested for HIV whose test result is HIV positive

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 PMTCT Indicators---
6. Percentage of pregnant/breast feeding women who received
routine viral load testing
7.Percentage of HIV positive pregnant & BF women with a
suppressed viral load (<1000 copies/ml)???
8.No/% of pregnant women attending antenatal care tested for
HBV
9. Number of pregnant women who were received prophylaxis
for HBV
10. Number % of pregnant women tested for syphilis

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PMTCT Indicators---

11.Number of Partners of Syphilis positive pregnant and lactating women

who are tested for syphilis
12. Proportion of pregnant women treated for syphilis
13. Proportion of pregnant/breast feeding women who put on 3-month multi-
month dispensing (MMD)
14. Number of Discordant couples who took PrEP in the PMTCT setting
15. Percent of infants who received a HBV BD within 24 hours after birth.
16. Percent of children under one year of age who have received third dose of
pentavalent vaccine
17. Percent of Congenital syphilis

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 PMTCT Indicators---
18. Percentage of infants born to HIV infected women receiving a virological test for
HIV within 12 months of birth
Number of HIV exposed infants who received an HIV DNA/PCR test within 2months of
birth, during the reporting period
Number of HIV exposed infants receiving HIV DNA/PCR test within 2months of birth
whose test result is HIV negative
Number of HIV exposed infants receiving HIVDNA /PCR test within 2months of birth
whose test result is HIV positive
Number of HIV exposed infants who received an HIV DNA/PCR test between 2to12
months, during the reporting period
 Number of HIV exposed infants receiving HIV DNA/PCR test within 2to12months of
birth whose test result is HIV Negative
Number of HIV exposed infants receiving HIV DNA/PCR test within 2to12months of
birth whose test result is HIV positive

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PMTCT Indicators---
19. Percentage of Infants born to HIV-infected women started co-
trimoxazole prophylaxis within two months of birth
20. Percentage of infants born to HIV-infected women receiving
antiretroviral (ARV) prophylaxis for prevention of mother-to-child
transmission.
21. Percentage of HIV exposed infants receiving HIV
confirmatory(antibody) test by18months
• Number of HIV exposed infants receiving HIV
confirmatory(antibody)by18months-whose test result is Negative
• Number of HIV exposed infants receiving HIV confirmatory(antibody)
by18months-whose test result is Positive

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National Strategic Plan for Triple Elimination of Mother-to-Child
Transmission of HIV, Syphilis, and Hepatitis B Virus 2021-2025

Overview of National Strategic Plan

OHB

Dec, 2022

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Background
HIV
• Nationally, there were an estimated 19,110 HIV
positive pregnant women in 2019
• Although the prevalence of HIV showed a
declining ,still higher among the pregnant
women
• MTCT of HIV is also high (14.96%)

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Cont’d
Syphilis
• About 80% of cases of syphilis in pregnant women can result in adverse outcomes of pregnancy
• The prevalence of syphilis ranged from 0.6% to 5.1% in studies in Ethiopia
HBV
• The prevalence of HBV among pregnant women ranges from a minimum of 2.3% in southern
Ethiopia to a maximum of 7.9% in Gambella Hospital
• The pooled prevalence of HBV infection among pregnant women was 4.8%
• High prevalence of HBV infection and syphilis among pregnant women which needs universal
screening

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Rationale for integration of HIV, syphilis and HBV as triple
framework initiative

• The global success story of the PMTCT of HIV programs

• The similarity in types of interventions makes the integration highly feasible,
and cost-effective
• The achievement of 11 countries for WHO validation for EMTCT of HIV and/or
syphilis in 2017 created energy for a large number of countries to launch the
current triple elimination strategy

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 Cont..
• The Government of Ethiopia committed to achieve the elimination of MTCT of
HIV, syphilis and path to elimination of HBV by 2025, based on
• The experience of the earlier years (1st & 2nd EMTCT strategy)
• Available documented scientific evidence
• The current global move
• The integration of the triple elimination is a synergy to improve a broad range of
MCH services and outcomes
• Ethiopia would like to achieve and in line with the sustainable development goal (SDG)

08/05/2024 34
 Situational Analysis
Targets for process and impact indicators, dual EMTCT strategy
SN Primary Indicators Baseline Target Achievement Data Remarks
in 2016 for of 2019/20 source
2019/20
1 HIV test during 85 95 85 HMIS Not
pregnancy, L & D and PNC DHIS2 achieved
(%)
2 ART for PMTCT (linked 57 95 91 HMIS Not
and Option B+) converge DHIS2 achieved
among HIV +Ve pregnant,
L & D and lactating
women (%)
3 ARV Prophylaxis among 41 95 61 HMIS Not
HIV exposed infants (%) DHIS2 achieved
4 Early Infant Diagnosis 25 95 67 HMIS Not
(EID) virologic test (at 2 DHIS2 achieved
months) (%)
5 National rate of MTCT of 18.1 <5 14.96 HMIS Not
HIV (% final) EPHI achieved
projection
6 Syphilis testing and 40.5 95 66 HMIS Not
treatment during DHIS2 achieved
pregnancy, L & D and PNC
(%)
7 Rate of congenital syphilis NA <50 Data not
(per 100,000 live births) available
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 Target for process and impact indicators OHB, HMIS (2016-
2020)
Sno. Indicators Baseline in Target for Achieveme Remark
2016 2020 nt 2020

