1. Post natal integrated clubs as a way to improve retention in care of mother infant pairs in a primary care setting, Khayelitsha, South Africa.
Aurélie Nelson1, Laura Trivino Duran1, Tali Cassidy1, Kate Buchanan1 Virginia de Avezedo2, Shariefa Abrahams2, Sarah Chapman 3
1Médecins Sans Frontières, Khayelitsha 2 City Health of Cape Town 3 mothers 2 mothers, Cape Town, South Africa
#448
Background and Objectives With the introduction of option B+, HIV mother to child transmission (MTCT) has dropped nationally to 2.3% at 2 months postpartum, but is estimated to be 4.2% at 18 months. The increased MTCT postnatally can be partly explained by poor retention in care (RIC) of the mother infant pairs (MIP). We describe and evaluate a primary care intervention to improve integration of care and post partum RIC of MIP.
Results
Mothers have informally expressed their satisfaction with the clubs, in particular the baby friendly environment and one-stop shop. Health workers are supportive of the intervention and have noted the benefit of peer support, although find the clinical visit lengthy.
Methods
Mothers2mothers (m2m), with the City of Cape Town Health and MSF developed the postnatal clubs (PNC), which have been piloted at Town 2 Clinic in Khayelitsha since July The clubs target all HIV positive mothers with exposed, but uninfected infants. MIP are recruited at their 6 week post natal visit and attend 9 sessions in total until 18 months of age.
The clubs are based on an adapted ARV adherence club model, integration of care and focus on the ‘first 1000 days.’
The m2m facilitate a group session, which provides education, adherence support, infant feeding support, mental health screening and early childhood development activities. These sessions aim to promote peer support and the m2m are able to provide individual psychosocial support.
The group session is followed by a clinical visit, which provides integrated HIV and non HIV care to both the mother and child. It is a one stop shop with pre-packed ART for the mother and Bactrim for the baby. High risk MIP (defined by Western Cape guidelines) receive additional support in the form of monthly home visits and monthly adherence counselling with the nurse.
Outcomes
Number
Percentage
PNC started
23 Clubs started
MIP recruited
130 (2 sets twins)
Mothers recruited
128
High risk mothers
8 (total)
2 low birth weight
2 ART initiated <12w before delivery
4 high viral load 6%
MIP retained in PNC (accumulative)
123
2 MIP transferred out
5 babies transferred out,
(mothers back to std. of care)
96%
The Post Natal Club Model
Mother: VL, FP, Pap smear
Child: HIV testing, Growth monitoring, Feeding support, Immunisations, IMCI
One stop shop
Clinical visit at every session
Pre-packed medicine
Postnatal nurse, NIMART
Mental health screen at baseline & 6 monthly
Early childhood development
Breast feeding support
45 min group session
Peer support
Adherence counseling
HIV and non HIV topics
Adult ART club model
1000 days
Integration of HIV and non HIV care
Integration of maternal and child health
Viral load monitoring
VL suppressed at baseline*
105/109
96%
VL suppressed at 10 weeks
63/65
97%
VL suppressed at 6 months
88/90
98%
*3 months prior to starting the club
Infant HIV testing
Test done
% Uptake
Positive result
10 week PCR
84/84
100%
18 week PCR (high risk)
4/7
57%
9 month rapid
52/52
4 (8%)
9 month confirmatory PCR
4/4
Conclusion
The PNCs have shown good early RIC of the MIP and viral load suppression, as well as zero HIV seroconversion in the infants. Some of the challenges facing the PNC include the length of time needed per clinical visit and the expertise required to offer integrated care of both maternal and child HIV and non-HIV related care. The impact of the pilot on the operations of the clinic is a limitation being taken into account in planning for possible scale up. More qualitative research is needed to understand the benefits of this integrated PNC model within the PMTCT program.