title: Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India.
abstract: In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.
  
  
  
  From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1.
  
  
  
  During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested.
  
  
  
  Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90095, CA, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Kojima
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.|Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Krupp
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Ravi
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Savitha
authors.initials: S
authors.lastname: Gowda
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Poornima
authors.initials: P
authors.lastname: Jaykrishna
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Leonardson-Placek
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Siddhaiah
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, 92093, CA, USA.
authors.forename: Claire C
authors.initials: CC
authors.lastname: Bristow
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India.
authors.forename: Anjali
authors.initials: A
authors.lastname: Arun
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, 90095, CA, USA.|Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.affiliation: Public Health Research Institute of India, 89/B, Ambika, 2nd Cross, 2nd Main, Yadavagiri, Mysuru, Karnataka, 570020, India. pmadhiva@fiu.edu.|Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, 33199, FL, USA. pmadhiva@fiu.edu.
authors.forename: Purnima
authors.initials: P
authors.lastname: Madhivanan
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration*; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission
keywords: HIV; India; Mobile Health; PMTCT; Pregnant; Women