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Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?

ABSTRACT: BACKGROUND:Early initiation of combination antiretroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care, disease-stage assessment delays, and loss to follow-up. INTERVENTION:Our intervention had 3 components: integrated HIV and antenatal services in 1 location with 1 provider, laboratory courier to expedite CD4 counts, and community-based follow-up of women-infant pairs to improve prevention of mother-to-child transmission attendance. Preintervention HIV-positive pregnant women were referred to HIV clinics for disease-stage assessment and cART initiation for advanced disease (CD4 count <350 cells/?L or WHO stage >2). METHODS:We used a quasi-experimental design with preintervention/postintervention evaluations at 6 government antenatal clinics (ANCs) in Southern Province, Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Postintervention data were collected from all antiretroviral therapy-naive, HIV-positive pregnant women and their infants presenting to ANC from December 2011 to June 2013. RESULTS:Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. The proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% [relative risk (RR) = 1.81; 95% confidence interval (CI): 1.57 to 2.08; P < 0.01]. The proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR = 2.25; 95% CI: 1.78 to 2.83; P < 0.01). The proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8% (RR = 1.33; 95% CI: 1.18 to 1.51; P < 0.01). CONCLUSIONS:Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.

SUBMITTER: Herlihy JM

PROVIDER: S-EPMC6754251 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?

Herlihy Julie M JM Hamomba Leoda L Bonawitz Rachael R Goggin Caitlin E CE Sambambi Kennedy K Mwale Jonas J Musonda Victor V Musokatwane Kebby K Hopkins Kathryn L KL Semrau Katherine K Hammond Emily E EE Duncan Julie J Knapp Anna B AB Thea Donald M DM

Journal of acquired immune deficiency syndromes (1999) 20151201 4

<h4>Background</h4>Early initiation of combination antiretroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care, disease-stage assessment delays, and loss to follow-up.<h4>Intervention</h4>Our intervention had 3 components: integrated HIV and antenatal services in 1 location with 1 provider, laboratory courier to expedite CD4 counts, and community-based follow-up of women-infant pa ...[more]

PMID: 26181813

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Project description:BackgroundMother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programmes against HIV infection of newborn babies. This study aimed to investigate factors associated with the acceptability and utilization of PMTCT of HIV.MethodsAn institution based cross-sectional study was conducted in April 2010 using exit interviews with 843 pregnant women attending antenatal care (ANC) clinics of 10 health centers and two hospitals in Addis Ababa, Ethiopia. Trained nurses administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about MTCT, practice of HIV testing and satisfaction with the antenatal care services. Six focus group discussions among pregnant women and 22 in-depth interviews with service providers complemented the quantitative data.ResultsAbout 94% of the pregnant women visited the health facility for ANC check-up. Only 18% and 9% of respondents attended the facility for HIV counselling and testing (HCT) and receiving antiretroviral prophylaxis, respectively. About 90% knew that a mother with HIV can pass the virus to her child, and MTCT through breast milk was commonly cited by most women (72.4%) than transmission during pregnancy (49.7%) or delivery (49.5%). About 94% of them reported that they were tested for HIV in the current pregnancy and 60% replied that their partners were also tested for HIV. About 80% of the respondents reported adequacy of privacy and confidentiality during counseling (90.8% at hospitals and 78.6% at health centers), but 16% wished to have a different counselor. Absence of counselors, poor counselling, lack of awareness and knowledge about HCT, lack of interest and psychological unpreparedness were the main reasons cited for not undergoing HIV testing during the current pregnancy.ConclusionsHIV testing among ANC attendees and knowledge about MTCT of HIV was quite high. Efforts should be made to improve the quality and coverage of HCT services and mitigate the barriers preventing mothers from seeking HIV testing. Further research should be conducted to evaluate the uptake of antiretroviral prophylaxis among HIV-positive pregnant women attending ANC clinics.

