Harare Family Care CRS Tichaona Vhembo 1 Presentation Outline 1. - - PowerPoint PPT Presentation

Harare Family Care CRS Tichaona Vhembo

1

Presentation Outline

1.

Introduction to Harare Family Care CRS

• 2. Outreach activities
• 3. Informed consent

process

• 4. Study entry

procedures

• 5. Pharmacy

considerations

• 6. Challenges.

2

Harare Family Care CRS

 Situated within Parirenyatwa

Hospital

 Recruitment activities take place

from within 40km radius, from 14 Harare City Primary Care Clinics

 Recruitment system has been in

place since 2007

 Established relationships  Enrolment into 7 protocols

(P1060,P1070,P1072,P1073,1077 BF, P1104,P1092)  New protocols presented at City

• f Harare Matrons meetings

 P1115: Enrolled 30ppts in step 1

and 5 in step 2

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OUTREACH ACTIVITIES



Participant identification



Daily up to 2 teams go to various clinics to recruit for all open protocols.



City Clinics may also call study staff for potential participants



Looking for “UNBOOKED” mothers who meet eligibility criteria:

I.

Pregnancy never registered at a health facility

II.

Test HIV positive during labour or soon after delivery

III.

No ART in current pregnancy.

1.

Review medical records and check time

• f delivery and gestational age at delivery

4

IC Process

 Sensitisation of potential

participants by nurse counsellors doing outreach duties.

 Potential participant then

transported to site a.s.a.p. after delivery

 Second review medical records

before IC process begins.

 IC process varies in time(3-5hrs)

 Participant literacy  Pain threshold of ppt (after-birth

pains)

5

Other Entry Procedures

Mother Neonate

 Mother’s sample #1 for HIV

test.

 Subject enrolment  History and physical exam  Do other procedures as per

SOE (inc. sample #2 for HIV test)

 History and physical exam  Initial blood draw for neonate

(HIV viral load + SOE)

 Second blood draw for

neonate 1hr later (for HIV DNA PCR).

 Issue prescription (stop NVP)

6

Pharmacy considerations

 Mother undergoes

adherence counselling

 Adherence strategies

discussed

 Mother selects and

communicates her adherence strategy plan

 Mother trained on

medication dosing

 Participant initiated on

ART and given first dose

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First Visit Timelines

30min s -1 hour

• Sensitization of potential participant
• Review of medical records

3-5 hours

• Informed Consent Process

35min s

• Maternal HIV test (Sample #1)

40mi ns

• Maternal and Neonatal history and physical examination

15 mins

• Initial Neonate blood draw ( viral load and SOE tests)

15min s

• Confirmatory HIV test for neonate >1hour after initial blood draw

30-45 mins

• Pharmacy

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Challenges

 Mother accepting the new HIV diagnosis-counseling  Mother concentrating on IC process despite after-birth

pains- analgesics and refreshments offered

 Collecting adequate blood volumes in neonates-

prioritise evaluations as indicated in LPC

 Mother apprehensive that her baby is being pricked

twice- counselling on importance of accurate diagnosis

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Thank you

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