Model mechanics

ART refills

Clinical consultations

Individual/group approach

Group

Individual, all on the same day

Who attends?

Mother infant pair (MIP)

MIP

Client recruitment

Where

At facility

By whom

Lay provider during ANC care and at 6 week infant PCR visit

Eligibility assessment

No eligibility assessment only classification as HRMIP or LRMIP by MNCH nurse
Exclusion: mother with active TB, HIV positive mother refusing integration of care

Group formation

By lay provider at the facility

HIV disclosure

Does it happen?

Yes

If yes, where?

Within the group

Health care visit schedule for client

10 weeks – 18 months post-partum
  1. 10 wks: Clinical review MIP (Infant: IMCI+ immunization+ growth check+ HIV PCR; Mother: VL + FP+ mental health screening) + script + maternal ART and infant cotrimoxazole refills + group adherence/baby care session
     
  2. 14wks: Clinical review MIP (Infant: IMCI+ immunization + growth check + neuro dev check; Mother: FP) + maternal ART and infant cotrimoxazole refills + group adherence/baby care session
     
  3. 18 wks: Clinical review MIP (Infant: IMCI+growth check; Mother: FP) + maternal ART and infant cotrimoxazole refills + group adherence/baby care session
     
  4. 22 wks: Clinical review MIP (Infant: IMCI+growth check; Mother: FP) + maternal ART and infant cotrimoxazole refills + group adherence/baby care session
     
  5. 6m: Clinical review MIP (Infant: IMCI+immunization + growth check + neuro dev check + Vit A; Mother: FP + VL+mental health) + rescript + maternal ART refill + group adherence/baby care session
     
  6. 9m: Clinical review MIP (Infant: IMCI+immunization + growth check + neuro dev check + HIV rapid; Mother:  ART clinical review + FP) + maternal ART refill + group adherence/baby care session
     
  7. 12m:  Clinical review MIP (Infant: IMCI+growth check + Vit A + deworm; Mother: VL + FP+ mental health screening) + rescript + maternal ART refill + group adherence/baby care session
     
  8. 15m: Clinical review MIP (Infant: IMCI+growth check ; Mother: Clinical ART review + FP) + maternal ART refill + group adherence/baby care session
     
  9. 18m: Clinical review MIP (Infant: immunization + growth check + neuro dev check+vit A+ deworm + HIV rapid; Mother: FP+mental health+VL) + rescript + maternal ART refill + group adherence/baby care session

Alignment of ART refill and clinic visits

Does it happen?

Yes, ART refill and clinical review all on same day

Strategy and timing for actioning high VL/other red flag results

Strategy

Immediate recall of client by club lay provider and/or red flagged for next visit

Minimum period for action/action failure risk

Immediately after result received by facility/medium risk

Maximum period for action/action failure risk

3 months/low risk

Clinical outreach from facility potential

Does it happen?

No, model is only feasibly provided at a facility due integrated MNCH and ART clinical care

ART refill preparation

Is ART pre-packed?

Yes

If yes, by whom?

Central Dispensing Unit

ART refill collection date

Scheduled appointment return date at facility

Clinical referral mechanism

Criteria

Mother or infant acutely unwell or adverse event.
Mother needs other prescription for other comorbidities (eg HTN), if mother scores high on mental health screening, if mother has consecutive high VL (400cp/ml) requiring switch to 2nd line ART

By

MNCH nurse

To

Facility doctor

When

Immediately after group

Up referral (return to standard of care)

Criteria

Infant diagnosed with HIV
Mother diagnosed with active TB
MIP missed two consecutive visits

Communicated by

MNCH nurse

Client records

Facility clinical folder

MIP folders filed together and pulled at each visit for completion at clinical review

Client ART card

Presented at each group meeting for return date completion

Monitoring system

At group meeting venue

Adult ART club paper register completed for mothers visits, managed by lay provider

At health care facility

Mothers HIV visits captured from club paper register into facility electronic monitoring system

Resources

Published evidence

Tools for Implementation