Improved knowledge and practices among end-users of mother-to-child transmission of HIV prevention services in rural Zimbabwe

Mother's knowledge on prevention of mother-to-child transmission of HIV, Ethiopia: A cross sectional study

OBJECTIVE

To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia.

METHODS

A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV.

RESULTS

The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowledge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary education and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibility to HIV (AOR = 10.72; 95%CI: 3.90, 29.39).

CONCLUSION

The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate mother's knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother's knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (> = 35years), rural residents, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV.

HIV EPIDEMIC HETEROGENEITY IN ZIMBABWE: EVIDENCE FROM SUCCESSIVE DEMOGRAPHIC AND HEALTH SURVEYS

Zimbabwe has one of the worst HIV epidemics in the world. This study investigated data from two successive Zimbabwe Demographic and Health Surveys (ZDHS) conducted in 2005-06 and 2010-11. A random representative sample of 30,000 men aged 15-59 and women aged 15-49 was selected from the two surveys. The HIV prevalence was mapped with a flexible, coherent regression framework using a geo-additive semi-parametric mixed model. HIV indicator prevalence maps were constructed at the regional level, and at the administrative level relevant for policy design, planning and decision-making. Substantial regional variation was found, not only in the burden of HIV, but also in its risk factors. The results suggest that responses/policies should vary at the regional level to ensure that the often diverse needs of populations across a country are met and incorporated into planning the HIV response. The use of geographically referenced data in two successive ZDHS provides crucial new insights into the spatial characteristics of the HIV epidemic in Zimbabwe. In particular, it highlights the HIV heterogeneity across Zimbabwe, with substantial regional variation, not only in the burden of HIV, but also in its risk factors.

Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study

BACKGROUND

Zimbabwe's Ministry of Health and Child Care (MOHCC) adopted 2013 World Health Organization (WHO) prevention of mother-to-child HIV transmission (PMTCT) guidelines recommending initiation of HIV-positive pregnant and breastfeeding women (PPBW) on lifelong antiretroviral treatment (ART) irrespective of clinical stage (Option B+). Option B+ was officially launched in Zimbabwe in November 2013; however the acceptability of life-long ART and its potential uptake among women was not known.

METHODS

A qualitative study was conducted at selected sites in Harare (urban) and Zvimba (rural) to explore Option B+ acceptability; barriers, and facilitators to ART adherence and service uptake. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with PPBW, healthcare providers, and community members. All interviews were audio-recorded, transcribed, and translated; data were coded and analyzed in MaxQDA v10.

RESULTS

Forty-three IDIs, 22 FGDs, and five KIIs were conducted. The majority of women accepted lifelong ART. There was however, a fear of commitment to taking lifelong medication because they were afraid of defaulting, especially after cessation of breastfeeding. There was confusion around dosage; and fear of side effects, not having enough food to take drugs, and the lack of opportunities to ask questions in counseling. Participants reported the need for strengthening community sensitization for Option B+. Facilitators included receiving a simplified pill regimen; ability to continue breastfeeding beyond 6 months like HIV-negative women; and partner, community and health worker support. Barriers included distance of health facility, non-disclosure of HIV status, poor male partner support and knowing someone who had negative experience on ART.

CONCLUSIONS

This study found that Option B+ is generally accepted among PPBW as a means to strengthen their health and protect their babies. Consistent with previous literature, this study demonstrated the importance of male partner and community support in satisfactory adherence to ART and enhancing counseling techniques. Strengthening community sensitization and male knowledge is critical to encourage women to disclose their HIV status and ensure successful adherence to ART. Targeting and engaging partners of women will remain key determinants to women's acceptance and adherence on ART under Option B+.

Knowledge of pregnant women on mother-to-child transmission of HIV, its prevention, and associated factors in Assosa town, Northwest Ethiopia

Introduction

HIV/AIDS is a leading cause of death of children in sub-Saharan African countries. Almost all HIV-positive children acquire infection through mother-to-child transmission (MTCT) of HIV. Successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection is highly dependent on everyone; especially, women of child-bearing age should have accurate and up-to-date knowledge about HIV transmission, risk of transmission to babies, and possible interventions. However, knowledge of MTCT of HIV, its prevention, and associated factors among women was not well studied in Benshangul Gumuz Region (Ethiopia).

Methods

A facility-based cross-sectional study was conducted involving 398 pregnant women who attended antenatal care services at governmental health institutions from February to March 2014 in Assosa town. Based on the flow of antenatal care attendants, the calculated sample size was proportionally allocated to the health facilities before data collection. Following this, systematic sampling method was used, and data were collected using an interviewer-administered questionnaire. Bivariate and multivariate binary logistic regression analysis was done using SPSS version 20 statistical packages.