1 HIV test at ANC, L&D and >95 95 >95% achieved

PNC

2 ART (Option B+) 43 95 77 Not Achieved

3 HEI prophylaxis 19 95 68 Not achieved

4 DNA/PCR 30 95 52 Not achieved

5 Transmission rate 18.4 <5 14.46 Not achieved

08/05/2024 36
 Strategic frame work

Vision

• MTCT of HIV, syphilis, and HBV free Oromia

Goal
• To achieve elimination of MTCT of HIV and syphilis, and on the path to
elimination of MTCT of HBV by 2025

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Process and impact indicators and targets

08/05/2024 38
Target for process and impact indicators OHB, 2021-2025
Sno Indicators Baseline in 2020 Target for 2025
1 1st ANC visit 98% 100%
2 HIV test at ANC, L&D and PNC >95% 95%
3 ART (Option B+) 77% 95%
4 Syphilis test at ANC 1st Visit 78% 95%
5 Reactive syphilis treatment 77% 95%
6 Hepatitis B test at 1st ANC Visit 57% 95%
7 Hepatitis B reactive prophylaxis/treatment 0 95%
8 HEI prophylaxis 68% 95
9 DNA/PCR 52% 95
10 Birth dose HBV for HEI >50%
11 Third dose of HBV for HEI >90%
12 Transmission rate 14.56% <5%
13 Case rate of congenital syphilis per 1000 live births <50
14 HBs Ag prevalence among under five children
08/05/2024
<1% 39
 Strategic objectives
1. Enhancing the primary prevention among adolescents, women, and men;

2. Preventing unintended pregnancy;

3. Improving the quality of obstetric care;

4. Enhancing the test and treatment uptake in the maternal and neonatal
continuum of care; and

5. Ensuring the continuity of prevention, treatment, care and support.

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Strategic direction

1. Enhancing the activities towards EMTCT of HIV, syphilis, and HBV

during the continuum of preconception to neonatal care

2. Strengthening community mobilization, engagement schemes

3. Improving health service capacity

4. Enhancing domestic financial mobilization

5. Improving leadership and governance

08/05/2024 41
Strategic direction….
1. Enhancing the activities towards EMTCT of HIV, syphilis, and
HBV during the continuum of preconception to neonatal care
Strategy:
1. Preconception care using available reproductive health service platforms to
enhance primary HIV, syphilis, and HBV prevention
2. Providing FP services to women in reproductive age groups to prevent
unintended pregnancy and HIV, syphilis, and HBV
3. Quality of ANC and skilled delivery and accelerate the EMTCT of HIV, syphilis,
and HBV
4. Improving screening and treatment of HIV, syphilis, and/or HBV infections
during pregnancy
5. Increasing the treatment uptake for HIV, syphilis, and/or HBV infections
6. Increasing the testing, prophylaxis, and treatment uptake of infants exposed to
HIV, syphilis, and/or HBV
7. Integrating HIV, syphilis, and HBV point-of-care testing in other RH service
08/05/2024 42
Strategic direction ……
2. Strengthening community mobilization, engagement schemes
Strategy:
1. Enhancing the community mobilization to increase the national coverage of the pregnant
2. Increasing public awareness about the benefit of early diagnosis of HIV, syphilis, and HBV
3. Promoting male/partner involvement in the maternal and neonatal continuum of care

3. Improving health service capacity

Strategy:
1. Improving the health facilities capacity to achieve the EMTCT of HIV, syphilis, and HBV

2. Improving the health workers’ capacity to diagnose, treat

08/05/2024 43
Strategic direction……

4. Enhancing domestic financial mobilization

Strategy:
1. Increasing the domestic financing and sustaining the cost exemption
2. Improving the EMTCT of HIV, syphilis, and HBV performance to ensure result oriented fund
mobilization

5. Improving leadership and governance

Strategy:
3. Strengthening the capacity of the health managers and programmers to enable the delivery of
quality EMTCT of HIV, syphilis, and HBV
4. Strengthening the EMTCT of HIV, syphilis, and HBV advocacy
5. Strengthen the multi-sectoral response and coordination through partnership and networking
among stakeholders
6. Improving the quality of data generation and management for effective M & E of the EMTCT of
08/05/2024
HIV, syphilis, HBV 44
M&E Framework for EMTCT of HIV, Syphilis and HBV

08/05/2024 45
Cont’d

08/05/2024 46
Roles and responsibilities stakeholders in the
implementation of strategic plan
 Parliamentarian and political leaders
 The Ministry of Health (MOH) with the HAPCO
 PMTCT TWG, RHBs,, HFs, HEP
 Zone and wored health offices
 Faith Based and Civil Society Organizations, including mothers living
with HIVDevelopment Partners, donors & implementing partners
 Media and communication
 Universities and colleges
 Private Sector and the business community

