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

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PMTCT - The Platform for integrating HIV/AIDS
Services in the MCH Clinic. Bola Oyeledun, MD,
MPH Track 1.0 Partners Meeting Washington DC.
August 2008
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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
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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)

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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

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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
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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 and infants at risk for disease progression
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Vaccination or Well-baby Clinics
Labor Delivery
Post- Partum Follow-up of Women
ANC

• 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)

• 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 Engaging women with HIV in
HIV care services Engaging partners
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
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NIGERIA PMTCT UPTAKE AT ICAP SUPPORTED SITES
Pre-intervention February 06 March 07Post
-intervention April 07- March 08
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RWANDA Shift from sd-NVP to multidrug ARV
regimens among HIV pregnant women in ANC, July
06 Dec 07
T171
T2136
T3144
T4200
T5163
T6139
Total ARV regimens
n619
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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

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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
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THANK YOU!

• THANK YOU