Reviewed and Current Research Agenda
The Maternal and Child Health (MCH) Division’s research agenda is rooted in the WHO strategy to mitigate the impact of HIV/AIDS on women’s, maternal and child health, which calls for:
- Preventing HIV infection in women of reproductive age;
- Preventing unintended pregnancies in HIV-infected women;
- Preventing mother-to-child transmission of HIV; and,
- Ensuring long-term care and treatment for HIV-infected children and mothers.
Because other Divisions within DTHC are focused on the first and fourth of these points (ie, prevention of HIV infection and care and treatment for HIV-infected children and adults), the major projects of the MCH Division focus specifically on the second and third points above. This work spans clinic- and population-based research questions, drawing on Divisional’ expertise in background in epidemiology and clinical medicine.
Preventing unintended pregnancies in HIV-infected women
The Division’s work in this area includes service-level interventions as well as a clinical trial.
The Family Planning Integration (FPI) project is a DFID-funded programme to strengthen the provision of contraception within HIV care and treatment services across the province, carried out in partnership with the Provincial Government of the Western Cape. The project focuses on the pragmatic integration of contraception and family planning services into existing public sector HIV care and treatment programmes through a comprehensive intervention that includes health care provider training, in-service support materials; and ongoing mentorship and guidance through facility-base ‘champions’. While the project is predominantly focused on innovative strategies for service delivery, it incorporates a rigorous monitoring and evaluation plan that includes semi-structured interviews with patients and health care providers at participating facilities before the implementation of the intervention as well as 6- and 12-months post-implementation. The project is currently in the last of its three years, and will be completed in August 2015.
The 2IUD-CT study is a randomised controlled trial comparing the copper-based versus levonorgestrel-releasing intrauterine devices (IUDs) on HIV disease progression, side effects and viral shedding. This NIH-funded project is based at the Gugulethu Community Health Centre, adjacent to HCTC, and includes UCT investigators from Public Health, Medicine and Obstetrics & Gynaecology at UCT along with international partners (FHI360, City University of New York, Rutgers University). In addition a substudy within the trial is examining HIV shedding in the female genital tract under different hormonal methods, in collaboration with the Division of Immunology (A/Prof JA Passmore). Given the urgent need to identify safe and effective long-acting reversible contraceptive (LARC) modalities for HIV-infected women, and given recent pharmacologic and/or safety concerns related to other LARC methods, this study has the potential to play a major role in contraceptive policymaking for HIV-infected women globally. Currently the trial is completing its first year of enrolment, and will run through end-2017.
Preventing mother-to-child transmission of HIV in pregnant women
This area has been the focus of the division over the past four years, with projects based at Midwife Obstetric Units (MOUs) in the Klipfontein-Mitchell’s Plain subdistrict in Cape Town.
The Rapid ART in Pregnancy (RAP) project was a one-year pilot project to develop and implement an intervention for immediate initiation of antiretrovirals in HIV-infected pregnant women. The project was pilot-tested at the Hanover Park MOU during 2011-2012, and demonstrated the safety and acceptability of this innovative approach to service delivery. The project directly informed subsequent developments at the Gugulethu MOU during 2012-2013, including the establishment of the Maternal-Child Health Antiretroviral Therapy (MCH-ART) study.
The MCH-ART study is a multi-component investigation of antiretroviral initiation and retention in pregnant women. This NIH-funded programme of research includes interlinked cross-sectional and cohort studies during the antenatal period, with selected participants entering a health systems trial postpartum. This work builds on the RAP project and previous PMTCT operations research in Gugulethu funded by the Elizabeth Glaser Pediatric AIDS Foundation. This work is in collaboration with colleagues at Columbia University, the HIV Centre for Clinical and Behavioural Studies at the New York State Psychiatric Institute, and several groups at UCT including the School of Public Health & Family Medicine, the Division of Virology and the Department of Obstetrics & Gynaecology at UCT. The study began recruitment in early 2013 and will continue follow-up through late 2015, with funding through end 2016.