PMTCT - The Platform for integrating HIV/AIDS Services in the MCH Clinic. Bola Oyeledun, MD, MPH

PMTCT - The Platform for integrating HIV/AIDS Services in the MCH

Clinic.

Bola Oyeledun, MD, MPH

Track 1.0 Partners MeetingWashington DC. August 2008

Limitations of current PMTCT approach

• Limited efficacy of single drug regimen for PMTCT – Imperative to move beyond concept of sd-NVP for PMTCT

• Does not address health needs of the woman

• Based on “single-visit” model… inconsistent with chronic disease

Need to move rapidly to MTCT-Plus Model

Linkage of MCH & ART Programs Ineffective

• High loss to follow-up when women are referred

• Long waiting time in ART clinics– Pregnant women not

prioritized– Missed opportunity to

provide effective pMTCT

• Missed opportunity to address health need of HIV+ woman within her medical home (MCH)

Follow-up of HIV-Exposed Infants Ineffective

• Women who missed pMTCT during pregnancy are likely to visit clinics with their infants

• HIV exposed infants NOT routinely followed

• HIV-exposed infants lost to follow-up are generally receiving immunizations and routine care in MCH clinics

Opportunities in Maternal and Child Health (MCH) Platform

Maternal Child Health (MCH) Programs are:

• Part of the health system attending to the needs of women and young children (comprehensive, integrated and continuous care approach)

• PMTCT traditionally provided within ANC/MCH

• Post-partum women and their infants are usually seen in these programs (well baby , immunization clinics etc).

• HIV resources can enhance MCH services

Integration of MTCT-Plus Components in MCH Programs

MCH SpectrumIdentification 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 and infants at risk for disease progression

ANC Labor & Delivery

Vaccination or Well-baby Clinics

Post- Partum Follow-up of Women

HIV testing of womenCD4 test and clinical staging of women & treatment for women with advanced HIVMore efficacious regimens for PMTCTEngaging and testing of partners Complete package of interventions

HIV testing of womenEngaging women with HIV in HIV care servicesEngaging partners

HIV testing of women and linkage to HIV care servicesFollow-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 regimens among 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 used to enhance PMTCT efforts

• ART pre-screening services at MCH are a key component in getting pregnant women to initiate HAART early

• MCH referral to ART clinic achievable with excellent results when ART clinic available on-site

Summary-2• In countries where ANC attendance and health

facility delivery rates are low, HIV testing and counseling in EPI clinics can identify HIV+ women and facilitate enrollment of mother-infant pairs in care and treatment

• HIV exposed infants can receive appropriate interventions through focus on integrating their care into MCH platform

MCH Platform can catalyze a transformation of services for pregnant women and their

children

THANK YOU

THANK YOU!