Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"How are HIV services integrated into postnatal care in Kenya?"
Charlotte Warren, Charity Ndwiga, and Eric Oweya

Background
In Kenya, although many women test for HIV during pregnancy, more than half deliver at home, and few receive postnatal care. Therefore providing continuity of care to new mothers and infants, especially those living with HIV, is problematic. An assessment of the use and existing quality of postnatal services was conducted to inform the design of an integrated package of postnatal and HIV care.

Methods
An assessment was conducted in twelve MCH clinics in Eastern Province, Kenya. Midwifery researchers observed 223 client–provider interactions at the routine six-week postnatal visit to assess providers' compliance with 46 indicators of quality of postnatal care, including HIV services. Observers did not participate in the interaction but noted all actions on a checklist. Data were analyzed using STATA. Summary scores were calculated by aggregating groups of indicators representing eight elements of PNC services: rapport, history taking, infant care, postpartum family planning, HIV/STI risk assessment, HIV counseling and testing, information on condoms, and referral to other services.

Results
Less than half of the providers built rapport with the client (greets client; uses client's name; ensures privacy and confidentiality). Although 48 percent of providers initiated discussion on infant feeding, less than half emphasized exclusive breastfeeding. Fewer than 25 percent of postpartum women received counseling on return to fertility, and 60 percent were not counseled on family planning at all. Although 33 percent of women were asked about their HIV status, those who knew their status were more likely to be re-tested. Few providers gave information on condoms or referred clients for additional services. The mean indicator score measuring the extent of the provision of integrated PNC/HIV before introducing a strengthened package was 12/46.

Conclusions
The existing quality of comprehensive postnatal care is weak. Nevertheless there are opportunities for further integration of HIV services into postnatal care.

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