COPE® for Services to Prevent Mother-to-Child Transmission of HIV
A Toolbook to Accompany the COPE® Handbook
Globally, one of the greatest threats to reproductive health today is the growing HIV and AIDS pandemic. In particular, the fact that HIV-infected mothers can pass the virus on to their children before, during, and even after birth presents a serious risk to the health of many of the world's children. The following data highlight the sad realities of mother-to-child transmission of HIV:
- By the end of 2003, some 2 million children were living with HIV or AIDS.
- In 2003, 630,000 children younger than 15 contracted HIV, the vast majority of them through mother-to-child transmission.
- More than 2.5 million children were at risk of HIV infection through mother-to-child transmission in 2001, most of these in Sub-Saharan Africa.
- In the absence of any intervention, an estimated 20% to 25% of mothers infected with HIV will transmit the virus during pregnancy and delivery, and an additional 5% to 15% will do so through breast milk.
These data suggest that women and men face very real difficulties in gaining access to quality services that meet their needs related to the prevention of HIV infection, and particularly to the prevention of mother-to-child transmission of HIV (referred to as PMTCT). In fact, only 1% to 3% of pregnant women in heavily affected countries have access to PMTCT services, revealing a major challenge for providers of health care services.
COPE®, which stands for "client-oriented, provider-efficient" services, is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients' needs. COPE provides staff with practical, easy-to-use tools to identify problems and develop solutions using local resources, and it encourages all levels of staff and supervisors to work together as a team and to involve clients in assessing services. Through COPE, staff develop a customer focus, learning to define quality in concrete terms. The process also enables staff to explore the strengths of their work site.
EngenderHealth's first COPE handbook, published in 1995 (COPE: Client-Oriented, Provider-Efficient Services), was focused on family planning. But over time, providers expressed the need for such tools for other health services, so the COPE process and set of tools were adapted for use in other types of service provision. In 2003, EngenderHealth revised the original handbook to include additional information about how to conduct COPE and began producing a set of accompanying toolbooks. This toolbook, which is intended to be used in conjunction with the new edition of the COPE handbook, is designed to assist providers and site staff identify and solve on-site problems that compromise the quality of PMTCT services
This volume presents versions of the COPE tools adapted to address topics relevant to the provision of quality PMTCT services, including:
- Information, education, and counseling on HIV prevention and care, including approaches to PMTCT
- Condom promotion
- Voluntary counseling and testing
- Family planning services
- Treatment of sexually transmitted infections
- Antenatal care
- Prevention of transmission using prophylactic antiretroviral regimens
- Safe labor and delivery practices
- Counseling and support for safer infant-feeding practices
- Community action to reduce stigma and discrimination and increase support for HIV prevention and care interventions