1
|
Mudji J, Olarewaju V, Madinga B, Malala J, Kayeye A, Horsmans Y. HIV testing and knowledge on mother-to-child transmission among pregnant women attending antenatal care at Vanga Hospital, Democratic Republic of Congo. J Public Health Afr 2023; 14:1991. [PMID: 37753436 PMCID: PMC10519118 DOI: 10.4081/jphia.2023.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 05/16/2022] [Indexed: 09/28/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) causes an infectious disease that can be transmitted from an infected mother to her child. Prevention of Mother-to-Child Transmission (PMTCT) programs provide a range of services to women and children that can reduce the risk of vertical transmission of HIV. Unfortunately, PMTCT programs face many challenges in the rural Democratic Republic of Congo (DRC). Methods A cross-sectional study was conducted among 460 pregnant women attending antenatal care at Vanga Hospital in the Vanga health zone, DRC from March 11th to June 25th, 2019. Serological tests were performed and a pre-tested questionnaire regarding HIV knowledge was given to all participants. Data were analyzed with STATA 13.0. Descriptive statistics of key variables were computed and logistic regression was used to assess the association between participant's characteristics and knowledge of MTCT. Results Among the participants, 95.4% (439/460) reported that they have heard about HIV, 82.4% (378/460) indicated sexual intercourse as one of the routes of HIV transmission but only 30.4% (139/460) mentioned MTCT as one of the routes. In addition, only 10.1% (46/460) had knowledge of the existence of PMTCT. Participants' age (>29 years), education level, previous antenatal care, and previous HIV tests were significantly associated with knowledge of MTCT. Also, age (>29 years) and education level were significantly associated with previous HIV test uptake. Most pregnant women 82.3% (376/460) reported that they have never been tested in the past for HIV infection and the prevalence was at 0.9% (4/460). Conclusions Knowledge of MTCT of HIV, previous uptake of HIV testing, and prevalence was low. The rural setting of Vanga and insufficient HIV sensitization activities are considered contributors to this. While the low prevalence is a positive finding, much needs to be done to improve the uptake of HIV testing and knowledge of HIV MTCT.
Collapse
Affiliation(s)
- Junior Mudji
- Hôpital Evangélique de Vanga, Vanga Mission, Democratic Republic of the Congo
- Department of Family Medicine and Primary Care, Protestant University of Congo, Democratic Republic of the Congo
| | - Victoria Olarewaju
- Swiss Tropical and Public Health Institute, Medical Department, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Blaise Madinga
- Hôpital Evangélique de Vanga, Vanga Mission, Democratic Republic of the Congo
- Department of Family Medicine and Primary Care, Protestant University of Congo, Democratic Republic of the Congo
| | - Justice Malala
- Hôpital Evangélique de Vanga, Vanga Mission, Democratic Republic of the Congo
| | - Auguy Kayeye
- Division Provincial de la Sante, Coordonnation Provincial/PNLS Kwilu, Bandundu, Democratic Republic of the Congo
| | - Yves Horsmans
- Department of Hepato-Gastroenterology, Cliniques Universitaires Saint-Luc, U.C.L., Avenue Hippocrate, Brussels, Belgium
| |
Collapse
|
2
|
Rasmussen DN, Unger HW, Bjerregaard-Andersen M, da Silva Té D, Vieira N, Oliveira I, Hønge BL, Jespersen S, Gomes MA, Aaby P, Wejse C, Sodemann M. Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study. PLoS One 2018; 13:e0199819. [PMID: 30067793 PMCID: PMC6070169 DOI: 10.1371/journal.pone.0199819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. METHODS We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson's χ2 test. RESULTS Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73-1.84), as was a lower educational status (APR 1.05; 95% CI 1.00-1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01-1.09) and on Sundays (APR 1.14; 95% CI 1.07-1.22) and Mondays (APR 1.12; 95% CI 1.05-1.19). CONCLUSIONS Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.
Collapse
Affiliation(s)
- Dlama Nggida Rasmussen
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- * E-mail:
| | - Holger Werner Unger
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Australia
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Department of Endocrinology, Hospital of South West Denmark, Esbjerg, Denmark
| | - David da Silva Té
- National HIV Programme, Secretariado Nacional de Luta Contra Sida, Ministry of Health, Bissau, Guinea-Bissau
| | - Noel Vieira
- Association Ceu e Terras, Bissau, Guinea-Bissau
| | - Inés Oliveira
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Bo Langhoff Hønge
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Sodemann
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| |
Collapse
|
4
|
Chan CPY, Mak WC, Cheung KY, Sin KK, Yu CM, Rainer TH, Renneberg R. Evidence-based point-of-care diagnostics: current status and emerging technologies. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2013; 6:191-211. [PMID: 23527548 DOI: 10.1146/annurev-anchem-062012-092641] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Point-of-care (POC) diagnostics brings tests nearer to the site of patient care. The turnaround time is short, and minimal manual interference enables quick clinical management decisions. Growth in POC diagnostics is being continuously fueled by the global burden of cardiovascular and infectious diseases. Early diagnosis and rapid initiation of treatment are crucial in the management of such patients. This review provides the rationale for the use of POC tests in acute coronary syndrome, heart failure, human immunodeficiency virus, and tuberculosis. We also consider emerging technologies that are based on advanced nanomaterials and microfluidics, improved assay sensitivity, miniaturization in device design, reduced costs, and high-throughput multiplex detection, all of which may shape the future development of POC diagnostics.
