PMTCT - The Platform forintegrating HIV/AIDSServices in the MCHClinic.
Bola Oyeledun, MD, MPH
Track 1.0 Partners Meeting
Washington DC.August 2008
Limitations of current PMTCT approach
•Limited efficacy of single drug regimen forPMTCT
–Imperative to move beyond concept of sd-NVP for PMTCT
•Does not address health needs of the woman
•Based on “single-visit” model… inconsistentwith chronic disease
Need to move rapidly to MTCT-Plus Model
Linkage of MCH & ART Programs Ineffective
•High loss to follow-upwhen women are referred
•Long waiting time in ARTclinics
–Pregnant women notprioritized
–Missed opportunity toprovide effective pMTCT
•Missed opportunity toaddress health need ofHIV+ woman within hermedical home (MCH)
Follow-up of HIV-Exposed Infants Ineffective
•Women who missed pMTCTduring pregnancy are likely tovisit clinics with their infants
•HIV exposed infants NOTroutinely followed
•HIV-exposed infants lost tofollow-up are generally receivingimmunizations and routine carein MCH clinics
Opportunities in Maternal and ChildHealth (MCH) Platform
Maternal Child Health (MCH) Programs are:
•Part of the health system attending to the needs of women andyoung children (comprehensive, integrated and continuous careapproach)
•PMTCT traditionally provided within ANC/MCH
•Post-partum women and their infants are usually seen in theseprograms (well baby , immunization clinics etc).
•HIV resources can enhance MCH services
Integration of MTCT-Plus Components in MCHPrograms
MCH Spectrum
Identification of HIV status: testing & counseling across all MCH services
Assessing maternal health status and ART eligibility within MCH services
Clinical staging & evaluation
CD4+ cell count
Providing multi-drug ART regimens within MCH
Short course (AZT+ sd-NVP)
HAART for women with advanced disease
Providing effective follow-up of HIV-exposed infants
Cotrimoxazole
Growth monitoring
Monitoring for evidence of HIV disease
Early infant diagnosis of HIV
Enhanced postnatal follow-up of mother and infant
Ongoing Infant feeding counseling and support
Universal access to family planning services
Evaluation of maternal health status during period of lactation
Promoting community based capacity to support identification and follow-up of mothers andinfants at risk for disease progression
ANC
Labor &Delivery
Vaccination or Well-baby Clinics
Post- Partum Follow-upof Women
HIV testing of women
CD4 test and clinical staging of women & treatment for women with advanced HIV
More efficacious regimens for PMTCT
Engaging and testing of partners
Complete package of interventions
HIV testing of women
Engaging women with HIV in HIV care services
Engaging partners
HIV testing of women and linkage to HIV care services
Follow-up of exposed infants
Cotrimoxazole
Growth monitoring & monitoring for evidence of HIV disease
Early diagnosis of HIV, linkage to Peds services and early initiation of ART
• HIV testing of women with unknown status
• Follow-up of women with HIV:
• counseling on infant feeding
• CD4 test and clinical staging of women
• ART for women with advanced HIV
• Complete package of interventions
• Engaging & testing (partners, other children)
NIGERIA: PMTCT UPTAKE AT ICAP SUPPORTED SITES
Pre-intervention: February 06 – March 07Post -intervention: April 07- March 08
RWANDA: Shift from sd-NVP to multidrug ARV regimensamong HIV+ pregnant women in ANC, July 06 –Dec 07
# sites
n1=5
n2=5
n3=14
n4=18
n5=18
Total ARV regimens
T1=71
T2=136
T3=144
T4=200
T5=163
T6=139
n6=19
Summary-1
•Approaches may differ based on setting and sero-prevalence but MCH platform can be effectively usedto enhance PMTCT efforts
•ART pre-screening services at MCH are a keycomponent in getting pregnant women to initiateHAART early
•MCH referral to ART clinic achievable with excellentresults when ART clinic available on-site
Summary-2
•In countries where ANC attendance and healthfacility delivery rates are low, HIV testing andcounseling in EPI clinics can identify HIV+ women andfacilitate enrollment of mother-infant pairs in careand treatment
•HIV exposed infants can receive appropriateinterventions through focus on integrating their careinto MCH platform
MCH Platform can catalyze a transformation
of services for pregnant women and theirchildren
THANK YOU
THANK YOU!