Integration of maternal, HIV services shows results
IRIN PlusNews | February 24, 2011
IRIN PlusNews reports on the Foundation’s role in integrating maternal and child health services with HIV care and treatment in western Kenya to diminish the stigma related to HIV.
The bold branding of HIV care centers in Kenyan hospitals stops many HIV-positive pregnant women from accessing vital HIV treatment that could protect their children from infection for fear of stigma.
"Many mothers were coming to the hospital and once referred to the comprehensive care centre [CCC] because they had tested HIV-positive, they just disappear - many of them ended up delivering HIV-infected babies," said Zaituni Ombuku, a prevention of mother-to-child HIV transmission (PMTCT) nurse at the Western Provincial General Hospital in Kakamega, in Kenya's Western Province.
Mary Nabwire is one such mother; she told IRIN/PlusNews she was too afraid of being spotted by neighbors to go to the CCC when directed by the antenatal care nurse. "When people see you go there, they just know you are sick with HIV," she said. "I just disappeared and when it was time to give birth, I went to a [a traditional birth attendant]."
Nabwire's child is HIV-positive; since his birth, however, her maternal and child health clinic has started providing HIV services and maternal health services under the same roof, making it more comfortable for her to get treatment for herself and her child. The clinic is part of a programme in western Kenya that aims to keep more mothers in care by integrating maternal and child health services with HIV services.
"It is better because they just give me everything at this clinic and nobody knows my status except them and my husband," she said.
According to Hadija Naliya, nursing officer in charge of the maternal and child health clinic at Western Provincial General Hospital, the integration has greatly increased the level of retention of both mothers and their children in Kakamega.
"The idea is to make the maternal and child health clinics a one-stop shop for the family - even fathers are provided these services should they need it," she said.
The clinics provide counseling, testing, reproductive health services, nutritional support and initiation on treatment and care to parents and children.
Fourteen health facilities in Western Province have so far been integrated through an initiative by the government, Elizabeth Glaser Pediatric AIDS Foundation and the US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II).
According to Beatrice Misoga, PMTCT officer at the APHIA II Western, weaknesses within the referral system in government health facilities often make PMTCT services ineffective. "When you integrate services it makes it easy to make follow-ups, keep client records and most importantly, it becomes the best way to deal with stigma, which stops mothers from seeking PMTCT services," she said.
In 2010, following the introduction of integrated services, only seven out of 197 HIV-positive mothers enrolled at the maternal and child health clinic in Western Provincial General Hospital delivered babies infected with HIV.
"When you look at that compared to the high dropout rates that we experienced in earlier years, you realize integration works," said the hospital's Ombuku.
The capacity of health personnel at the maternal and child health clinic has also been strengthened through HIV and reproductive health training.
"It would be pointless to integrate services and leave the health workers as they were. We initiated training for them on counseling, testing, nutritional issues and treatment to make them more effective and as a way of boosting their morale," said APHIA II's Misoga.
An added benefit of service integration is a reduced workload for over-burdened staff at the CCCs, say the medical workers.
The Kenyan government estimates about 32,000 babies are infected with HIV at birth every year. Integration of maternal and child health is a major part of the country's plan to reduce mother-to-child transmission to below 5 percent of the 100,000 mothers who test positive annually.