HIV and other infant feeding policies, programmes and practices
Q.25 How should these new approaches be integrated to deliver comprehensive and better care within routine maternal and child health (MCH) services?
Infant feeding counselling and support is important for all mothers and infants, and should be implemented in an integrated way at the primary health care level. HIV-infected mothers should be able to find support for both infant feeding and provision of ARVs at this level.
Integration may not mean the same thing in every setting, and authorities will have to consider the other services that should be integrated according to the type of health facilities and services available. To the extent possible, pregnant women and mothers of infants should always be able to access HIV testing, care and treatment interventions within maternal and child health services. Such interventions should include access to CD4 count testing and appropriate ARV interventions for the woman’s health and to prevent mother-to-child transmission of HIV, including family planning.
Integration is facilitated by having personnel adequately trained; having a shared aim (e.g. mothers alive and without symptoms of AIDS, infants alive and HIV uninfected); knowing exactly what is expected of them and what package of interventions should be received by every pregnant woman; being motivated to provide the range of services; and also by having facilities make supplies and equipment available where and when needed. Integration is helped by good record-keeping, so that health workers can easily see what services an individual woman and/or infant actually receive on a particular visit, and so they can follow-up those women who miss key appointments.
Health authorities may wish to carry out an assessment of the status of integration of services in different settings and develop a workplan/strategy for improving the situation. Specific key actions have been recommended to ensure integration of services related toPMTCT, including building capacity within antenatal and postnatal care settings to support breastfeeding and complementary feeding and identifying opportunities to integrate infant and young child feeding interventions. (See Guidance on global scale up of the prevention of mother-to-child transmission of HIV).