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Mentor Mothers Provide Valuable Support in Kenya

Support for Orphans and Vulnerable Children in Nairobi and Coast Counties of Kenya, also known as the Nilinde Project, is a Plan International USA-led, United States Agency for International Development (USAID)-funded project improving the welfare and protection of children affected by HIV. Nilinde supports creative and innovative, evidence-based approaches that strengthen the capacity of caregivers and communities to increase their ability to provide for children’s basic needs, while also strengthening social systems and structures to improve support to orphans and vulnerable children (OVC).

Nilinde is being implemented in Nairobi, Mombasa, Kilifi, Kwale, Taita Taveta , and Lamu Counties of Kenya, in coordination with a wide variety of government and civil society stakeholders. Other core partners include mothers2mothers (m2m), Childline Kenya and Ananda Marga Universal Relief Team (AMURT).

Funded by the President’s Emergency Plan for Aids Relief (PEPFAR), the project is responsive to PEPFAR’s goals of ensuring that all people who are living with HIV know their status, and that those who are HIV-positive are on antiretroviral therapy and achieve viral suppression. While Nilinde has a variety of means to link children and their caregivers to HIV testing and treatment, one that is providing targeted and effective support to these goals is our Community Mentor Mother approach.

The Mentor Mother (MM) model is an evidence-based, peer-to-peer approach to provide support for HIV education, care, and treatment. Under this model, women living with HIV with recent Prevention of Mother to Child Transmission (PMTCT) experience are recruited, trained, and employed to work as “Mentor Mothers” within their communities. Under the standard model, each Mentor Mother is based at a health facility, where she works alongside the doctors and nurses at the maternal child health clinic and at the comprehensive care center. These Facility Mentor Mothers (FMMs) provide health education related to key, reproductive, maternal, newborn, child health, and HIV services, and they support clients to navigate the health care system in order to access needed services.

Under the Nilinde project, the MM model was expanded to include Community Mentor Mothers (CMM) who work in the communities to support case management for HIV-positive project beneficiaries—OVC and their caregivers. Like their facility-based counterparts, the CMMs undergo training to build their knowledge and capacity to carry out their role. The curriculum is adapted from the Kenya Mentor Mother Training curriculum. They then provide a range of services, including intensive case finding and referral; defaulter tracing; case management; support groups; health education; and support for enrollment, retention, and adherence, while also tracking and reporting their work to Nilinde via a service delivery partner (SDP)—nongovernmental organizations (NGOs) and community-based organizations (CBOs) that implement Nilinde’s community- and household-based OVC activities.

The CMMs work primarily with children living with HIV (0-9 years); adolescent girls and boys (10-19 years) (irrespective of HIV status); pregnant and breastfeeding HIV-positive mothers in Nilinde households; and caregivers living with HIV. To ensure high-quality care, Nilinde strives to keep the CMM to beneficiary ratio low; they may interact with about five households per day, or about 100 per month. At the community level, the CMMs complement the role of Community Health Volunteers (CHVs) by providing more targeted support to address the specific needs of these populations. At the facility level, they are linked to Facility Mentor Mothers (FMMs) and work in collaboration with the FMMs to identify, link, follow up with, and provide support to HIV-positive patients to ensure adherence to treatment and care. Their roles are interdependent in ensuring facility and community linkages and follow up for a robust continuum of care for affected households.

To implement the CMM Model, Nilinde first established seven model CMM sites at the level of service delivery partners. Here, CMMs work alongside CHVs, building their capacity to identify target beneficiaries and providing CMM services. At the same time, the project is building the capacity of the SDPs to replicate the model across the six target counties. In total, 50 CMMs have been trained to date on the CMM model across the target districts.

In early 2017, Nilinde initiated an HIV case management approach to monitor viral suppression for 450 children living with HIV (CLHIV) using a community family folder and a viral suppression tracking tool that were available to the project. In addition to their regular support, CMMs tracked viral loads and other clinical tests in the family folders, developing targeted case plans for the 20 CLHIV with high viral loads in collaboration with the health facility point persons. Preliminary results show that while almost all HIV-positive beneficiaries in this initial cadre were on antiretroviral therapy (ART), there are gaps in testing for viral load. The approach requires especially close collaboration between Nilinde and the health facilities and will be refined and scaled up over time across the project areas, building a deliberate, focused, and continuously monitored component of HIV testing, care, and support within the project and its broader OVC case management approach.

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