08/05/2024 47
Dash board for 11months,2015
SNo Indicators present (%) Score
1 HIV test for mothers 100
2 ART uptake 66
3 Dual prophylaxis 42
4 DBS 56
5 DBS <2months 67
6 CPT 43
7 Syphilis test 80
8 Syphilis positive Rx. 100
9 Hepatitis B test 97
10 Hepatitis B test prophylaxis/RX 0.1
08/05/2024 48
Performance improvement plan
Program Gap identified Action items Responsible

Low engagement of leadership at lower level Provide awareness creation/work shop on PMTCT
PMTCT services for leaders Team/C&T/OHB

five year strategic plan of eMTCT is not lounched Launch eMTCT five year plan at regional
level OHB

OHB/ZHD/THO/WHO
low commitment at zone/town/woreda and Facility level Ensure accountability at all level
No assign focal person at all level assign focal person at all level ZHD/THO/WHO
Leadership and
management Avail PMTCT service 8hrs a day by Facility Mgt.
Intrubtion of the PMTCT service during night off assigning responsible person.
Establish PMTCT/Pediatric TWG at OHB
No functional TWG at regional level region level
Trained staff turnover and shortage Trained PMTCT Provide basic and gap filling
provider trainings/refresher PMTCT Team/C&T

Strengthening partnership and networking OHB/ZHD/THO/WHO

poor integration of different stkeholders with all stakeholders in the region
Performance improvement plan
Program Gap identified Action items Responsible

Advocate PMTCT related services

Weak PMTCT advocacy service
using local media, community
gatherings ,HEPs and panel PMTCT
discussions Team/C&T
Demand
Creation Poor counseling and irregular client health Ensure provision of proper
education during follow up counselling using CUE card and PMTCT
provide HE regularily Team/C&T/HFs
Provide awareness creation through
Low Male partner involevement in maternal care PMTCT
different platforms
Team/C&T

Strengthen communication among

Communication gap between MCH ,Labor ward MCH/Labour /Lab and PMTCT
and Laboratory for HIV positive delivers, Dual based CSM by Lead hospital and MCH/Labor/lab
prophylaxis and time of postnatal care OHB mentors
Performance improvement plan
Program Gap identified Action items Responsible
Enhance EID coverage by Line listing of PMTCT
Low EID coverage and FO testing eligible client and tracing back for FOCA/LMSG/HE
testing. W
Weak high viral load management at PMTCT Strengthen HVL management at PMTCT PMTCT Team/
EID service clinic as per NGL C&T /3rd 95 team
utilization
Conduct weekly/monthly audit of ANC
Missed opportunity of HEI test test HTS Focal/CDO
Poor linkage of HEI from L&D to PMTCT Strengthen internal facility linkage to PMTCT Team/
service PMTCT service C&T /3rd 95 team
Use innovative testing strategies (scale
Centralized EID testing service up of POC Testing EPHI/RHB
Strengthen PMTCT CSM and Enhance
tracing by MSG using standard HFs/MSG/HEW/
Poor LTFU tracing of HEI from care appointment colander Mentors
 Performance improvement plan
Program Gap identified Action items Responsible
Provide integrated DBS/VL sample collection
Inappropriate DBS sample collection practice training RHB/RRL
Communication gap between referring,Testing
and Post Curriers Strengthening smooth communication between
Clinic Lab interface / Referring, Testing and Post Office HF/Post Office
Sample referral Ensure DBS request completeness by
Incompleteness of DBS request form mentoring PMTCT/Lab

Poor Sample and result tracking system Ensure referred sample and truck result timely Lab/PMTCT
Referring/Testing /Post
Long TAT Monitor and follow EID TAT at all level office
Frequent DBS kit and Cartridge stock out in some
HF Timely report RRF and communicate EPSS EPSS/RHB

EID commodities are not timely requested by RRF Ensure timely request of RRF HFs store/RHB/RRL
EID supply
Management
Poor supply management(IFRR,Bincard.etc) at
HFs level Ensure regular IFRR and Bin card updating HFs store/Lab/RRL

Strength communication between EPSS/EPHI/

Maldistribution/miss of EID Cartridge RHB EPSS/EPHI/RHB
 Performance improvement plan
Program Gap identified Action items Responsible
Poor data quality at all level (DHIS2 vs Conduct EID data verification (DHIS2 vs
DATIM/HAPMT DATIM) FMOH,OHB, Partners
Regularily analyze data and provide PMTCT
Poor data quality at HFs level corrective feedback Team/C&T,M&E

Strengthen PMTCT CSM to Update

poor updating , monitoring and analysis of cohort, analyze and monitor for decision All PMTCT Providing
cohort for decision making making at facility level HFs

EID data capturing Support HFs to utilize dashboard PMTCT

and Management poor utilization dashboard information information during site support Team/C&T,M&E
No periodic performance review at HFs Strengthen MDT and PMT during CM
level and fololw by PIP RHB/mentors
No frequent program focused site support Conduct regular program focused site
support PMTCT Team/C&T

Strengthen and Conduct PMTCT PMTCT

Weak and Poor quality of hospital based
mentorship training for Lead hospital Team/C&T/Mentorship
PMTCT mentorship
mentors and for Zonal/Town focal team
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