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Opportunities and Challenges to Adherence: A Field Experience

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  • 1. Some Opportunities and Challenges to Adherence in PMTCT Fabienne Shumbusho, Family Health International Kigali, 19 October 2009
  • 2. Follow-up of PMTCT Women in Ante-Partum Period Eligible to triple therapy
    • Indicators tracked and
    • reported
    • No indicators tracked
    • and reported
    • In 2008 (49 ART sites):
      • 1365 HIV+ women
      • 1336 HIV+ women received ART prophylaxis
      • 1258 deliveries and 89% at facility level
    ? ? ? 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. 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. 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. 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.
    • Opportunities
    • Big proportion of clients tested for HIV
    • We know how many start treatment (ART; CTX)
    • Availability of CD4 count machines in district hospitals
    • Scaling-up and task-shifting for ART
    • Challenges
    • Number of visits to HF (time spent at HF)
    • Home visits?
    • Not all sites offer ART
    • No reporting on refills
    • No indicators on CD4 count (proportion who get their results; controls)
    • Pre-ART
  • 7.
    • Thank you

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