Coordinating in the clinic
Q.48 Where should ARVS for prophylaxis be dispensed from? Who should dispense them?
The underlying principle should be to organize services, including where and who should dispense ARVs, in order to remove barriers to mothers receiving effective ARVs and to support optimal infant feeding. This organization will vary according to the local epidemiology of HIV (high and low HIV prevalence), prevalence of breastfeeding, local dispensing regulations and use of existing routine health opportunities, such as immunization attendance. Several different models can be considered:
- nurses in routine MCH services, e.g. immunization clinics providing both ARVs and infant feeding support;
- integrated family treatment sites;
- specific PMTCT nurses at antenatal clinics continuing to provide ARVs and infant feeding support during the first year of the infant’s life with or without additional specialized support for infant feeding.
In most high HIV prevalence settings, the provision of ARVs and support for infant feeding should be 'normalized' and regarded as general services that all health workers should be able to provide, rather than being the responsibility of one or two specific nurses or other health care providers.
- For mothers on lifelong antiretroviral therapy (ART), how would dispensing of maternal ARVs link with counselling and support for infant feeding? (Q.46)
- What is the recommended timing of visits for dispensing of nevirapine and infant feeding counselling and support? How often should ARVs for prophylaxis be given to mothers? (Q.47)