Expanded Services for the Prevention of Mother-to-Child HIV Transmission

Abstract

At the start of 2007 an estimated 2.3 million children in sub-Saharan Africa were infected with HIV most of whom had acquired the virus around the time of birth. As services in the region move toward more complicated and efficacious drug regimens for prevention of mother-to-child transmission of HIV (PMTCT) acceptability is a critical component to overall program effectiveness. Several studies have observed poor follow-up among patients concerned about stigma or disclosure of their HIV status. The risk of viral drug resistance after use of drugs such as nevirapine (NVP) may only add to a patients reluctance to adhere to specific PMTCT drug regimens. We evaluated a pilot program designed specifically to link PMTCT services provided routinely as part of antenatal care to long-term HIV care and treatment in Lusaka Zambia. Kanyama Health Center is among the largest of the Lusaka Districts 24 primary care centers and the site of robust government programs for PMTCT and antiretroviral therapy (ART). To link PMTCT to HIV care and treatment we implemented specific referral procedures. This began with a scripted talk on the benefits of long-term HIV care and the importance of CD4+ cell count screening. All women were encouraged to enroll into long-term HIV care and treatment. Women interested in enrollment that day were escorted by community health workers to the on-site HIV care and treatment facility and seen immediately. (excerpt)