Integrating PMTCT Into Maternal, Newborn, and Child Health and Related Services: Experiences From the Global Plan Priority Countries

Abstract

The urgency to scale-up sustainable programs for the prevention of mother-to-child transmission of HIV (PMTCT) prompted priority countries of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) to expand the delivery of PMTCT services through greater integration with sexual and reproductive health and child health services. Countries approached integration-what, where, and how services are provided-in diverse ways, with predominantly favorable results. Approaches to integrated services have increased access to a broader range of PMTCT interventions, and they also have proved to be largely acceptable to clients and providers. The integration of PMTCT interventions with maternal, newborn, and child health settings was supported by strategies to reconfigure service delivery to provide additional services, including shifting tasks to nurses (such as initiating antiretroviral therapy and providing long-term follow-up). This was complemented by supporting community outreach and integrating HIV and sexual and reproductive health services bidirectionally, including by providing family planning through antiretroviral therapy clinics and HIV testing in family planning clinics. A systematic and rigorous study of country experiences integrating HIV and maternal, newborn, and child health services, including maternal and pediatric TB services, cost analysis, could provide valuable lessons and demonstrate how such integration can improve systems for health care delivery.

Integration of postpartum healthcare services for HIV-infected women and their infants in South Africa: A randomised controlled trial

“…Related to this, there has been a call for integrating HIV care and treatment services into the broader platform of primary healthcare, particularly in the context of PMTCT [ 12 ]. Integration of ART into antenatal care (ANC) services has proven critical to the successful delivery of ART to pregnant women under Option B+ across sub-Saharan Africa [ 13 ]. However, there has been little consideration given to the integration of health services during the postpartum period, when HIV+ women’s retention and adherence may be under greatest threat.…”

Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013–2016

“…7 Higher dropout rates have been documented after delivery and at two years of follow-up, suggesting that service integration and linking mothers to routine ART services are important determinants of retention in care. [8][9][10] As well as being detrimental to their own health, losing mothers from care contributes to higher HIV transmission risks to their infants, and poorer uptake of services across the cascade of infant care. 11 The timing of adoption and roll-out of PMTCT policies, and the extent to which policies are implemented within health facilities, will be important in determining whether countries meet global targets for mothers living with HIV and their infants.…”

Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

“…[24][25] Various studies suggest that integrated healthcare services are more cost-effective than fragmented services due to economies of scope and scale, are time saving for patients, and contribute to the long-term outcome of healthier communities. [26][27][28][29] However, cost benefits of integration depend on the model of integration used and this needs to be tested at scale. 26…”