Project description:BackgroundAccess to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+.ObjectiveTo assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti.MethodsLongitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan-Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition.ResultsAmong 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9-37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6-52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001).ConclusionsART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.

Project description:BackgroundThe mass scale-up of antiretroviral therapy (ART) in Zambia has taken place in the context of limited infrastructure and human resources resulting in many operational side-effects. In this study, we aimed to empirically measure current workload of ART clinic staff and patient wait times and service utilization.MethodsWe conducted time and motion (TAM) studies from both the healthcare worker (HCW) and patient perspectives at 10 ART clinics throughout Zambia. Trained personnel recorded times for consecutive discrete activities based on direct observation of clinical and non-clinical activities performed by counselors, clinical officers, nurses, and pharmacy technicians. For patient TAM, we recruited consenting patients and recorded times of arrival and departure and major ART services utilized. Data from 10 clinics were pooled to evaluate median time per patient spent for each activity and patient duration of stay in the clinic.ResultsThe percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4?min, interquartile range [IQR] 2-7), 46.1% for nurses (3?min, IQR 2-4), 57.2% for pharmacy technicians (2?min, IQR 1-2), and 78.5% for clinical officers (3?min, IQR 2-5). Patient workloads for HCWs were heaviest between 8?AM and 12?PM with few clinical activities observed after 2?PM. The length of patient visits was inversely associated with arrival time - patients arriving prior to 8?AM spent 61% longer at the clinic than those arriving after 8?AM (277 vs. 171?min). Overall, patients spent 219?min on average for non-clinical visits, and 244?min for clinical visits, but this difference was not significant in rural clinics. In comparison, total time patients spent directly with clinic staff were 9 and 12?min on average for non-clinical and clinical visits.ConclusionCurrent Zambian ART clinic operations include substantial inefficiencies for both patients and HCWs, with workloads heavily concentrated in the first few hours of clinic opening, limiting HCW and patient interaction time. Use of a differentiated care model may help to redistribute workloads during operational hours and prevent backlogs of patients waiting for hours before clinic opening, which may substantially improve ART delivery in the Zambian context.

Project description:BackgroundAdherence to antiretroviral therapy is very essential to achieve a great outcome of drugs via suppressing viral load, preventing multidrug resistance, and reducing mother to a child transmission rate of the Human Immune Virus.ObjectiveThis study aimed to assess the level of adherence to option B plus PMTCT and associated factors among HIV Positive pregnant and lactating women in public health facilities of Hawassa city, Southern Ethiopia, 2020 G.C.MethodsInstitution-based cross-sectional study was done on 254 HIV-positive pregnant and lactating women attending the prevention of mother-to-child transmission (PMTCT) follow-up. Participants were selected by simple random sampling. Data collected through a structured interviewer-administered questionnaire were cleaned and entered into Epi-data 3.1 and exported to SPSS 20 for statistical analysis. Descriptive analysis was done. Bivariable and multivariable logistic regressions were done to measure the strength of association between independent and dependent variables using the odds ratio and 95% of confidence interval. A p-value <0.05 was taken as statistically significant.ResultThe overall adherence level to option B+ was 224 (88.2%). Respondents in age group of ≤ 25 [AOR = 0.12, 95% CI (0.03, 0.42)], with no formal education [AOR = 0.12, 95% CI (0.03, 0.51)], experienced drug side effects [AOR = 0.11, 95% CI (0.04, 0.32)], have good knowledge of PMTCT [AOR = 3.6, 95% CI (1.16, 11.3)], and get support from partner/family [AOR = 4.5, 95% CI (1.62, 12.4)] were identified associated factors with adherence level.ConclusionThe level of adherence to option B plus PMTCT was 88.2% which is suboptimal. Ages, educational level, knowledge on PMTCT, getting support from partner/family, and drug side effect were significantly associated with adherence. Therefore, educating and counseling on the service of PMTCT to improve their knowledge and encouraging partner/family involvement in care are mandatory to achieve the standard adherence level.

