Postnatal clubs, South Africa

In Cape Town, South Africa, postnatal clubs were developed to improve rates of post-delivery retention of women initiated on ART in pregnancy, strengthen early infant diagnosis of HIV and align postpartum care for women and their infants. All women living with HIV on ART who give birth at the facility are able to join a postnatal club. Women do not need be established on ART, but are assessed to be part of a low-risk mother-infant pair (LRMIP) or a high-risk mother- infant pair (HRMIP), with differences in visit frequency and package of care. Each club includes 6-12 mother-infant pairs (MIPs) grouped by month of delivery. Clubs are facilitated by a lay provider within the maternal, newborn and child health (MNCH) service at a local primary health clinic.

Club meetings occur within the clinic setting and the support provided focuses on infant care and maintenance of maternal adherence to ART. At each session, the lay provider dispenses maternal ART and infant cotrimoxazole refills in the group for the period until the next club visit (monthly from when the infants are 10 weeks old until they are 6 months old, due to provincial guidelines mandating monthly baby check-ups, and 3 monthly thereafter until the infant is 18 months old). Each MIP receives a single integrated clinical consultation.

The clinical package of care provided changes at each visit. In general, the package follows the immunization and infant follow-up schedule with HIV testing of the HIV-exposed infant at 9 and 18 months and additional HIV care for mothers who receive 6-monthly viral loads and clinical consultations for HIV. HRMIP receive additional support with a weekly home visit by a lay provider and monthly clinical consultations until reassessed as LRMIP. Any infant newly diagnosed with HIV is referred, with their mother, from the postnatal club to the HIV clinic. When the child reaches 18 months and is HIV negative, the club transitions to a community adult adherence club for the mothers.

Data presented in 2020 showed that 18-month retention in the programme was 79.2%. Viral loads were taken from 76% of mothers between 12-18 months, and suppression was 94%. HIV testing at 9-months was completed by 81% of infants in the Clubs and 64% had 18-month HIV testing, compared to 51% and 32% of historical controls, respectively.

Postnatal clubs are an example of a health care worker-managed group model. They are also an HIV treatment model for adults who are established on ART, that was already part of South African national guidelines and widely implemented before being adapted for postnatal women.

Eligibility

All women living with HIV who are post-partum.

Building Blocks

ART Refills

Clinical consultation

Psychosocial support

*Only describes maternal HIV clinical building blocks. Infants receive immunizations, infant follow-up and repeat HIV testing as per guidelines at their clinical consultations which take place after each group ART refill.