Implementing family‐focused HIV care and treatment: the first 2 years’ experience of the mother‐to‐child transmission ‐plus program in Abidjan, Côte d’Ivoire

Abstract

Summaryobjectives To describe a family-focused approach to HIV care and treatment and report on the first 2 years experience of implementing the mother-to-child transmission (MTCT)-plus program in Abidjan, Cô te d'Ivoire.program The MTCT-plus initiative aims to enrol HIV-infected pregnant and postpartum women in comprehensive HIV care and treatment for themselves and their families. Of their 568 male partners reported alive, 52% were aware of their wife's HIV status and 30% were tested for HIV; 53% of these tested partners were found to be HIV-infected and 78% enrolled into the program. Overall only 10% of the women enrolled together with their infected partner. On the other hand, the program involved half of the seronegative men who came for voluntary counselling and testing (VCT) in the care of their families. Of 1624 children <15 years reported alive by their mothers (excluding the last newborn infants of the most recent pregnancy systematically screened for HIV), only 10.8% were brought in for HIV testing, of whom 12.3% were found to be HIV-infected.lessons learned and challenges The family-focused model of HIV care pays attention to the needs of families and household members. The program was successful in enrolling HIV women, their partners and infants in continuous follow-up. However engaging partners and family members of newly enrolled women into care involves numerous challenges such as disclosure of HIV status by women to their partners and family members. Further efforts are required to understand barriers for families accessing HIV services as strategies to improve partner involvement and provide access to care for other children in the households are needed in this West African urban setting.

Scaling up antiretroviral therapy for HIV-infected children in Côte d’Ivoire: determinants of survival and loss to programme

“…The barriers to scaling-up treatment include the failure to identify maternal HIV infection, weak links between PMTCT and child care programmes, and limited access to HIV-RNA testing for early diagnosis. 5,7,44 Education about ART should start antenatally and should be monitored to increase postnatal infant HIV screening from the age of 6 weeks. Political commitment is needed to mobilize health-care and community leaders.…”

“…Third, providing a continuum of care covering postnatal diagnosis in infants and HIV treatment after a PMTCT intervention in mothers still remains a challenge in 2009. 1,5 Fourth, chronic diseases requiring lifelong daily treatment are more difficult to manage in children, especially when paediatric formulations and dosages are not available. 6,7 As a result of these difficulties, in 2008 only an estimated 38% of all children aged < 15 years worldwide thought to need ART actually received it.…”

Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother‐to‐child transmission of HIV in the Dominican Republic

“…The formidable barriers encountered in enrolling pregnant, HIV-infected women, their partners, and older children in comprehensive HIV care programs in the DR could potentially be overcome by closer collaboration between PMTCT and comprehensive HIV care programs [19,20]. Such relationships might be promoted if HAART were included in the PMTCT armamentarium for pregnant women diagnosed with HIV infection before the onset of labor [15].…”

Effectiveness of the Regular Implementation of the Mother to Child Transmission Plus (MTCT-Plus) Program in Burkina Faso, West Africa

“…The effectiveness of MTCT-plus program depends, first of all, on the VCT acceptance rate, the real entry point into the program. Actually, wide variations in the VCT acceptance rate were recorded in different geographic environment especially because of different cultural and organizational factors (Perez et al, 2004;Pignatelli et al, 2006;Tonwe-Gold et al, 2009). The high number of pregnancies (more than 3,000/year) and of the ante-natal visits did not allowed our staff to provide an individual counselling and obliged us to adopt the opt-in strategy.…”