Result

A total of 386 pregnant women participated with a response rate of 97%, and 222 (57.5%) of them had full knowledge about the three critical modes of HIV transmission from mother to child, but only 67 (17.4%) knew the possible prevention methods. Knowledge on MTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (adjusted odd ratio [AOR] =2.86, 95% confidence interval [CI] =1.54–5.32), women who had a favorable attitude to provider-initiated HIV counseling and testing (AOR =2.19, 95% CI =1.22–3.92), and women who did not expect any partner’s reaction to positive HIV test result after testing (AOR =1.58, 95% CI =1.01–2.49). Correspondingly, knowledge on PMTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (AOR =2.64, 95% CI =1.24–5.65), women who had favorable attitude toward provider’s counseling and testing (AOR =4.27, 95% CI =1.95–9.34), and women who did not expect any partner’s reaction to positive HIV test result after testing (AOR =3.56, 95% CI =1.58–8.01).

Conclusion

Knowledge on MTCT and its prevention among women is low in the study area. We recommend more efforts to be exerted on improving women’s knowledge of PMTCT of HIV.

Tracing defaulters in HIV prevention of mother-to-child transmission programmes through community health workers: results from a rural setting in Zimbabwe

Introduction

High retention in care is paramount to reduce vertical human immunodeficiency virus (HIV) infections in prevention of mother-to-child transmission (PMTCT) programmes but remains low in many sub-Saharan African countries. We aimed to assess the effects of community health worker–based defaulter tracing (CHW-DT) on retention in care and mother-to-child HIV transmission, an innovative approach that has not been evaluated to date.

Methods

We analyzed patient records of 1878 HIV-positive pregnant women and their newborns in a rural PMTCT programme in the Tsholotsho district of Zimbabwe between 2010 and 2013 in a retrospective cohort study. Using binomial regression, we compared vertical HIV transmission rates at six weeks post-partum, and retention rates during the perinatal PMTCT period (at delivery, nevirapine [NVP] initiation at three days post-partum, cotrimoxazole (CTX) initiation at six weeks post-partum, and HIV testing at six weeks post-partum) before and after the introduction of CHW-DT in the project.

Results

Median maternal age was 27 years (inter-quartile range [IQR] 23 to 32) and median CD4 count was 394 cells/µL³ (IQR 257 to 563). The covariate-adjusted rate ratio (aRR) for perinatal HIV transmission was 0.72 (95% confidence intervals [95% CI] 0.27 to 1.96, p=0.504), comparing patient outcomes after and before the intervention. Among fully retained patients, 11 (1.9%) newborns tested HIV positive. ARRs for retention in care were 1.01 (95% CI 0.96 to 1.06, p=0.730) at delivery; 1.35 (95% CI 1.28 to 1.42, p<0.001) at NVP initiation; 1.78 (95% CI 1.58 to 2.01, p<0.001) at CTX initiation; and 2.54 (95% CI 2.20 to 2.93, p<0.001) at infant HIV testing. Cumulative retention after and before the intervention was 496 (85.7%) and 1083 (87.3%) until delivery; 480 (82.9%) and 1005 (81.0%) until NVP initiation; 303 (52.3%) and 517 (41.7%) until CTX initiation; 272 (47.0%) and 427 (34.4%) until infant HIV testing; and 172 (29.7%) and 405 (32.6%) until HIV test result collection.

Conclusions

The CHW-DT intervention did not reduce perinatal HIV transmission significantly. Retention improved moderately during the post-natal period, but cumulative retention decreased rapidly even after the intervention. We showed that transmission in resource-limited settings can be as low as in resource-rich countries if patients are fully retained in care. This requires structural changes to the regular PMTCT services, in which community health workers can, at best, play a complementary role.

