Horizons Projects | From PPTCT to PPTCT Plus: Improving Access to Treatment, Care, and Support for HIV-positive Women and Their Families

HORIZONS PROJECT
From PPTCT to PPTCT Plus: Improving Access to Treatment, Care, and Support for HIV-positive Women and Their Families

In India, the national prevention of parent-to-child transmission of HIV (PPTCT) program has demonstrated that antenatal care is an effective entry point to preventing HIV transmission from mother to child. But does the program also serve as an entry point to other HIV and sexual and reproductive health (SRH) services for HIV-infected mothers? Horizons and several Indian NGOs undertook an operations research study (formally titled "From PPTCT to PPTCT Plus—A Diagnostic Operations Research to Inform the National Initiative on Improving Access to Treatment, Care, and Support for HIV-positive Women and Their Families") to better understand the extent to which these services are linked and how they are linked.

A total of 40 in-depth interviews and 268 structured interviews were conducted with HIV-positive pregnant and postpartum women (0–24 months post-delivery) who had received PPTCT services through the public or private sector in three cities in high-prevalence states (Bangalore, Hyderabad, and Imphal—located in Andhra Pradesh, Karnataka, and Manipur, respectively). In addition, 30 service providers and program managers of public sector and NGO-run PPTCT programs were interviewed.

Key findings:

In Bangalore and Hyderabad, the vast majority of women were first tested for HIV as part of antenatal care, whereas in Imphal, most women were first tested in a voluntary counseling and testing center.
Obtaining informed consent prior to testing was not uniform across the cities.
A very high proportion of husbands had undergone HIV testing.
PPTCT service providers rarely provide HIV treatment information and referrals.
HIV testing for children is high, but follow-up for treatment is poor.
NGOs and families play an important role in providing support to HIV-positive women.
A significant proportion of pregnancies among HIV-positive respondents were unplanned.
Safe sex during pregnancy is promoted by service providers.

The study indicates that linkages between PPTCT and HIV care services, as well as PPTCT and reproductive health services, are limited. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, better equip PPTCT providers to inform and counsel women about these topics, and engage NGOs in the community who have outreach services to maintain contact with women over time and link them and their families to a continuum of care. Study results will be used to strengthen links between PPTCT and other services vital to HIV-positive women and their families.

Location

Andhra Pradesh, Karnataka and Manipur, India

Duration

July 2005–February 2007

Horizons and Population Council researchers

Vaishali Sharma Mahendra, Avina Sarna, Naomi Rutenberg

Non-Council collaborators

Ashok Rau, Christopher Skill (Freedom Foundation)

L. Birendrajit Singh (Social Awareness Service Organization)

Donors

US Agency for International Development

United Nations Children's Fund (UNICEF)

United Nations Development Fund for Women (UNIFEM)

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2007
Khan, Hena. "India: Are PPTCT programs an entry point to other HIV and reproductive health services?" Horizons Report, June. Washington, DC: Population Council. (full text)

Mahendra, Vaishali S., Rupa Mudoi, Archana Oinam, Venkat Pakkela, Avina Sarna, Sucheta Panda, Ashok Rau, L. Birendrajit Singh, and Naomi Rutenberg. “Continuum of care for HIV-positive women accessing programs to prevent parent-to-child transmission: Findings from India,” Horizons Final Report. Washington, DC: Population Council. (PDF)