Sunday, February 11, 2007

What is the Kwejuna Project?

The Kwejuna project is a World Harvest Mission program that is supported by a grant from the US-based Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) which Drs. Scott & Jennifer Myhre received at the end of 2003. The main aim of the Kwejuna project was to establish a district-wide program in Bundibugyo to prevent mother to child transmission of HIV (PMTCT). HIV infected mothers can pass HIV onto their babies during pregnancy, during delivery and through their breastmilk. The program identifies pregnant mothers who are HIV positive by offering HIV counseling and testing to all pregnant women at their first prenatal care visit. Most women agree to be tested, the results are available within 20-30 minutes, and before the women go home that day, they (and we) are aware of who is HIV infected. For those who test positive, they receive additional counseling about what this means for them and their baby and they are then given a single dose of an HIV drug called nevirapine to take during labor. The baby is also supposed to get this drug, in syrup form, within 3 days of its birth, and this combination of drug to both mother and baby, cut in half the risk that a baby will be born HIV infected. Without any drug intervention, an HIV infected mother has about a 30% chance of having a baby that is also HIV infected.

From the pregnant mothers attending prenatal care who were first tested in April 2004, we have so far tested over 21,000 (!) and identified a little under 600 who are HIV infected (which is an HIV prevalence of 2.5%). The program began in 2 sites that year and by the end of 2006 was operational in all 9 Ministry of Health-run health centers, and largely implemented by Ministry of Health staff that the Kwejuna project, with EGPAF support, has helped to train in PMTCT. EGPAF has also paid for us to encourage mothers to deliver at health centers by supporting the cost of a mama kit which is given as a gift/incentive for every health center delivery. (This is important because most mothers here, 70-80%, deliver their babies at home and this makes it really challenging for the baby born to the HIV positive mother to receive the nevirapine syrup in time for it to make a difference.) The mama kit, given out to all mothers regardless of their HIV status, includes a plastic sheet which covers the delivery table, sterile gloves, a tie for the umbilical cord, and a sterile blade to cut the cord. The highlight of the kit is a piece of local cloth, called a kitengye, which the new born baby is wrapped in (like in the picture) and then goes home in. Giving a kitengye to every new born baby in a health center has been a huge hit and in 2006 we saw a 30% increase in births at health centers across the district.

Other aspects of the Kwejuna project include linking our mothers into HIV care so that they can receive HIV drugs for themselves and remain healthy for longer. We also try to link any familiy members, including their husbands or babies, who are HIV infected into HIV care as well. Another aspect of Kwejuna is the provision of food supplements to these families. (See the 'God gives generously' blog entry for a description of that.)

The Kwejuna project takes its name from the expression of congratulations that are given to women here when they have just delivered a baby. Webale Kwejuna means thank you for surviving (the birth of your baby).

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