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Type of submission: Oral
Conference track: Practice
Topics: Integrated Harm Reduction Services; Women, Drug Use and Harm Reduction
Presenting author: Benjamin Kirimo
Benjamin Kirimo, Javan Njau, Zawadi Yaa, Saade Abdallah
ISSUES: Despite awareness of methadone regulating fertility among females on MAT, family planning uptake is low in Malindi. National guidelines silent on management of HIV exposed and opioid dependent infants.
SETTING: Malindi town has about 2000 people who inject drugs (PWID), 10% being females with high HIV prevalence (32.3%).
PROJECT: In February 2015, Kilifi county government, Ministry of Health, USAID and UNODC established MAT at Malindi hospital. All males who inject drugs and opioid dependent females were eligible. At baseline, clients screened for HIV, VDRL, HCV, HBV and pregnancy for (females). Oral contraception, condoms availed to non-pregnant females. Clients with co-morbidities were referred for services at hospital. Pregnant clients followed up at MAT and ANC (antenatal care) clinics until delivery.
OUTCOME: Within 18 months, a total of 474 clients were accessing MAT. Females comprised 9%, with 90% of reproductive age, 70% married. At 3 months of MAT, many female clients expressed desire for a child upon resumption of menstruation.20% (8/40) females subsequently became pregnant ,50% HIV positive with Mean duration of conception in MAT at 4 months.3 HIV infected females initiated or continued ART (TDF,3TC, EFV) at hospital.
September 2016, 75% (6/8) of pregnant females gave birth, 5 at hospital, 1 by Caesarean-section due to previous scar. Nevirapine administered at birth to HIV exposed infants, with PCR testing at 6 weeks and 6 months. One infant treated for neonatal abstinence syndrome (NAS). 1 HIV infected mother who declined ART and hospital delivery her infant died three days later. Exclusive breastfeeding recommended, with one infant discontinued upon testing PCR negative at 6 months.
Integrating MAT with ANC and PMTCT significantly improves pregnancy outcomes for HIV infected and opioid dependent mothers. Further study needed to establish optimal infant feeding option for effective elimination of mother to child transmission among this population.