Project description:Anemia is a major cause of morbidity and mortality of pregnant women and increases the risks of fetal and neonatal morbidity and mortality. Approximately 50% of all anemia is estimated to be caused by low dietary intake of iron, poor absorption of dietary iron, or blood loss. The objective of the present study was to determine the prevalence of and assess the dietary habits associated with anemia in pregnant women receiving antenatal care (ANC) in Unguja Island, Tanzania. A cross-sectional study was conducted to select 338 pregnant women at Kivunge, Mwembeladu, and Mnazimmoja hospitals from March to June 2018. Hemoglobin concentration was measured using a HemoCue photometer on capillary blood. Sociodemographic data and dietary habits were collected using a structured questionnaire. Multivariate logistic regression analysis was carried out to determine the predictors of anemia in pregnant women. The overall prevalence of anemia was 80.8%. Of these 68.64% had mild anemia, 11.24% had moderate anemia, and 0.89% had severe anemia. Anemia was significantly associated with inadequate dietary diversity [adjusted OR (AOR): 1.16; 95% CI: 0.57, 2.36; P < 0.05], drinking tea or coffee with a meal (AOR: 0.06; 95% CI: 0.03, 0.13; P < 0.001), consuming <3 meals/d (AOR: 2.92; 95% CI: 1.60, 5.84; P < 0.001), higher education level (AOR: 3.4; 95% CI: 1.6, 7.2; P < 0.0001), birth interval <2 y (AOR: 3.6; 95% CI: 1.1, 11.9; P < 0.05), and multigravida status (AOR: 1.2; 95% CI: 0.3, 4.4; P < 0.0001). The prevalence of anemia in this study demonstrates a severe public health problem among pregnant women. Inadequate dietary diversity coupled with inadequate daily meal intake and consumption of tea or coffee were the dietary habits predicting anemia in pregnant women. Other predictors of anemia were higher education level, multigravida status, and birth interval <2 y. Nutrition policy interventions are needed to complement ANC services by providing important information on healthy eating habits during pregnancy.

Project description:BackgroundIntimate partner violence (IPV) refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It is the most common form of violence in women's lives. According to a World Health Organization report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life. In the Gambia, about 62% of pregnant women experience at least one form of violence from an intimate partner. IPV has severe physical and mental health consequences on a woman ranging from minor bodily injury to death. It also increases the risk of low birth weight, premature delivery, and neonatal death.MethodsA health facility-based cross-sectional study design was carried out to assess the magnitude and factors associated with intimate partner violence among pregnant women seeking antenatal care in the rural Gambia. The study enrolled 373 pregnant women, and a multi-stage sampling technique was used to select the respondents. An interviewer-administered structured questionnaire was used to obtain information from the study participants. The collected data were analyzed using SPSS Ver.22. Bivariate and multivariate logistic regression were used to determine the association between dependent and independent variables. Odds ratio with 95% confidence interval (CI) was computed to determine the presence and strength of associated factors with IPV.ResultThe study reveals that the prevalence of IPV in The Gambia is 67%, with psychological violence (43%) being the most common form of IPV reported by the respondents. The multivariate logistic regression result reveals that being aged 35 years or older [AOR 5.1(95% CI 1.5-17.8)], the experience of parents quarreling during childhood [AOR 1.7(95% CI 1.0-2.75)], and having cigarette smoking partners [AOR 2.3 (95% CI 1.10-4.6)] were significantly associated with IPV during pregnancy.ConclusionThis study has demonstrated that all forms of IPV in rural Gambia are frequent. Women older than 35 years, had experienced parents quarreling, had a partner who smoked, and a partner who fight with others were more likely report IPV compared to other pregnant women in the study. We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in rural Gambia.

Dataset Information

Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?

Publications

Implementation and Operational Research: Integration of PMTCT and Antenatal Services Improves Combination Antiretroviral Therapy Uptake for HIV-Positive Pregnant Women in Southern Zambia: A Prototype for Option B+?

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