Session 3 - MTCT-Plus: A Family Perspective
MTCT-Plus Overview: Elaine Abrams, MD, Director of the MTCT-Plus Initiative, reviewed the critical and interlinking relationship between the health of an HIV infected woman (during pregnancy and postpartum) and her child’s health. She stressed the rationale for aggressively identifying and initiating pregnant and post-partum women eligible for antiretroviral treatment and described the importance and challenges of linking PMTCT programs with pediatric/infant follow-up care and using PMTCT as an entry point for family-focused care and treatment services. Elaine also outlined the ICAP MTCT-Plus model of care, describing the MTCT-Plus concept and successes and challenges in implementation, including routine HIV testing, CD4 screening and HAART for eligible women.
Country Experiences and Challenges: Lesotho and Swaziland: Routinely Offering HAART to Eligible Pregnant Women: Cristiane Costa, MPH, Senior Project Officer for Lesotho, Swaziland, Zambia, and South to South, described the “supermarket approach” to comprehensive HIV/AIDS services in a hospital-based maternal and child health clinic in Lesotho and a Swaziland model of building active linkages from ANC to ART services and decentralizing to primary health care centers. Cristiane highlighted challenges to implementing effective MTCT-Plus services, such as the human resource shortage, poor workforce allocation, and lack of space for PMTCT/ART. She advocated gentle, persistent pressure to overcome such challenges, via aggressive staff sensitization and training, facilitation of task shifting, patient flow redesign, and integration of a multidisciplinary approach to service delivery, etc.
Country Experiences and Challenges: Nigeria: PMTCT: Expanding from sd-NVP to HAART: Jonas Chanda, MD, MPHIL, Senior PMTCT Advisor for ICAP-Nigeria, presented the case study of ICAP-Nigeria expanding PMTCT from sd-NVP TO HAART at a state hospital. He described challenges such as patient drop-out at various stages in the PMTCT cascade and lack of experienced laboratory and clinical staff. Among the lessons learned he noted that the national PMTCT guidelines are difficult to implement, that scale-up of services in phases is advisable, and that transportation logistics are crucial to program success.
Issues raised during Question & Answer session:
- Increasing men’s involvement
- In Nigeria, there are situations where women and men sit together in a room and participate in support groups. It takes much effort to engage men; one man worked hard to encourage other men to come to a breakfast meeting at the hospital, encouraging them to get counseled and tested, and to bring their wives with them on subsequent visits.
- ICAP Mozambique’s PMTCT program increased men’s participation by giving each pregnant woman a written invitation for her partner to come to the antenatal care (ANC) unit . It was not previously accepted to have men in the ANC unit, but it is becoming gradually more accepted.
- Lesotho
- Renovation and task shifting for staff were 2 areas that required significant change to effectively move HIV services into the MCH.
- The ART provided in the MCH was only for pregnant women; non-pregnant women and men received ART in a separate ART clinic.
- Swaziland
- Currently, counseling is routinely done lecture-style in a crowded space with many distractions, and participants are often unengaged and do not ask questions. ICAP worked with counseling staff, encouraging them to start off by asking participants what they know about ART and engaging them by dispelling misconceptions.
- Nigeria
- It is difficult to incorporate traditional birth attendants or home deliveries into the hospital’s PMTCT activities. In one support group, group members may bring drugs back to women delivering at home.