Health care worker-managed groups

Post-natal clubs

Clinical
Specific populations
Context

Post-natal clubs are being piloted in a clinic in Khayelitsha, Cape Town, South Africa by MSF in partnership with City of Cape Town and mothers2mothers (M2M)*. All HIV-positive mothers are made aware of the existence of the post-natal club during their ANC visits. Recruitment for both low-risk mother-infant pairs (LRMIP) and high-risk mother-infant pairs (HRMIP) is done by a M2M facility-based educator at post-natal 6-week visit, and the first club group visit takes place approx. 10 weeks post-partum. Each club includes 6-12 mother-infant pairs (MIPs) (grouped by month of delivery) and is facilitated by a lay provider (M2M community mentor). Group support focuses on infant care and development and maintaining maternal adherence. The lay provider dispenses ART and cotrimoxazole refills in the group for the period until the next club visit (monthly from 10 weeks to 6 months and 3 monthly thereafter). The MIP will then be seen by an MNCH nurse for an integrated consultation (maternal and child, HIV and non HIV care). HRMIP receive extra support from M2M with weekly community visits and continued monthly clinical review until assessed as LRMIP. HIV-positive infants and their mothers are referred out of the post-natal club to the HIV clinic. When the infants reach 18 months, the group of mothers convert into a community adult adherence club.

 

*June 2017: Model currently being adjusted and further simplified to facilitate scale out in Cape Metro district, Cape Town, South Africa.  Model description will be updated as changes to model are made.

Who is eligible for this model?

Post-partum HIV positive women and their infants from 10 weeks to 18 months*.
*Mothers with active TB or refusing to have their HIV care integrated with their MNCH care at the same facility are excluded from the model

ART Refills

WHAT

Weighed
ART + Cotrimoxazole refill
Structured group adherence and baby care support

WHEN

5 x 1 monthly
Thereafter 3 monthly

WHERE

MNCH service at PHC

WHO

Lay provider

Clinical consultation

WHAT

Mother
Clinical monitoring
ART rescripting
Laboratory tests (VL 6 monthly)
Family planning
Pap smear
Infant
Immunization / Vit A / deworming
Growth check
Neuro dev check
HIV tests: PCR (10 w, 18 w for high risk), rapid test (9m; 18m)
IMCI

WHEN

5 x 1 monthly
Thereafter 3 monthly  

WHERE

MNCH service at PHC

WHO

MNCH nurse

Summary of the model (10weeks – 18months)

* Mother: 4
   Child: 2

Location

Khayelitsha, Cape Town, South Africa

Post-natal clubs
Cape Town, South Africa

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