Opportunities and Challenges to Adherence: A Field Experience

505 views
470 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
505
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Opportunities and Challenges to Adherence: A Field Experience

  1. 1. Some Opportunities and Challenges to Adherence in PMTCT Fabienne Shumbusho, Family Health International Kigali, 19 October 2009
  2. 2. Follow-up of PMTCT Women in Ante-Partum Period Eligible to triple therapy <ul><li>Indicators tracked and </li></ul><ul><li>reported </li></ul><ul><li>No indicators tracked </li></ul><ul><li>and reported </li></ul><ul><li>In 2008 (49 ART sites): </li></ul><ul><ul><li>1365 HIV+ women </li></ul></ul><ul><ul><li>1336 HIV+ women received ART prophylaxis </li></ul></ul><ul><ul><li>1258 deliveries and 89% at facility level </li></ul></ul>? ? ? Start of ART Week 5-6 Lab exams Every 2 weeks for 1 month Delivery at facility Labour & delivery 2 education sessions + additional lab exams (biochem; hematology) Week 4-5 Result CD4 count test (CD4 ≤ 350/mm 3 or stage IV or pregnancy ≥ 34 weeks) Week 2-3 Sample for CD4 Week 1 HIV test Hg RPR test 1 st contact (t 0 )
  3. 3. Follow-up of PMTCT Women in Ante-Partum Period Not eligible to triple therapy ? ? ? ? Lab exams Every 2 weeks for 1 month Delivery at facility Labour & delivery Every 3-6 months CD4 control Refills for ART prophylaxis Monthly Start of AZT ≥ 28 weeks pregnancy Result CD4 count test (CD4 > 350/mm 3 ) Week 2-3 Sample for CD4 Week 1 HIV test Hg RPR test 1 st contact (t 0 )
  4. 4. Follow-up of PMTCT Women in Intra & Post-Partum Period ? ? Every 3-6 months CD4 control Cotrimoxazole prophylaxis refills ART (if on txt) Each 4 weeks (monthly) AZT/3TC After delivery: for 7 days AZT/3TC/NVP During labour
  5. 5. Follow-up of PMTCT Infants in Intra & Post-Partum Period ? ? ? Cotrimoxazole prophylaxis refills Each 4 weeks (monthly) Result DBS/PCR +/- 10 weeks and over Immunization DBS/PCR Cotrimoxazole prophylaxis 6 weeks NVP SD at birth and AZT (>90%) Delivery up to 4 weeks
  6. 6. <ul><li>Opportunities </li></ul><ul><li>Big proportion of clients tested for HIV </li></ul><ul><li>We know how many start treatment (ART; CTX) </li></ul><ul><li>Availability of CD4 count machines in district hospitals </li></ul><ul><li>Scaling-up and task-shifting for ART </li></ul><ul><li>Challenges </li></ul><ul><li>Number of visits to HF (time spent at HF) </li></ul><ul><li>Home visits? </li></ul><ul><li>Not all sites offer ART </li></ul><ul><li>No reporting on refills </li></ul><ul><li>No indicators on CD4 count (proportion who get their results; controls) </li></ul><ul><li>Pre-ART </li></ul>
  7. 7. <ul><li>Thank you </li></ul>

×