PEE1635
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Title
Integrated postnatal clubs show improved maternal viral load completion and infant testing uptake compared to historical controls in Khayelitsha, South Africa
Presenter
Keitumetse Lebelo
Authors
K. Lebelo * (1), T. Cassidy (1,2), L.T. Duran (3), V. Bhardwaj (1), N. Mantangana (1), L. Mdani (1), N. Malabi (1), K. Buchanan (1), L. Snyman (1), D. Hacking (1), V. de Azevedo (4), S. Patel-Abrahams (4), C. Hofmeyr (5), J. Igumbor (5), A. Nelson (1)
Institutions
(1) Medecins Sans Frontieres, Khayelitsha, Cape Town, South Africa, (2) University of Cape Town, Division of Public Health Medicine, Cape Town, South Africa, (3) Medecins Sans Frontieres, Cape Town, Cape Town, South Africa, (4) City of Cape Town Health, Cape Town, South Africa, (5) Mothers2mothers, Cape Town, South Africa

BACKGROUND: Despite declining HIV mother-to-child transmission in South Africa, challenges still persist, including 4.3% transmission at 18 months, poor maternal retention and low infant testing uptake. To address these challenges, MSF, City of Cape Town Health and mothers2mothers developed postnatal clubs (PNC) in Khayelitsha, a low-income, high HIV prevalence area in South Africa. The model integrates psychosocial support, early childhood development, and maternal and child health. A mothers2mothers mentor facilitates a group session of 3-11 mother-infant pairs (MIPs) and each MIP consults with a nurse.
METHODS: We included MIPs enrolled in PNCs with 18 months of follow-up from June 2016-December 2018. Controls were recruited at birth for another study in Khayelitsha where infants were tested with birth PCR, mothers counselled on infant testing at birth and traced if infants were not known to have tested. We included MIPs with babies born from November 2015 to June 2016 with a negative 6-week PCR. We report on maternal viral load completion and suppression (<400copies/mL) by 12 months (7-365 days after birth) and 18 months (12-18 months), and infant rapid test completion at 9 months (8-10months) and 18 months (17-19months). For both cohorts, we excluded babies that seroconverted from subsequent testing denominators. We evaluated the additional cost burden to the health facility of PNCs.

Historical controlsPostnatal clubsRisk Ratio
(95% CI)
[PNC/controls]
Infants

9 month rapid completion (8-10mth)
112/221
51%
114/141
81%
1.6
(1.4-1.9)
18 month rapid completion (17-19mth)70/220
32%		90/140
64%		2.0
(1.6-2.6)
Mothers

0-12 month viral load completion
149/221
67%
140/141
99%
1.5
(1.3-1.6)
0-12 month viral load suppression141/149
95%		134/140
96%		1.0
(0.96-1.1)
12-18 month viral load completion65/221
29%		107/141
76%		2.6
(2.1-3.2)
12-18 month viral load suppression63/65
97%		101/107
94%		0.97
(0.9-1.0)

RESULTS: In the PNC cohort (N=141), one infant seroconverted (after exiting the PNC) before their 18 months test, while two control group infants (N=221) seroconverted before 18 months. Infant testing completion rates were higher in the PNC cohort at nine months (81% vs 51%) and 18 months (64% vs 32%) than the historical controls. Mothers' viral load completion rates were higher in the PNC cohort at 12 months (99% vs 67%) and 18 months (76% vs 29%), with similar viral suppression rates (Table 1). PNCs entailed minimal additional cost.
CONCLUSIONS: PNCs provided women with peer support and convenience, and improved maternal viral load monitoring and infant testing.