Collapse
Affiliation(s)
- Cangel Pui Yee Chan
- Accident and Emergency Medicine Academic Unit, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | | | | | | | | | | | | |
Collapse
|
6
|
Touré H, Audibert M, Dabis F. To what extent could performance-based schemes help increase the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs in resource-limited settings? A summary of the published evidence. BMC Public Health 2010; 10:702. [PMID: 21080926 PMCID: PMC3000852 DOI: 10.1186/1471-2458-10-702] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 11/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In resource-limited settings, HIV/AIDS remains a serious threat to the social and physical well-being of women of childbearing age, pregnant women, mothers and infants. DISCUSSION In sub-Saharan African countries with high prevalence rates, pediatric HIV/AIDS acquired through mother-to-child transmission (MTCT) can in largely be prevented by using well-established biomedical interventions. Logistical and socio-cultural barriers continue, however, to undermine the successful prevention of MTCT (PMTCT). In this paper, we review reports on maternal, neonatal and child health, as well as HIV care and treatment services that look at program incentives. SUMMARY These studies suggest that comprehensive PMTCT strategies aiming to maximize health-worker motivation in developing countries must involve a mix of both financial and non-financial incentives. The establishment of robust ethical and regulatory standards in public-sector HIV care centers could reduce barriers to PMTCT service provision in sub-Saharan Africa and help them in achieving universal PMTCT targets.
Collapse
Affiliation(s)
- Hapsatou Touré
- INSERM U897, Institut de Santé Publique d'Épidémiologie et de Développement (ISPED), Université Victor Segalen, 146 Rue Léo Saignat, 33000, Bordeaux, France
| | - Martine Audibert
- CNRS, Centre d'Etudes et de Recherches sur le Développement International (CERDI), Université d'Auvergne, 65 Boulevard François Mitterrand, 63000, Clermont-Ferrand, France
| | - François Dabis
- INSERM U897, Institut de Santé Publique d'Épidémiologie et de Développement (ISPED), Université Victor Segalen, 146 Rue Léo Saignat, 33000, Bordeaux, France
| |
Collapse
|
7
|
Kasenga F. Making it happen: prevention of mother to child transmission of HIV in rural Malawi. Glob Health Action 2010; 3:10.3402/gha.v3i0.1882. [PMID: 20606769 PMCID: PMC2896902 DOI: 10.3402/gha.v3i0.1882] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/10/2010] [Accepted: 05/19/2010] [Indexed: 11/15/2022] Open
Abstract
HIV and AIDS, in resource-limited settings, contribute to increased maternal and infant mortality where such vital indicators are already high. In these settings, babies born to HIV-positive women continue to have added risks of acquiring HIV infection and dying from it before their fifth birthdays if no interventions are employed. Prevention of mother-to-child transmission (PMTCT) is an international initiative whose implications within the local context need to be known. An operational research approach was adopted to study the demand and adherence of key components within the PMTCT Programme among women in rural Malawi. This study was carried out at Malamulo SDA Hospital in rural Malawi and employed the mixture of both quantitative and qualitative approaches. While the introduction of innovative policies in antenatal care (ANC) that has positive impact particularly on marginalised women's access to the services, negative effects are also inevitable. Marginalised women in resource-poor settings fail to deliver at the health facility due to lack of transportation, economic difficulties, gender inequalities, tradition and negative attitude of health workers. Integration of HIV testing and opt-out testing in ANC coupled with the introduction of free maternal care resulted in more women accessing maternal services and PMTCT services. It is as a result of this that institutional delivery facilitates increased adherence to antiretroviral prophylaxis and is supported by both women and the communities. The paper summarises the research conducted and elaborates on how it contributed to actions to improve staff attitude, increase male involvement in reproductive health care and discussions on how available resources can be maximised.
Collapse
Affiliation(s)
- Fyson Kasenga
- Department of Community Medicine, Malamulo SDA Hospital, Makwasa, Malawi
- Department of Health Ministries, Malawi Union of SDA Church, Blantyre, Malawi
| |
Collapse
|
8
|
Low prevalence rate of indeterminate serological human immunodeficiency virus results among pregnant women from Burkina Faso, West Africa. J Clin Microbiol 2010; 48:1333-6. [PMID: 20129958 DOI: 10.1128/jcm.01734-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid human immunodeficiency virus (HIV) antibody tests have been adopted into national guidelines for HIV testing in many countries in sub-Saharan Africa. One goal of HIV rapid testing is to minimize the occurrence of indeterminate results. From January 2005 to December 2007, plasma (or serum) samples from pregnant women in Bobo-Dioulasso (Burkina Faso, West Africa) were screened for HIV by using two rapid tests (the Determine HIV1/2 test [Abbott] and Genie II HIV-1/HIV-2 [Bio-Rad]) through a sequential algorithm prior to enrollment of HIV-1-infected women in a prevention of mother-to-child transmission (PMTCT) trial (WHO/ANRS 1289 Kesho Bora trial). Samples exhibiting indeterminate results (Determine positive and Genie II negative) were further tested with a fourth-generation HIV enzyme immunoassay (EIA) (Murex HIV Ag/Ab combination in 2005 and 2006 and Vironostika HIV Uni-Form II Ag/Ab in 2007). If positive, they were finally assessed for HIV-1 RNA (Generic HIV-1 RNA viral load assay; Biocentric). From a total of 44,653 samples tested, 597 (1.3%) showed indeterminate results. Of these, 367 could be analyzed by EIA. Only 15 (15/367, 4.1%) samples were found EIA reactive. Of these, 11 could be tested for HIV-1 RNA. All were HIV-1 RNA negative. In our clinical practice, pregnant women with such indeterminate results are now reassured during posttest counseling that they are very unlikely to be infected with HIV-1. As a consequence, such women with indeterminate results can reliably be considered negative when urgent clinical decisions (such as providing PMTCT prophylaxis) need to be taken.
Collapse
|