Overview of Safer Conception Services at Wits RHI

Transcription

1 SA AIDS Satellite Session 13 June 2017 Presented by Diantha Pillay on behalf of Dr. Natasha Davies, Sheree Swartz, Nicolette Naidoo & Saiqa Mullick Overview of Safer Conception Services at Wits RHI

2 Safer Conception Study Overview Background to safer conception services Overview of Safer Conception Demonstration Project Outcomes of Safer Conception Demonstration Project Key lessons learnt and considerations for wider implementation

3 Background

4 PLHIV take risks to have children Partner to partner HIV transmission Mother to baby HIV transmission Safer Conception Services can help Nurse-led services Risk Desire Help individuals to manage HIV risks whilst fulfilling their desire to build a healthy family

5 Low cost, low tech safer conception options ART with viral suppression STI Screening and Treatment Timed Condomless Sex PrEP (but not in pregnancy) Safer Conception Toolbox Selfinsemination with syringe MMC Encourage disclosure and partner testing / treatment

6 South African Policy Context 1. Contraception and Fertility Planning Policy (2012) Shift to include support for planned pregnancy Seeking to reduce new HIV infections in AGYW and achieve EMTCT 2. USAID 90/90/90 targets 90% of PLHIV aware of status, 90% on ART, 90% virally suppressed 3. EMTCT and the Last Mile Plan SA seeking EMTCT validation from WHO but significant gaps still remain Last Mile Plan prioritizes preconception and postnatal care to close gaps Focus on strengthening PMTCT prongs 1 and 2 (prevention of HIV and unplanned pregnancies) Safer Conception Services can support progress in all three policy areas yet only 2 delivery sites exist in Hillbrow and Witkoppen

7 Phase 1 Demonstration Project Update

8 Client Uptake (June 2015 April 2017) Access to Services by Gender 449 females, median age = 33yr (IQR 29-36) 676 individuals, representing 461 partnerships (both accompanied & unaccompanied), have accessed the service Couple vs Individual Enrolment 227 males, median age = 37yr (IQR 32-41) Couples Enrolled = 430 Unaccompanied Females = 235 Unaccompanied Males = 11 HIV Dynamics of Enrolled Partnerships Sero- Concordant = 45% (n = 209) Sero- Discordant = 30% (n = 138) Sero- Unknown = 25% (n = 114)

9 Pregnancy Outcomes Median Age = 33 (range 21-41) Median of 4 SCS visits per couple 42 couples All HIV negative women retested negative at pregnancy confirmation 44 unaccompanied females (7 undisclosed) All engaged in early antenatal care (less than 15 weeks) 86 confirmed pregnancies 55 % Sero-concordant couples 40 % Sero-discordant couples 5% Unknown Partner Status 31 live births 25 HIV exposed babies Birth PCR Negative Male Partner All HIV negative male partners retested negative

10 HIV transmission outcomes Horizontal Transmission Vertical Transmission No partner to partner HIV transmissions No mother to baby HIV transmissions

11 Pregnancies -Challenges Conception Before Clinically Ready 30% (26/86) conceived before given the green light Reasons not considered ready included: only having attended baseline visit, male partner not yet engaged, viral suppression not yet confirmed, not yet on ART for 3 months, or peak fertility timing had not been established Miscarriages 16 miscarriages reported so far, all first trimester This is within expected rates for the general population (19%) 1 was an ectopic, 9 women re-instated after miscarriage to try again, 2 have conceived Advanced Maternal Age Advanced maternal age is a risk (35/86,41%, 35yrs) One child has been born with Down Syndrome (Trisomy 21)

12 Implications for 90/90/90 15 clients were diagnosed at SCS through HCT 38 females, 31 males received ART optimisation 52 clients were not yet on ART and have been initiated 17 clients switched 89/587 (15%) HIV positive clients enrolled had detectable viral load (>200 copies) at first visit Viral suppression rates 3 months after treatment initiation have been excellent. Just 3 clients were not suppressed by 3 months

13 Supports prevention: disclosure, VL suppression, PrEP, CaCx screening Supports EMTCT: healthy women, early booking, male involvement, improved knowledge Supports 90/90/90: testing, ART initiation, viral suppression High client demand and satisfaction Lessons Learnt Positive provider feedback: healthy pregnancies, male engagement Integrated PHC service (ART, PrEP, STI, CaCxscreening) feasibleand acceptable Benefits partnerships of all HIV dynamics

14 Challenges for Consideration

15 Time consultations, particularly with couples, take time Non-disclosure or partial disclosure places healthcare provider in a difficult position Complex relationship dynamics staff need to be sensitised to many issues within partnerships Pregnancies before green light couples not clinically optimised for safe conception Infertility high rates suspected but no services

16 Next Step Expansion Project

17 Thank you for your attention Questions or Comments?

18 For further questions, please contact: Lead Clinician Natasha Davies