 I'm very much humbled to be part of you today sharing the program which is real next to my heart or close to my heart. What I'm gonna share today is the post-natal clubs. They are the first of its kind in South Africa and they are in Kailitsha. So I'm sure Kailitsha is real a learning world. Post-natal mothers and child transmission in South Africa is high at 4.3% at 18 months. The uptake of child infant HIV testing is also poor. That's the reason why we wanted to try and come up with solutions. This is my team which I would really be happy if they are online in Kailitsha way back home in South Africa. Kailitsha is a peri-epid informal settlement with a population of 500,000 people, 12 health care centers, HIV antenatal prevalence at 34% in 2012, mother-to-child transmission at 0.8 at 10 weeks in 2015 and unknown at 18 months. We have conducted a VED study which we have seen that in this particular clinic where we have tested all babies PCRs postnatally and we have found that 25% at 18 months of these babies were traced, were tested before being traced. Then additional 13% of the babies were tested after tracing. What we have done, we have done follow-ups with these babies and after the follow-ups we try to do two phone calls and one home visit. Then what are the solutions? We've adopted the adult art club, integration of mother-to-child health, integration of HIV and non-HID care and a thousand days. What you are doing in the postnatal clubs, we recruit the mother infant pair at six weeks, then at 10 weeks they start to be part of the club. We are having the first session at 10 weeks which lasts for 45 minutes, a peer support facilitated by mothers-to- mothers mentors. HIV and non-HID topics are discussed including high risk and non-high risk mother infant pair. Then it's a one-stop station. They are seen by a post nematness or a nematness in a clinical visit at every session. This nest gives them extra care. Mother is given the HIV care and non-HID care to the mothers and with the children we do PMTCT and EPI, that is the vaccination of the babies. We screen for mental health, early childhood development and support breastfeeding. Here I will be sharing this slide with you but before I share this slide we started this postnatal program in a clinic in town too, way back in June 2016 and these are the results from the postnatal clubs from July 2016 until March 2018. We've recruited 296 mothers. I want us to concentrate on the 18 months because the program we recruit them from six weeks until six months but they are in care for 18 months. So what I want us to look here it's there the 18 months. We are having 82% remaining in care in 18 months. Then we are having we are doing viral completion and looking into suppression. The viral completion in 18 months it's 96 as you can see and the viral suppression is 96. We also look at the infant coverage of vaccination there. We vaccinate them at intervals but we are more interested in the 12 months vaccination which is 84.5% and we look at the infant rapid test uptake. At nine months we've got 99% and at 18 months we've got 93% which is good and we don't have any positive baby in the program. We have conducted qualitative studies and we have done in ten in-depth interviews and three focus groups. Here I'm sharing the perception of the participants, non-participants, non-club participants and club participants. This is the knowledge that they have acquired. Adherents, they said that it has the PNC had improved the adherents. I was educated about the importance of breastfeeding a baby that is the perception of a participant, a mother participant. Infant feeding and healthy diet for mothers and babies follow up test and treatment for babies. Early childhood development activities. Before the child is tested you receive counseling. All of us would talk about the test that is going to be done on the baby. We test the babies at certain intervals. We test the baby at nine months and 18 months then 18 months is the last one that you can confirm that the baby is negative. P.S. support generated by PNC. Dynamic. This is their perception. They started not knowing each other on the first visit but now they are friends. We learn to share in the club if one of you doesn't have you provide. They become friends. It improves their relationships, community support and knowledge transmission, family support, disclosure, advice, stigma reduction, role models. They give the clear understanding of HIV and the ability of sharing it at home. The knowledge they gain from the PNC, they teach the others at home, they can even send a body to come to the clinic if they don't have time to come. Influence of PNC on behavior. Health behavior has improved. PNC participants adopt their behavior based on advice they receive in the PNC. PNC helped me to monitor my health and my baby's health. Motherhood, PNC participants said they gained reassurance about their ability to breastfeed and care for their babies. Now I know that a baby can hear so I must speak to my baby and I must play with him. Advantages of PNC, sharing experiences, time saving, comprehensive care, staff attitude and sending and setting, patients follow-up and data collection, health education, mental health assessment and support, health outcomes, improved assistance to the participants. Again, they are having their own perceptions about the advantages. We are taken care of with my child at the same time and the care they portray is excellent. Remember I said this is a one-stop station, you see the mother and the baby at the same consultation. They know exactly when the child is due for their blood test, their results, their immunization. It's a nice program. Challenge is related to PNC, space and confidentiality issues, length of session, HR and workload issues, quality versus quantity. PNC meeting dates, sustainability and graduation. They graduate at 18 months because we are looking after them from 10 weeks to 18 months. If you use clinic staff, it would not have been the same because the clinic staff cannot sit eight hours doing 10 mothers and infant pairs there. Here again, we are looking at quality versus quantity. That's a topic on its own because as nurses, we've got our own targets. How many patients are supposed to be seeing? By the way, the PNC, the quality is the best more than the quantity. I wish it can always be like this and we do not graduate at the same stage. I wish we are not removed and always be in, even if our kids are old, we can stay in. Other challenges, complex preparation of the club, scheduling of clubs, scripting, recruitment by two weeks of age, space and limitation for clubs to take place, some clubs too small, others clubs too large, high-risk mothers taking a lot of time and outcome not really improved, perceived increased length of visit, lengthy stationery that we have tried to shorten, need experience that is the nimadness or skills in maternal and child health. Conclusion. PMTCT postnatal retention and care of mother infant pairs remains a problem. The PNC model offers a comprehensive integrated package of care to mother infant pair and improve health outcomes. The model generates knowledge and triggers positive changes in health behaviors and motherhood. PNC generates great peer support. Participants and staff show a high level of satisfaction with the model despite some operational challenges. PNC model highlights the absolute necessity to consult mother infant as a pair and proposes high level of care requiring acceptance for reorganization and training of clinic staff. I would like to thank all the people that have been involved in the support and implementation of the program that is the MSF team, mothers to mothers mentors, clinic staff at town to clinic, all mothers and infant pair of the PNC. I thank you.