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Maximising reproductive possibilities and choices for women living with HIV – pre-conception care and the prevention

Maximising reproductive possibilities and choices for women living with HIV – pre-conception care and the prevention of unintended pregnancies . John Odero Ong’ech MBChB,MMed(Ob/Gyn),MPH Kenyatta National Hospital-University of Nairobi, Kenya

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Maximising reproductive possibilities and choices for women living with HIV – pre-conception care and the prevention

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  1. Maximising reproductive possibilities and choices for women living with HIV – pre-conception care and the prevention of unintended pregnancies John Odero Ong’ech MBChB,MMed(Ob/Gyn),MPH Kenyatta National Hospital-University of Nairobi, Kenya Presentation at XIX International AIDS Conference in Washington, D.C., USA 25th July 2012

  2. Country Profile • Country Population-40,512,682 • Number living with HIV/AIDS-1.6million • Number of pregnant women living with HIV-87,000 • HIV prevalence(15-49)-6.2% • HIV prevalence, pregnant women-9% • Number of Adults on ART-432,000/590,000-73% • Number of children on ART-36,096/158,000-23% • Annual new HIV infections-Adult-91,000, Children-13,000 • Annual deaths attributable to HIV/AIDS-80,000

  3. Fertility desires and Contraceptive Use among HIV positive Women in Kenya • Desire for a child in the future among married or cohabitating HIV positive women aged 15-49 years by self reported HIV status-24% (KAIS 2007) • HIV infected women in married or cohabitating relationships who have a need for contraception and not using any contraception-57.9%(KAIS 2007) • The above gaps was a Justification for prioritizing pre-conception care and prevention of untended pregnancies among HIV positive women in Kenya

  4. HIV Prevalence &Program sites • Hhh Kenyatta N. Hospital(Nairobi) X10 sites in Eastern province

  5. Program description/Activities • Baseline assessment • Pregnancy intension screening tool in the specialized HIV comprehensive care clinic(CCC); i) Family planning option- Provided within the CCC-integration where feasible ii) Desired pregnancy intention option • Male involvement to discuss options and male status

  6. Program description/activities Desired pregnancy scenarios i) Concordant couple-ART, Ovulation induction, time conception, linkage to Prevention of vertical transmission program ii) Discordant couple-Two scenarios A-Male Positive, Female negative- ART in Male, Ovulation induction with clomiphene, time intercourse with option of PEP in female . Sperm wash in KNH and insemination(sperm wash cost USD 200)

  7. Program description/activities B-Male Negative, Female Positive- ART in Female, achieve viral suppression (Viral load or CD4 used ), ovulation induction, timed intercourse or insemination

  8. Team –Multi desciplinary • Doctors • Clinical officers • Nurses • Counselors • Lab Technologies • Community Workers, social workers and Peer support groups

  9. Outcomes • 20% of the HIV positive women screened would want to get pregnant • Most of those offered the services had successful term pregnancies where there was no other underlying pathology like tubal blockage, Fibroids, Sperm abnormalities etc • Afew women (2%) had preterm deliveries, Miscarriages • No Fetal abnormalities were observed

  10. Lesions Learnt • Pregnancy screening tool is effective in identifying HIV positive women reproductive Health needs • Lack of knowledge from clients on existence of options • Skills lacking in health care workers to provide services for pregnancy intention • Multi disciplinary team is essential • Integration is feasible • Provision of safe pregnancy option for HIV positive women is feasible in resource poor settings

  11. Recommendations • People living with HIV/AIDS sensitization on safe pregnancy options-peer support groups and community Health workers • Provision of comprehensive integrated Reproductive Health services( Family planning in the HIV clinics, cervical cancer screening, pregnancy intention screening etc) • Health System Strengthening in both Facility and community is essential for provision safe pregnancy options for HIV positive women

  12. Challenges • Low Male involvement • Lack of Human resource to provide services • Poor infrastructure-lack of space to provide integrated services, poor lab services • Poor supply of commodities ie Family planning

  13. Acknowledgement • PACT-COE project-KNH Support • ICAP-UoN project- Eastern province • CDC/PEPFAR • MoH, GoK • KNH • UoN

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