Working alongside Matinise at Khayelitsha’s Site B is international humanitarian organisation Medicines Sans Frontières (MSF), where MSF Clinical Mentor Manager Dr Mary Ibeto says Option B+ made follow-up, post-ARV initiation counselling more important.
“It’s quite a shock, you’re pregnant, you find out you’re HIV positive and that you have to take treatment for life,” says Ibeto, describing the first antenatal care visit at which a woman is diagnosed and must also be started on ARVs. “She needs a lot of support after starting treatment (before) bringing in all the other messages you might need to bring in.”
To avoid overwhelming women, MSF starts mums off slowly in counselling, saving more complicated messages about PMTCT for follow up sessions after mums start ARVs.
“In the first session of counselling, counsellors don’t go into all that is traditionally done in pre-ARV sessions (but) they focus on supporting women to accept their HIV diagnosis,” Ibeto says. “Second to that is creating a written adherence plan on how she is going to take the treatment.”
“It’s very practical and leaves her walking away with a tool, something that she has written herself,” says Ibeto, who adds that the plan outlines what to do if a woman cannot get to a clinic to collect treatment and who will support her in making sure that she takes treatment daily.
To make it work, clinic staff must ensure women get follow-up counselling sessions before leaving the clinic on subsequent visits – and more nurses and midwifes have to be trained to initiate and manage pregnant women on ARVs, Ibeto tells Health-e News.
Lessons from the Western Cape
AIDS lobby group the Treatment Action Campaign (TAC) has welcomed the move to Option B+ but is concerned that weak provincial health systems may not be able to cope with an increased demand on ARV services and drugs, according to Portia Serote, the TAC’s Women’s Sector representative.
Western Cape Department of Health manager for HIV prevention Manjekana Dyeshana, says the province analysed the health system before moving to Option B+ and decided to expand sites that offered ARVs. The province also has a dedicated ARV medicines depot. In countries like Zambia, having a dedicated ARV supply chain has helped to cut down stock-outs.
Both MSF and the Western Cape have also stressed the need for regular viral load testing for pregnant women. Viral load testing measures the amount of HIV in a person’s blood and can help detect when mothers are struggling to adhere to treatment, making them more likely to pass the virus onto their babies.
Dyeshana adds that funding, as well as properly trained professional nurses, pharmacists and admin clerks were all key to the roll-out, which has not suffered high drop-out rates of mums on Option B+ as in Malawi. MSF is currently analysing its data to see if the same holds true in the clinics it supports.
Both Ibeto and Dyeshana say one of the biggest lessons learned in the roll out was the need to adapt ARV patient databases to track mums and babies together.
“The lesson learned was that before you start something big and important like this you have to have structures in place,” Dyeshana says. “Your monitoring and evaluation tools have to be in order.”– Health-e News.