Re: PMTCT questions

[Guest guest]

Dear Forum, [Two combined messages. Moderator]

1) Medical Officers do not even attempt to elicit information from patients on

RTI/STI.

aa Britto

2) MTCT service delivery models

Dr. Chandrakant Ruparelia

__________________________________

1) Medical Officers do not even attempt to elicit information from patients on

RTI/STI.

aa Britto

This is Indeed a good question and I am glad that Ms.M.Jalan has raised it.

In a recent rapid appraisal we did of 42 Primary Health Centers in three

districts in Maharashtra, we found that the Medical Officers (who are mostly

males) do not even attempt to elicit information from patients on any RTI/STI

let alone treating them. The GoI policy is to go by the syndromic diagnosis but

that requires skills that these people just do not have or do not care to

deploy. How can PMTCT can be implemented properly under these circumstances?

The PHC manual has incorporated HIV.

I too seek your inputs since I am assisting in transforming some PHCs.

Thanking you in advance,

BRITTO

Director: NARC

gabriel aa britto " <britto@...>

_______________________________________________

2) MTCT service delivery models

Dr. Chandrakant Ruparelia

You have raised some very pertinent questions about the PMTCT program. To answer

your first question I would say we need both. However,it is very vital that

PMTCT program is fully integrated into overall MCH program. Question might be

why do we need to integrate PMTCT services within the MCH services? There are

several practical reasons for the same.

1. To ensure smooth client flow and reduce the amount of " stops " and client

waiting time. It has been found in several countries that if the number of stops

and waiting time is increased then the drop out rate also will increase. This

can be found by looking at number of new antenatal visits, number of women going

for pretest counseling, number of women agreeing to get tested and then the

number returning to get their results.

2. It is important that the mothers receive results on the same day if program

was to be effective in terms of uptake of services and so it has to be

integrated into MCH rather than with stand alone VCT/VCT for walk-in clients or

clients from internal referral.

3. In high client load sites, opt-out approach is being recommended these days.

It means all mother should be offered HIV-testing as a part of routine MCH

services and those who do not want the test can refuse. So even in Opt-out

approach the clients' rights to consent is maintained equally well. Integration

into MCH would be key to achieve this.

4. The HIV status of woman will have several implications on the obstetric

practices and so there has to be better communication between the laboratories

and labor room. This is achieved better if integrated into MCH services.

5. The HIV status of woman will have further implications on postpartum

management of women and their babies, this could be achieved if there is

better ownership of PMTCT intervention within the MCH service delivery areas and

staff.

6. Most places I have seen PMTCT services are integrated into MCH and they are

doing very well.

7. Dispensing Nevirapine would be easy if program was integrated into MCH

particularly when it comes to giving it at the onset of labor, many times in the

labor room. Baby needs to get Nevirapine within 72 hours of birth and that also

would be easy if it was part of MCH services.

8. Not all positive mothers delivers in Hospital. One options for positive woman

is to give her Nevirapine and explain that she needs to take it at the onset of

labor at home. Bring baby to the clinic for Nevirapine but it may not be

culturally acceptable and physically possible for women to bring their babies to

the clinic. In India it might be possible for the NAM/midwife in the area to go

and deliver Nevirapine during the first PNC visit that should occur within 72

hours of birth. But in countries like Sub Saharan Africa home visits hardly ever

occur for several reasons. As a result in several instances it is notpossible to

get Nevirapine to the babies born to HIV positive mothers.

9. Though the skills of counseling remain the same the content of counseling a

pregnant mother for HIV testing would differ from general VCT. So, having

counselors trained in PMTCT/VCT and housing them in MCH service delivery area

will have better impact on the uptake of services.

10. Under the international approach PMTCT-plus is to provide ART to positive

mothers and their family members requiring ART and that is one reason that

integration may serve better.

11. Also the issue of confidentiality will be addressed better if PMTCT is

within the MCH services.

Let me attach a model (Sorry, the attached file did not come through. Moderator)

for PMTCT service delivery with this email and you will see that integrating

PMTCT in MCH service will work much better than otherwise.

Currently I am not working in India so do not have information on latest

position of GOI. Experts at NACO, I am sure are in a better position to answer

the second question.

Best

Dr. Chandrakant Ruparelia, MBBS, MPH

E-mail: <rupa_rupa_99@...>