In the KwaZulu-Natal (KZN) province of South Africa (SA), where antenatal HIV prevalence is 39.5%, there has been substantial impact of programs to prevent mother-to-child transmission (PMTCT) of HIV.However, despite the recognized benefits of early ART initiation for HIV-infected infants and maternal health care, there is substantial loss to follow-up of HIV-infected mothers and their infants after delivery. Barriers to effective utilization of postnatal HIV care and treatment services include logistical factors, competing demands, and psychological factors such as fear of stigmatization. One approach to reducing these barriers is the codelivery of postnatal HIV and MCH services at the same point of care. In preparation for a large (NIH R01) study of co-delivering HIV and MCH services in the well-child setting, investigation of existing well-child services and organization practices is needed, as well as assessment of the feasibility and acceptability ofintegrated HIV and MCH service delivery from the perspective of both health care providers and mothers of infants. The specific aims of this RAP project are; 1) To investigate enablers of and barriers to provision of integrated postnatal HIV and MCH services in the well-child clinical setting in a high HIV prevalence community in SA, and 2) to assess the acceptability of offering postnatal HIV and MCH services to mothers and infants in the well-child clinical setting, including HIV testing and follow-up HIV care. We will use qualitative and quantitative methods, including ten focus groups with mothers of infants <12 months old (N=80), semistructured interviews with health providers (N=70), and structured interviews with mothers of infants <12 months old (N=250). We will also conduct rapid facility reviews of all established primary health clinics in the study district (N=30 clinics) to assess existing capacity for co-delivering HIV and MCH services within the wellchild setting.

UCSF Faculty Mentor: George Rutherford, MD