The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience (original) (raw)
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The aim of this study was to establish the barriers to the uptake of Prevention of Mother to Child Transmission (PMTCT) services by women in rural Blantyre and Balaka districts in Malawi. Methods: A qualitative study was conducted with data collected through in-depth interviews and focus group discussions. A total of 52 participants were interviewed. Results: The main barriers to uptake of the PMTCT services were: stigma and discrimination against those with HIV-infection, opposition from male partners commonly leading to divorce, long waiting time at voluntary counseling and testing centres, fear of being bewitched, cost of infant feeds and lack of privacy and confidentiality when a woman joins a PMTCT programme. Conclusion: In order to promote utilization of PMTCT services by HIV-infected women, male involvement need to be enhanced. In addition to this, there is need to raise awareness of PMTCT services in the community, enhance provision of free infant supplementary feeds, prolong breastfeeding and improve services in health care facilities such as reduction of waiting time, improve confidentiality, provision of quality counselling services including couple counselling.
Texila International Journal of Public Health, 2019
Objectives: The aim of this study was to investigate and understand the barriers that contribute to successful uptake and implementation of Prevention of Mother to Child Transmission (PMTCT) services for pregnant and breastfeeding mothers at Mulanje Mission Hospital in Malawi. Methods: A Qualitative study was conducted with data collected through in-depth interviews and focus group discussions. A total of 64 participants were interviewed. Results: The main barriers to uptake and implementation of PMTCT services were stigma and discrimination against those infected with HIV, traditional and religious beliefs, long waiting time at PMTCT clinic, lack of male involvement, opposition from male partner leading to divorce and gender-based violence and lack of privacy due to non-conducive infrastructure. Conclusion: In order to promote successful uptake and implementation of PMTCT service, male involvement in reproductive issues has to be enhanced by raising community awareness. In addition, HIV testing and counseling should also be an agenda of community awareness so that women should not wait to be pregnant and then go for testing. Issues of stigma and discrimination should be dealt with during campaign and community meeting with chiefs. Staffing in health facilities should be improved to minimize the waiting time and also improve the quality of care given.
Barriers to accessing PMTCT services in a rural area of South Africa
African Journal of AIDS Research, 2005
Despite good intentions and commitment from providers, prevention-of-mother-to-child-transmission of HIV (PMTCT) services can be difficult for pregnant women to access, despite the provision of free health services for women and children. We examined the introduction of PMTCT services in a very poor rural area of the Eastern Cape, South Africa, to assess the context's impact on the provision of this service. Our approach involved 13 individual in-depth interviews and 26 focus group discussions, spread over six clinics in a single district, supplemented by situational observations. Our goal was to suggest how access to PMTCT services at the clinics may be improved.
Barriers and facilitators to PMTCT in Nkhoma Malawi
Prior to 2011, uptake of PMTCT in Malawi remained low despite increased access to antiretrovirals. We sought to understand barriers to PMTCT in rural Malawi. Twenty-two HIV-infected pregnant and postpartum women in PMTCT programs were interviewed in Nkhoma, Malawi, between April-May 2010. All women were staged by WHO criteria or CD4 count as ineligible for three-drug treatment by Malawi's HIV Guidelines at the time. The median age was 26 years (range 22-39) and 77% were married. Barriers to accessing PMTCT care included transportation to clinic, stigma in the community leading to avoidance of HIV disclosure, food insecurity, and providers' attitudes towards HIV-infected pregnant women. Given Malawi's transition to Option B+ for PMTCT in which women are initiated on antiretroviral therapy (ART) during pregnancy and continued for life, strategies to improve access and retention will need to address barriers and incorporate facilitators that motivate and retain women in HIV care. Afr J Reprod Health 2013 (Special Edition); 17[4]: 118-129).
BMC Health Services Research, 2010
Background: As in other resource limited settings, the Ministry of Health in Zambia is challenged to make affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the introduction of context-specific interventions. Methods: Interventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September 2008. Data was checked for internal and external consistency using logic built into databases used for data management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre-and post-intervention. Results: Uptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and 99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29% to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in the percentage of HIV positive pregnant women referred for clinical care. Conclusions: Uptake of PMTCT services in resource-limited settings can be improved by utilizing innovative alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships with the government. These health system based approaches provide a sustainable improvement in the capacity and uptake of services.
Maxwell Manuscript, 2023
Background: Globally, HIV pandemic remains a public health concern. HIV can be transmitted from mother to child either during pregnancy, labor, delivery, or breastfeeding. Presently, developing countries including Cameroon accord importance to the prevention of mother to child transmission. Despite this effort and commitment to the provision of access to prevention of mother to child transmission of HIV (PMTCT), annual HIV positive births are still being recorded. On this basis, this study aimed to examine the factors influencing the utilization of PMTCT services among antenatal mothers at the Bonassama District Hospital. Methods: A descriptive cross-sectional design was used to assess 92 participants who were included by convenient sampling. Data was collected with a structured quwationnaire, analyzed with MS Excel 2010 and results presented on frequency tables, bar and pie charts. Results: The results show that 74 women (80%) had knowledge on PMTCT, while main factors influencing PMTCT included financial difficulty (63%), infant feeding choices (55%), and distance from health facility (48%), stigmatization (31%), and poor health workers' attitude (30%). Conclusion and recommendations: More needs to be done to eliminate the barriers to achieve better results. This underscores the need to prioritize and target HIV prevention efforts in disproportionately affected communities and ensure that both individual and social determinants of risk are considered in the design and implementation of prevention efforts and formulation of policies. Infant feeding counseling should be reinforced and PMTCT services made more accessible and affordable. Keywords: PMTCT services, influence, utilization
Reproductive Health
Introduction: Although progressive improvements have been made in the coverage and quality of prevention of HIV/AIDS mother-to-child transmission (PMTCT) services in Ethiopia, the national coverage remained persistently low. Analysis of the cascaded PMTCT services can reveal the advancements made and the biggest hurdles faced during implementation. Objective: To examine the progresses and unaddressed needs in access and utilization of PMTCT services in Ethiopia from 2006 to 2010 thereby developing best-fit regression models to predict the values of key PMTCT indicators at critical future points.