Integrating HIV Prevention and Care into Maternal and Child Health Care Settings

Introduction

Two decades after the emergence of HIV/AIDs pandemic, most women in developing countries are not reached by effective prevention and care interventions because of limited service delivery as well as socioeconomic and gender-related barriers that impede access to existing services. MCH care settings may offer women and their families an important entry point to critical services because of their widespread availability and community acceptance. Moreover many women make repeated visits for antenatal, postpartum, and infant care, thus increasing their potential access to vital HIV/AIDS services that focus on primary prevention, vertical transmission, and care and support of those infected.


This report documents lessons learned from Horizons intervention studies that focus on integrating HIV prevention and care activities into MCH settings. Horizons is a USAID-funded operations research program aimed at refining HIV/AIDS prevention, care, and support efforts. Horizon identifies problems in service delivery, tests new approaches, and disseminates the research findings to program managers and policymakers to foster improved policy and program development.

The information contained in this report emerged from a three-day consultation in Maasai Mara, Kenya, July 23-25, 2001, that brought together study investigators and service managers, including district medical officers and nurses in charge of individual clinics. Participants represented studies that focus on a broad range of topics related to delivery of HIV prevention and care in the MCH setting, including prevention of mother-to-child transmission (PMCT), HIV counseling and testing, male involvement in antenatal care (ANC), and partner violence. The Horizons studies that are discussed in this report focus on either integrating HIV/AIDS activities into key services that make up the continuum of care for women, including family planning, ANC and delivery, and postnatal care; or on making voluntary counseling and testing (VCT) services more responsive to the need of adolescent and adult women.

During the consultation, each participant presented an overview of his or her study, including objectives, major activities and milestones, and outcome measures. The presentations highlighted what has and has not worked in terms of program feasibility, acceptance, and effectiveness, and recommendations for replication and scale-up. The broad representation of participants enabled the sharing of experiences on such topics as training of health workers, communication strategies, monitoring and evaluation, and service delivery. The focus of discussions ranged from the introduction of specific new HIV services such as VCT and antiretroviral (ARV) prophylaxis to the strengthening of existing routine MCH services to addressing policy barriers. Critical areas for additional operations research were noted.

The retreat was followed by a one-day meeting in Nairobi on July 27, 2001, to further enrich the workshop discussions with the insights and experiences of agencies to prevent mother-to-child transmission of HIV. In addition to workshop attendees, participating organizations included the Ministry of Health of Kenya, USAID/Kenya, USAID/Uganda, WHO/Uganda, the African Regional Office (AFRO), the East and Southern Africa regional office of UNICEF, German Development Cooperation (GTZ), Medecins sans Frontieres, and the U.S. Centers for Disease Control and Prevention (CDC).

The report organizes workshop presentations and discussion around seven key components that all quality programs should incorporate:

• Training and motivation to improve the performance of health workers.
• Supervision and quality assurance.
• Care for the mother, including antenatal care, follow-up for HIV-positive women, and help for HIV-negative women to avoid risking infection.
• Voluntary HIV counseling and testing.
• Counseling on infant feeding.
• Provision of ARVs to reduce mother-to-child transmission.
• Involvement of male partners.

Many countries are currently grappling with the problem of how to initiate, expand, and increase the effectiveness of HIV-related interventions, including VCT and PMCT programs. It is hoped that the lessons learned through the Horizons studies--- which are shared in this report---will benefit both the replication and scaling up of HIV programs in the MCH setting.

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