Integrating Comprehensive HIV Care into Routine Maternal Health Services Improves Access and Quality

Background Vertical implementation of prevention of mother-to-child-transmission (pMTCT) services has resulted in low utilization in many areas. Since 2006, the Mozambican public-sector progressively integrated pMTCT and HIV diagnostic and treatment services into antenatal care (ANC) care. Innovative interventions include opt-out testing by antenatal nurses, on-site CD4 testing and ARV treatment, and ANC nurses prescribing advanced preventative regimens including AZT and intermittent preventative treatment for malaria.

Methods: Analysis of 5 years (2004-2009) of routine data collected from ANC and pMTCT programs from 30 key sites in central Mozambique where integration interventions were implemented at different times.

Results and Lessons Learned: Integrating HIV care and pMTCT into routine antenatal care reduces the human resource burden by streamlining the patient visit, expands access to HIV testing and treatment, and is associated with improvements in other maternal-child care indicators like early prenatal visits and institutional delivery. Opt-out testing was associated with a rise in HIV testing acceptance from 60% of women to 90%. When on-site HIV care was offered, the proportion of women who enrolled and received ARV treatment more than doubled. Allowing ANC nurses to distribute AZT-containing prevention regimens increased utilization from 12% to almost 40%. Over the 5 year period, rates of institutional delivery for HIV positive women rose from 40% to over 70%.

Key Recommendations: Comprehensive systems of HIV care should be fully integrated into routine ANC to improve not only access to HIV prevention and treatment services but also the quality and utilization of maternal-child health services.