Pre- and post-intervention assessment of a PMTCT-programme-strengthening initiative in a rural area of the Eastern Cape, South Africa

The research assesses prevention-of-mother-to-child-transmission-of-HIV (PMTCT) services following implementation of programme-strengthening activities in a municipality in the Eastern Cape Province, South Africa. A pre-intervention and post-intervention design was used to conduct facility assessments and client exit interviews at baseline and after 28 months. For the facility assessments, unstructured interviews were conducted with the heads of maternity wards at each delivery facility (n = 4), nurses (n = 9) and lay counsellors (n = 18). District Health Information System (DHIS) records were used to assess changes on PMTCT-programme indicators. Observations were conducted at the fixed clinics and hospitals to determine compliance to the national criteria for PMTCT-services delivery. For the exit interviews with clients, the pre- and post-assessment samples, respectively, included women attending for antenatal care (n = 296; n = 239) as well as HIV-positive women attending for postnatal care (n = 70; n = 142). The personnel generally perceived the PMTCT services as having been strengthened as a result of the initiative and the DHIS records showed positive changes. Client exit interviews revealed significant increases in the numbers of women who: were aware of the PMTCT programme; were tested for HIV during their pregnancy; were aware of VCT before coming to the facility; knew their HIV-test result; and, had helpful pre-HIV-test and/or post-HIV-test counselling experiences. The long waiting periods at the facilities and the relatively short length of the counselling sessions remained a serious concern. Lessons learnt may help with designing strategies to expand the national programme in South Africa as well as PMTCT programmes elsewhere.

Knowledge and attitude of women on the available PMTCT services at the antenatal clinic of the Coast Province General Hospital

INTRODUCTION

Several high profile events of the last decade have served as catalysts for the now widely available prevention of mother-to-child transmission of HIV services. However, Kenya continues to face challenges in assuring that all women in need of PMTCT services receive the full package.

METHODS

A cross sectional survey was undertaken. Systematic sampling method was used for sample selection. Data was collected using pretested structured questionnaires. Data was analyzed in SPSS and Epi Info using bivariate and multivariate logistic regression.

RESULTS

Approximately 75% of participants were seeking PMTCT services in CPGH for the first time, 71% knew of their HIV status. About 95% of participants were satisfied with privacy during testing. Clients who had never delivered in CPGH had a significantly (p<0.001) higher odds compared to those who had previously delivered in CPGH and had their first PMTCT visit. participants who had never lost a pregnancy in CPGH and were in the hospital for the first time were 3 times likely to seek PMTCT services compared to those who had lost a pregnancy in CPGH. There was a significant association between family planning use before pregnancy and first PMTCT.

CONCLUSION

Participants seeking PMTCT services had poor HIV knowledge; but reported positive experiences and good provider-client relationship. However for a successful PMTCT program in CPGH attention needs to be paid in the patient experiences as they seek other reproductive services.

Mother to Mother (M2M) peer support for women in Prevention of Mother to Child Transmission (PMTCT) programmes: a qualitative study

Introduction

Mother-to-Mother (M2M) or “Mentor Mother” programmes utilise HIV positive mothers to provide support and advice to HIV positive pregnant women and mothers of HIV exposed babies. Médecins Sans Frontières (MSF) supported a Mentor Mother programme in Bulawayo, Zimbabwe from 2009 to 2012; with programme beneficiaries observed to have far higher retention at 6–8 weeks (99% vs 50%, p<0.0005) and to have higher adherence to Prevention of Mother to Child Transmission (PMTCT) guidelines, compared to those not opting in. In this study we explore how the M2M progamme may have contributed to these findings.

Methods

In this qualitative study we used thematic analysis of in-depth interviews (n = 79). This study was conducted in 2 urban districts of Bulawayo, Zimbabwe’s second largest city.

Results

Interviews were completed by 14 mentor mothers, 10 mentor mother family members, 30 beneficiaries (women enrolled both in PMTCT and M2M), 10 beneficiary family members, 5 women enrolled in PMTCT but who had declined to take part in the M2M programme and 10 health care staff members. All beneficiaries and health care staff reported that the programme had improved retention and provided rich information on how this was achieved. Additionally respondents described how the programme had helped bring about beneficial behaviour change.

Conclusions

M2M programmes offer great potential to empower communities affected by HIV to catalyse positive behaviour change. Our results illustrate how M2M involvement may increase retention in PMTCT programmes. Non-disclosure to one’s partner, as well as some cultural practices prevalent in Zimbabwe appear to be major barriers to participation in M2M programmes.

Community strategies that improve care and retention along the prevention of mother-to-child transmission of HIV cascade: a review

Introduction

While biomedical innovations have made it possible to prevent the vertical transmission of HIV from mother to child, poor retention along the prevention of mother-to-child transmission (PMTCT) cascade continues to limit the impact of programmes, especially in low-resourced settings. In many of the regions with the highest burden of HIV and the greatest number of new paediatric cases, the uptake of facility-based care by pregnant women remains low. In such settings, the continuum of care for pregnant women and other women of reproductive age necessarily relies on the community. There is no recent review capturing effective, promising practices that are community-based and/or employ community-oriented groups to improve outcomes for the prevention of vertical transmission. This review summarizes those studies demonstrating that community-based and community-oriented interventions significantly influence retention and related outcomes along the PMTCT cascade.

