Results In the 10 months after implementation, ART initiation of eligible pregnant women increased by 5 times, rising to 28% (106/386) (figure 2). Prior to integration of services, only 5% (20/392) initiated ART. 25 family units were enrolled in the ART clinic, illustrating this model’s potential to promote family centered care. Overall, 275 patients initiated ART in the post-integration period, of which 106 (39%) were pregnant women. The proportion of other clients continued to increase in the second half of the post integration period. Challenges Not all HIV positive women return for CD4 count results. Lack of readiness by non-symptomatic, eligible women to initiate HAART. Difficulty of disclosure to partners/spouses. Increasing numbers of non-pregnant patients accessing ART services (due to lack of additional ART services at KSII PHU) is straining the capacity of the MCH clinic .
Providing HIV Care & Treatment Services for Women & Families
PROVIDING HIV CARE & TREATMENT SERVICES FOR WOMEN & FAMILIES Stephen Lee Sr. Program Director, Prevention, Care & Treatment Services Elizabeth Glaser Pediatric AIDS Foundation
Benefits of Providing ART to HIV- Positive Pregnant Women <ul><li>The most effective regimen for preventing MTCT among women who require it for their own health is ART during pregnancy </li></ul><ul><li>Women with immune-suppression or clinical AIDS have the highest risk of transmitting HIV </li></ul><ul><li>HIV treatment prolongs the life of infected women </li></ul><ul><li>Benefits the survival of children; decreases the chance that an infant will be infected </li></ul>
Challenges <ul><li>Fast-tracking pregnant women into HIV treatment services </li></ul><ul><li>PMTCT and HIV treatment services often implemented as vertical programs </li></ul><ul><li>Weak referral mechanisms </li></ul><ul><li>MCH sites lack the capacity to treat HIV infected women </li></ul><ul><ul><li>Inability of MCH sites to identify pregnant and post-natal women who need treatment </li></ul></ul>
Efficacy of Pre-ART Care at PMTCT/VCT Sites vs. Referral of HIV+ Patients to ART Sites <ul><li>Pilot study </li></ul><ul><li>July to September 2007 </li></ul><ul><li>Feasibility </li></ul><ul><li>Rate of enrollment </li></ul><ul><li>Stages of infection </li></ul><ul><li>Impact on referrals </li></ul>
Conclusions <ul><li>Provision of care in VCT/PMTCT site: </li></ul><ul><li>Effectively enrolled more patients in care </li></ul><ul><li>Patients are enrolled earlier </li></ul><ul><li>More effective referrals occurred </li></ul>
Increasing ART Access for Pregnant Women through Integration of ART Services into MCH <ul><li>HIV prevalence among pregnant women in Swaziland is 39.6%, the highest in the world </li></ul><ul><li>King Sobhuza II Public Health Unit (KSII) is the busiest government primary care center in Swaziland. Each month, 250-350 pregnant women test for HIV </li></ul><ul><li>34% of pregnant women were eligible for ART, but few were accessing it. Eligible pregnant women were referred to other hospitals. Few women completed their referral </li></ul>
Intervention <ul><li>In collaboration with MOHSW, EGPAF supported integration of ART services into MCH in KSII by placing a medical officer in the MCH, renovating the unit, and providing essential supplies and equipment </li></ul><ul><li>ART services in MCH began in February 2007 </li></ul><ul><li>Women, partners and children were offered HIV testing and counseling </li></ul><ul><li>Individuals who tested positive were assessed by the medical officer for ART eligibility and those meeting the national criteria initiated ART </li></ul><ul><li>Care and treatment services were also offered to spouses and children of the women </li></ul>
ART in ANC to Increase Treatment Initiation in HIV-infected Pregnant Women <ul><li>To evaluate whether providing ART integrated into ANC clinics resulted in a greater proportion of treatment eligible women initiating ART during pregnancy compared with the existing approach of referral to ART </li></ul><ul><li>8 public sector clinics in Lusaka district </li></ul><ul><li>Main outcome indicators were the proportion of treatment eligible women enrolling into HIV care within 60 days of diagnosis </li></ul><ul><li>The proportion initiating ART during pregnancy </li></ul>AIDS, January 2010, 24:85-91
Intervention <ul><li>SOC: all Lusaka public ANC clinics used a “reflex CD4” testing and referral strategy for linking PMTCT and ART services </li></ul><ul><li>In the intervention sites: if the patient’s CD4 cell count made her eligible for ART she was enrolled into ART care on the day she returned for her result </li></ul><ul><ul><li>Standard written protocols were used </li></ul></ul><ul><ul><li>Clinical officer performed detailed history and physical </li></ul></ul><ul><ul><li>Nurse midwife provided health education and ANC services </li></ul></ul><ul><ul><li>Adherence and counseling on ARV drugs was provided by a peer counselor </li></ul></ul>
Enrollment and ART Initiation Outcome of ART Eligible Patients
Discussion <ul><li>Provision of ART in ANC is feasible in resource limited settings </li></ul><ul><li>Requires investment in laboratory capacity, drugs, staff and training </li></ul><ul><li>May be more effective than referral to ART services </li></ul>DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.
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