Interface of Maternal–Child Health & HIV care in South Africa

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Presentation transcript:

Interface of Maternal–Child Health & HIV care in South Africa

Conflict of Interest

Overview

Rationale for integrating MCH & HIV services

Rationale MCH services: major primary care platform Antenatal care (pregnant women) Postnatal care (infants) Reproductive health services (women) Venue for engaging women in health care Strong traditions of health seeking separate from HIV

Fragmented care for mothers & infants

Integration of ART into antenatal care services

Postpartum care: “the broken thread” Ongoing challenges in providing ART Maternal adherence to therapy Maternal & child retention in services Uptake of EID Services struggle to engage mothers postpartum Focus on infant Contrast to antenatal / obstetric care Walker J Perinat Educ 2015

Examples of successful integration

MCH-ART study: integrating MCH and HIV services improves outcomes Randomised 471 HIV+ women on ART, infants: Integrated maternal-child postnatal care, vs Separate adult ART (mothers) and EPI (child) Through 12m postpartum, integrated postnatal care leads to: Higher maternal viral suppression Better retention in care Longer duration of breastfeeding (EBF, any BF) CROI 2017

Trial outcomes

Design of the MCH-ART intervention Integration of: antenatal + postnatal care Same providers seeing pregnant, postpartum women mother + infant care Co-scheduling of follow-up for mothers & children HIV + MCH care ART, family planning, infant feeding support, cervical cancer screening, routine primary care concerns

Cluster RCT (12 facilities, n=369 women) Package of interventions to support PMTCT engagement & mother-infant retention Task shifting Integrated MIP care: location, scheduling Partner involvement encouraged Community engagement plans Aliyu Lancet HIV 2016

Challenges & questions

Another perspective…..

Challenges of integrated services

Questions around integration

There is a model for integrated service delivery….

Thank you!