Ensuring the Continuum of Care

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Ensuring the Continuum of Care

• Catherine M Wilfert, MD
• August 3, 2008

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EGPAF International Family AIDS Initiatives

• Acknowledges all of the host countries for
  supporting this work,
• Thanks all of our staff in the US and in country,
• Thanks all the people we serve, and
• Permission for pictures was obtained and should
  not imply anything about HIV status

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Uganda
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EGPAF Country Programs2000 8 sites in 6
countries2008 2500 sites in 17 countries
Russia
Georgia
India
Thailand
Dominican Republic
Rwanda
Uganda
Cote dIvoire
Honduras
Kenya
Cameroon
Tanzania
D.R. Congo
Malawi
Mozambique
Angola
South Africa
Zimbabwe
Zambia
Swaziland
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Mozambique
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Cumulative PMTCT Cascade All Countries 2000-2008
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Numbers of HIV Women Identified, Numbers of
Moms and Babies Receiving ARV Prophylaxis
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Counseled and Tested in Maternity 2007-2008
212,748
230,889

242,748
260,918
269,758

Number of deliveries

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Zimbabwe
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Breastfeeding Women With Low CD4 Are at Most Risk
of Infecting Their Infants ZimbabweIliff PJ et
al. AIDS 200519699-708
Postnatal HIV Infection from Age 6 Weeks - 18
Months (N2,055)
Women Who Would be Eligible for HAART
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Reported Access of HIV Women to Care and
Treatment
HIV women 175,278
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Uganda
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HIV Exposed Infants Number Reported At Regular
Well Child Visits
117,788
80,967
66,009
Number of HIV Exposed Infants
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Models of Integrated Service Delivery Swaziland
Data Summary Jan-June 2007
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Zimbabwe
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Linkage Facility Level Interventions

• Child Health Card - Zimbabwe
• Referral Form - Tanzania, Kenya, South Africa,
  Zambia
• Immunological and clinical staging of
  HIV-positive women in PMTCT program Rwanda,
  Tanzania
• Early infant diagnosis DBS PCR Zambia, Rwanda
• Identification of HIV-exposed Children Rapid
  testing in Under 5 Clinic Tanzania, Kenya

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Linkage Facility Level Interventions

• Dual Appointment System - Lesotho
• Home Visits - Russia
• Adherence counseling for Family Support Group
  members enrolled in the PMTCT program - Uganda
• HIV/ART Physician in PMTCT Clinic - Swaziland

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Reported Supervised Delivery Rates in All
Countries
first ANC visits 1,915,036 deliveries
1,217,061 (64) HIV 109,199 HIV
deliveries 54,211 (50) HIV on Therapy
4257 HIV on RX del. 4,476
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Increasing access to care for mothers and
children identified through PMTCT EGPAF TZ
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Tanzania
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How We Did It

• Physical proximity Reproductive Child health and
  Comprehensive Treatment Center
• Shared resources equipment, drugs, test kits
• Integrated supportive supervision one technical
  officer for both programs
• Joint planning budgeting, technical/programmatic
  review meetings

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How We Did It

• EGPAF requires reports on care indicators from
  PMTCT
• Sensitization of PMTCT service providers on CT
• Referral forms with detachable piece
• Transfer of mothers info onto child card
• Training for MCH staff on basic care using
  modified ART curriculum
• Assignment of CTC nurse to improve linkages
  between programs

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Summary Thoughts

• Integration of PMTCT services does not ensure
  longitudinal follow up of HIV mothers or HIV
  exposed infants
• Counseling and testing can be provided in
  maternity to increase access to services
• Examples of providing HIV care and treatment
  within MCH seems to facilitate care for HIV
  mothers
• Uptake of sd NVP has improved with dispensing of
  maternal drug at time of diagnosis and
  dispensing infant drug to mom in ANC

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Zimbabwe
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Summary Thoughts

• HIV women are usually not routinely staged,
  enrolled in care, and too few are accessing ARV
  therapy for their own immunocompromise
• HIV women on therapy seem to access a facility
  for delivery at a higher rate than the general
  pregnant population

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