International Center for AIDS Care and Treatment Programs

1
2007 ICAP Annual Meeting
The Key to Adherenceto Care and Treatment for
Pregnant Women Appropriate Counseling and
Support Xoliswa Keke Senior Psychosocial/Adheren
ce Advisor ICAP-Swaziland October 2 2007
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Swaziland Background

• In Swaziland, pregnant women present early for
  ANC services (at least from 14 wks)
• The health care system cannot properly follow up
  the women
• Only 30 of HIV pregnant women who have done a
  CD4 count receive the result (one site)
• No integration of PMTCT, ANC, and ART services
• Poor community support programs

3
Barriers to ART Access and Adherence

• Health care workers attitudes and misconceptions
• Poor and inappropriate counseling
• Pregnant women feeling healthy despite
  eligibility status and not wanting to go to ART
  Clinic
• Mothers provided with SD-NVP and AZT at diagnosis
  are given a sense of complete protection to the
  baby
• ANC and ART assume the other will take care of a
  woman who becomes pregnant on ART
• Non disclosure of HIV status to male partners
• Lack of transport

4
Swaziland Solutions

• Change approach to counseling and support
• Improve the counseling approach from group
  counseling/information sessions for all to small
  size, focused and interactive group counseling
• Introduce contextualized individual counseling
  that goes beyond post test counseling session
• Support the introduction of expert clients by
  MOHSW to do most of the counseling to complement
  the work of HCW
• Mentor expert clients at clinic level where most
  of the pre-ART care takes place

5
Thank you

• ICAP- Swaziland team
• ICAP-NY
• MOHSW