Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies

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dc.contributor.advisorMyer, Benjamin
dc.contributor.authorNelson, Aurelie
dc.date.accessioned2024-05-30T09:46:03Z
dc.date.available2024-05-30T09:46:03Z
dc.date.issued2023
dc.date.updated2024-05-28T08:53:51Z
dc.description.abstractBackground Despite the reduction in the HIV mother-to-child transmission (MTCT) rate in South Africa, there are ongoing concerns in the breastfeeding period, linked to poor retention in care. To improve this retention, Post Natal Clubs (PNC) were created as an integrated, differentiated model of care providing psychosocial support and comprehensive care for the mother-infant pairs (MIP). We describe the implementation of PNC and examine its health outcomes in a peri-urban primary health care setting in Cape Town, South Africa. Methods In this cohort study, conducted between June 2016 and December 2019, MIPs were recruited into PNC between 6 weeks and 6 months of age and followed-up until 18 months of age. PNC MIPs were compared to a historical control group from the same setting. Outcomes included maternal Viral Load (VL), HIV testing at 9 and 18 months of age, and other maternal and child health outcomes. Results During the implementation of PNC study period, n=484 MIP were recruited with 84% overall attendance, 95% overall viral load suppression, and 98% overall uptake of HIV infant testing. Compared to historical controls, the PNC infant rapid test completion was 1.6 times higher (95% CI: 1.4-1.9) at 9 months and 2.0 times higher at 18 months (95% CI: 1.6-2.6). Through 12 months and between 12-18 months, maternal VL completion was higher in the PNC group compared to the historical control by 1.5 times (95% CI: 1.3-1.6) and 2.6 times (95% CI: 2.1- 3.2), respectively, with similar maternal VL suppression. Of 105 infants attending the 12 months visit, 99% were fully vaccinated by one year. Conclusion MIP in the PNC showed better PMTCT outcomes than historical controls with high levels of retention in care. Other outcomes such as immunisation results suggest that integration of services, such as in the PNC, is feasible and beneficial for MIPs.
dc.identifier.apacitationNelson, A. (2023). <i>Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies</i>. (). ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/39771en_ZA
dc.identifier.chicagocitationNelson, Aurelie. <i>"Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies."</i> ., ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2023. http://hdl.handle.net/11427/39771en_ZA
dc.identifier.citationNelson, A. 2023. Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies. . ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/39771en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Nelson, Aurelie AB - Background Despite the reduction in the HIV mother-to-child transmission (MTCT) rate in South Africa, there are ongoing concerns in the breastfeeding period, linked to poor retention in care. To improve this retention, Post Natal Clubs (PNC) were created as an integrated, differentiated model of care providing psychosocial support and comprehensive care for the mother-infant pairs (MIP). We describe the implementation of PNC and examine its health outcomes in a peri-urban primary health care setting in Cape Town, South Africa. Methods In this cohort study, conducted between June 2016 and December 2019, MIPs were recruited into PNC between 6 weeks and 6 months of age and followed-up until 18 months of age. PNC MIPs were compared to a historical control group from the same setting. Outcomes included maternal Viral Load (VL), HIV testing at 9 and 18 months of age, and other maternal and child health outcomes. Results During the implementation of PNC study period, n=484 MIP were recruited with 84% overall attendance, 95% overall viral load suppression, and 98% overall uptake of HIV infant testing. Compared to historical controls, the PNC infant rapid test completion was 1.6 times higher (95% CI: 1.4-1.9) at 9 months and 2.0 times higher at 18 months (95% CI: 1.6-2.6). Through 12 months and between 12-18 months, maternal VL completion was higher in the PNC group compared to the historical control by 1.5 times (95% CI: 1.3-1.6) and 2.6 times (95% CI: 2.1- 3.2), respectively, with similar maternal VL suppression. Of 105 infants attending the 12 months visit, 99% were fully vaccinated by one year. Conclusion MIP in the PNC showed better PMTCT outcomes than historical controls with high levels of retention in care. Other outcomes such as immunisation results suggest that integration of services, such as in the PNC, is feasible and beneficial for MIPs. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - Public Health and Family Medicine LK - https://open.uct.ac.za PY - 2023 T1 - Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies TI - Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies UR - http://hdl.handle.net/11427/39771 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/39771
dc.identifier.vancouvercitationNelson A. Postnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies. []. ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/39771en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectPublic Health and Family Medicine
dc.titlePostnatal Clubs: Implementation Of A Differentiated And Integrated Model Of Care For Mothers Living With Hiv And Their HIV-Exposed Uninfected Babies
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPH
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