Methods

Literature on retention within prevention of vertical transmission programmes available on PubMed, Psych Info and MEDLINE was searched and manuscripts reporting on key prevention of vertical transmission outcomes were identified. Short-listed studies that captured significant PMTCT outcome improvements resulting from community-based interventions or facility-based employment of community cohorts (e.g. lay counsellors, community volunteers, etc.) were selected for review.

Results

The initial search (using terms “HIV” and “PMTCT”) yielded 430 articles. These results were further narrowed using terminology relevant to community prevention of vertical transmission strategies addressing retention: “community,” “PMTCT cascade,” “retention,” “loss to follow up” and “early infant diagnosis.” Nine of these reported statistically significant improvements in key prevention of vertical transmission outcomes while meeting other review criteria. Short-listed articles reflect diverse study designs and a variety of effective interventions. Two interventions occurred exclusively in the community and four effectively employed community groups within facilities. The remaining three integrated community- and facility-based components. The outcomes of the included studies focus on knowledge (n=3) and retention along the PMTCT cascade (n=6).

Conclusions

This review captures an array of promising community-based and community-oriented interventions that demonstratively improve key prevention of vertical transmission outcomes. Though the strategies captured here show that such interventions work, the limited number of rigorous studies identified make it clear that expansion of community approaches and complementary reporting and related research are sorely needed.

Knowledge of Pregnant Women on Mother-to-Child Transmission of HIV in Yaoundé

Introduction:

Mother–to-child transmission of HIV is a major public health problem in Cameroon. The aim of this study was to assess knowledge of pregnant women on HIV transmission and prevention, particularly the four pillars of mother-to-child transmission.

Materials and Methods:

This was a descriptive cross-sectional study from October 2008 to January 2009 at the Yaoundé Gynaecology-Obstetrics and Pediatric Hospital. All women presenting at the Ante-Natal Care (ANC) Clinic for the first time were included in the study after obtaining a verbal informed consent.

Results:

The ages of the 260 women included in the study ranged from 15 to 42 years. Almost 99% (257/260) of the women interviewed had heard about HIV. Respectively, 80.5% (209/260), 89.3% (232/260) and 81.2% (211/260) of the women cited pregnancy, delivery, and breastfeeding as risk periods for HIV transmission from mother to child. Use of the male condom, the female condom, abstinence, and faithfulness to a single partner were considered as effective methods of HIV prevention by 73% (190/260), 76% (198/260), 88% (229/260) and 46% (120/260) of respondents respectively. About 79% (64/81) of participants with higher education considered HIV infection to be contagious as opposed to 45.5% (5/11) of women with no formal education (P = 0.008).

Conclusion:

Our data suggest that women have some good knowledge on the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Nevertheless, improving the formal educational level of these women may contribute to a further reduction of HIV transmission.

A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia

OBJECTIVE

There has been much debate about the value of condoms in HIV/STI programming. This should be informed by evidence about intervention impact on condom use, but there is limited compiled literature. This review aims to quantify intervention impact on condom use in sub-Saharan Africa and Asia, in different types of partnership.

METHODS

A systematic review was conducted of papers published between 1998 and 2006 presenting evaluations of interventions involving condom promotion in sub-Saharan Africa and Asia. Data on reported postintervention levels of condom use, and various measures of changes in condom use, by partnership type, were compiled.

RESULTS

A total of 1374 abstracts were identified. Sixty-two met the inclusion criteria (42 reporting significant increases in condom use): 44 from sub-Saharan Africa and 18 from Asia. Many (19) reported on condom use in commercial sex (15 significant), six on use with casual partners (three significant), 11 on use in marital/steady partnerships (nine significant), 14 on use by youths (eight significant) and 20 combined partnership types (11 significant). There is substantial evidence of interventions targeted at sex workers and clients achieving large increases in condom use. Far less evidence exists of intervention impact on condom use in casual relationships. In primary partnerships, postintervention condom use was low unless one partner was knowingly HIV-infected or at high-risk, or avoiding pregnancy. Evaluations of interventions targeting youths recorded limited increases in condom use.

CONCLUSIONS

The findings illustrate the range of evidence about postintervention condom use in different partnerships, and how patterns of use are influenced by partnership type and perceptions of risk. Where possible, intervention studies should also assess biological endpoints, since prevention of infection is the measure of most interest in the evaluation of condom promotion interventions.