The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya (original) (raw)
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PloS one, 2018
Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner...
Background: Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provides a unique opportunity for the implementing prevention of mother-to-child transmission (PMTCT) programs against HIV infection of newborn babies. Objective: To identify factors affecting Knowledge of prevention of mother to child transmission of HIV services among pregnant women attending antenatal clinic in Bungoma County Referral Hospital. Methodology: A cross-sectional study was conducted among pregnant mothers attending antenatal care clinic at Bungoma County Referral Hospital. A systematic random sampling technique was used to select 50 respondents, using Fisher et al, 1999. The data was collected using structured interviewer administered questionnaire prepared to address knowledge, and associated factors on PMTCT services. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Findings: A big number (40%) of the mothers did not know about PMTCT services which were being offered in the hospital. It was noted that the respondents who had little or no knowledge of the services were mostly below 25 years of age and those with low education levels. On the attitude towards PMTCT services it was found that (44%) reported that it is good to take on PMTCT services if reactive and (56%) of respondents reported that PMTCT services are wastage of time because AIDS has no cure. Conclusion: The educational level was the most important factor in understanding PMCTC services Recommendation: To improve and increase sensitization and awareness to the communities on what PMTCT program entails.
Tropical Medicine & International Health, 2010
Objectives To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration-intervention project for Safe Motherhood and prevention of mother-to-child transmission of HIV in Kenya.Methods Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single-dose nevirapine (sd-NVP).Results About half of women in rural and urban settings (52.2% and 49.2%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30% (5894/19 432) of women. By mid-2006, provision of nevirapine to HIV-positive women had increased from 32.5% and 11.7% in rural and urban clinics, to 67.0% and 74.6%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate.Conclusion Provision of ANC services, including sd-NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence-based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.
Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019
Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother’s unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake...
Prevention of mother-to-child transmission of HIV in Kenya: challenges to implementation
Bmc Health Services Research, 2014
Background: The prevention of mother-to-child transmission of human immunodeficiency virus (HIV) is lauded as one of the more successful HIV prevention measures. However, despite some gains in the prevention of mother-tochild transmission of HIV (PMTCT) in sub-Saharan Africa, mother-to-child transmission rates are still high. In Kenya, mother-to-child transmission is considered one of the greatest health challenges and scaling up PMTCT services is crucial to its elimination by 2015. However, guideline implementation faces barriers that challenge scale-up of services. The objective of this paper is to identify barriers to PMTCT implementation in the context of a randomized control trial on the use of structured mobile phone messages in PMTCT. Methods: The preliminary analysis presented here is based on survey data collected during enrolment in PMTCT services at one of two health facilities in Nairobi, Kenya, with overall number of antenatal care (ANC) visits determined from 48 hour follow up data. Results: Data was collected for 503 women. Despite significant differences in the type of facility and sample characteristics between sites, all women presented to care at 20 weeks gestation or later and 88.8% attended less than four ANC visits. PMTCT counselling at first visit had high coverage (86%), however less than a third of women (31.34%) reported receiving contraception counselling. Although 60.8% of women had reportedly disclosed their status to their partners, only 40% were aware of their partner's status. Very few women had been tested for TB (10%) or received single dose nevirapine during their first antenatal care appointment (20%). Conclusion: Revised PMTCT guidelines aim to reduce the inequity between PMTCT services in high and low resource settings in efforts to eliminate mother-to-child transmission. However, guideline implementation in low resource settings continues to be confronted with challenges related to late presentation, less than four ANC visits, low screening rates for opportunistic infections, and limited contraception counselling. These challenges are further complicated by lack of disclosure to partners. Effective scale up and implementation of PMTCT services requires that such ongoing program challenges be identified and appropriately addressed within the local context.
Journal of Medicine, Physiology and Biophysics, 2015
Background: The transmission of the Human Immune Deficiency Virus (HIV) from mother to child during pregnancy, birth and breastfeeding period is the most common way of HIV infection in children. Prevention of Mother to Child Transmission (PMTCT) of HIV program is aimed at reducing the Mother to Child Transmission of HIV. The study aimed at exploring and describing factors which affect compliance to the utilization of PMTCT service package among HIV positive mothers who delivered outside a health facility. Methods: The study adopted a descriptive qualitative study design and entailed in-depth interviews with the HIV positive postnatal mothers attending the maternal child health and family planning clinic (MCH/FP) at Turbo Health Centre as key informants. The interviews were taped with a voice recorder, transcribed and analysed using NVivo computer software for qualitative research to document emerging themes. Results: Four themes emerged from the results as follows 1) Knowledge of P...
International Journal of Maternal and Child Health and AIDS (IJMA)
Background: Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework. Methods: A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and ch...
2022
Background: It has been estimated that 90 per cent of paediatric HIV is through mother-to-child transmission, and the incidence of mother-to-child transmission is 40% among HIV positive pregnant women. Research has shown a reduction in the risk of mother-to-child transmission of HIV (MTCT) to less than 2% to 5% in non-breastfeeding and breastfeeding mothers respectively with the introduction of PMTCT services such as; reproductive health services, family planning services, HIV counseling and testing/partner counselling and referral services (PCRS), antiretroviral drugs for infected women and children, safe delivery services, infant feeding options and support, early infant diagnosis within six weeks, PCR (polymerase chain reaction) test done six weeks after cessation of breast feeding, and community support. These services may be available but certain factors may interfere with their access and utilization by HIV positive pregnant women. This study therefore sought to determine factors that predict the utilization of PMTCT services among HIV positive pregnant women in Taraba State, Nigeria. Methods: The study adopted a mixed-method research design employing an institutional based cross sectional design. The population for the study consisted of 3,315 HIV positive pregnant women attending Antenatal Clinic and their service providers. Cluster random sampling technique was used to select facilities for the study. Convenience random sampling technique was used to select 605 HIV positive pregnant women (HIV positive pregnant women who were present during antenatal clinic days, who give their consent will be included in the study). The key informants for the study were selected using purposive sampling technique. A questionnaire and Key informant interview protocol were used for data collection. Percentages, Chi-square and logistic regression analyses were used to analyze the quantitative data while the qualitative data were thematically analyzed using Nvivo software. Results: Demographic factors of age, education, marital status and distance were associated with PMTCT services utilization, however, only age was a predictor of PMTCT services utilization (p≤0.05). Conclusion: The study concluded that some demographic factors (age, occupation, educational level) are associated with PMTCT services utilization, while only age predicted HIV positive pregnant women's utilization of PMTCT services. This predictor could be addressed through health education especially among the older women, text message reminders and some incentives.
AIDS Patient Care and STDs, 2015
The aim of this study was to identify factors associated with prevention of mother-to-child transmission (PMTCT) in an area of Kenya with widely accessible free PMTCT services. A matched case-control study was conducted at 31 public facilities in western Kenya. HIV-infected mothers with infants aged 6 weeks to 6 months were interviewed and medical charts were reviewed. Cases were mothers of infants with a definitive diagnosis of HIV. Controls were mothers of infants testing HIV negative. Cases and controls were matched in a 1:3 ratio on socio-demographic factors. Fifty cases and 135 controls were enrolled. Conditional (matched) logistic regression analysis was conducted. Odds of being a case were higher for women who first learned their HIV status during pregnancy [OR:2.85, 95%CI:1.41-5.78], did not adhere to antiretroviral therapy (ART) [OR:3.35, 95%CI:1.48-7.58], or had a home delivery [OR:2.42, 95%CI:1.01-5.80]. Based on medical record review, cases had higher odds of their provider not following guidelines for prescription of ART for mothers [