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

2. Conflict of Interest

3. Overview

4. Rationale for integrating MCH & HIV services

5. 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

6. Fragmented care for mothers & infants

8. Integration of ART into antenatal care services

9. 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

10. Examples of successful integration

11. 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

12. Trial outcomes

13. 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

14. 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

15. Challenges & questions

16. Another perspective…..

17. Challenges of integrated services

18. Questions around integration

19. There is a model for integrated service delivery….

20. Thank you!