John Odero Ong’ech MBChB,MMed(Ob/Gyn),MPH Kenyatta National Hospital-University of Nairobi, Kenya Presentation at XIX International AIDS Conference in Washington, D.C., USA 25th July 2012

Country Population-40,512,682 Number living with HIV/AIDS-1.6million  Number of pregnant women living with HIV- 87,000 HIV prevalence(15-49)-6.2% HIV prevalence, pregnant women-9% Number of Adults on ART-432,000/590, % Number of children on ART-36,096/158, % Annual new HIV infections-Adult-91,000, Children-13,000 Annual deaths attributable to HIV/AIDS-80,000

 Desire for a child in the future among married or cohabitating HIV positive women aged years by self reported HIV status-24% (KAIS 2007)  HIV infected women in married or cohabitating relationships who have a need for contraception and not using any contraception-57.9%(KAIS 2007)  The above gaps was a Justification for prioritizing pre-conception care and prevention of untended pregnancies among HIV positive women in Kenya

 Hhh Kenyatta N. Hospital(Nairobi) X10 sites in Eastern province

 Baseline assessment  Pregnancy intension screening tool in the specialized HIV comprehensive care clinic(CCC); i) Family planning option- Provided within the CCC-integration where feasible ii) Desired pregnancy intention option  Male involvement to discuss options and male status

Desired pregnancy scenarios i) Concordant couple-ART, Ovulation induction, time conception, linkage to Prevention of vertical transmission program ii) Discordant couple-Two scenarios A-Male Positive, Female negative- ART in Male, Ovulation induction with clomiphene, time intercourse with option of PEP in female. Sperm wash in KNH and insemination(sperm wash cost USD 200)

B-Male Negative, Female Positive- ART in Female, achieve viral suppression (Viral load or CD4 used ), ovulation induction, timed intercourse or insemination

 Doctors  Clinical officers  Nurses  Counselors  Lab Technologies  Community Workers, social workers and Peer support groups

 20% of the HIV positive women screened would want to get pregnant  Most of those offered the services had successful term pregnancies where there was no other underlying pathology like tubal blockage, Fibroids, Sperm abnormalities etc  Afew women (2%) had preterm deliveries, Miscarriages  No Fetal abnormalities were observed

 Pregnancy screening tool is effective in identifying HIV positive women reproductive Health needs  Lack of knowledge from clients on existence of options  Skills lacking in health care workers to provide services for pregnancy intention  Multi disciplinary team is essential  Integration is feasible  Provision of safe pregnancy option for HIV positive women is feasible in resource poor settings

 People living with HIV/AIDS sensitization on safe pregnancy options-peer support groups and community Health workers  Provision of comprehensive integrated Reproductive Health services( Family planning in the HIV clinics, cervical cancer screening, pregnancy intention screening etc)  Health System Strengthening in both Facility and community is essential for provision safe pregnancy options for HIV positive women

 Low Male involvement  Lack of Human resource to provide services  Poor infrastructure-lack of space to provide integrated services, poor lab services  Poor supply of commodities ie Family planning

 PACT-COE project-KNH Support  ICAP-UoN project- Eastern province  CDC/PEPFAR  MoH, GoK  KNH  UoN