Abstract
BackgroundHealth facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood.Methodology/Principal FindingsWe conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering.Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33–68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant.Conclusions/ResultsWe observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage.
Highlights
Despite the universal recognition of efficacious interventions and unprecedented resources to reduce MTCT, in 2009, only 26% of pregnant women living in low and middle income countries had been tested for HIV and among identified HIV-positive women, only an estimated 53% received an antiretroviral (ARV) regimen to prevent mother-to-child HIV transmission (PMTCT) [1]
We previously reported prevention of mother-to-child transmission of HIV (PMTCT) coverage in a survey among women delivering in 43 health facilities in Cameroon, Cote d’Ivoire, South Africa, and Zambia between 2007 and 2009 [5]
Description of the health facilities Cord blood and facility survey data were collected from 32 facilities (8 facilities in Cameroon, 9 facilities in Cote d’Ivoire, 6 in South Africa, and 9 in Zambia)
Summary
Despite the universal recognition of efficacious interventions and unprecedented resources to reduce MTCT (mother to child transmission), in 2009, only 26% of pregnant women living in low and middle income countries had been tested for HIV and among identified HIV-positive women, only an estimated 53% received an antiretroviral (ARV) regimen to prevent mother-to-child HIV transmission (PMTCT) [1]. A multi-site PMTCT effectiveness study in four African countries called PMTCT Effectiveness in Africa: Research and Linkages to Care (the PEARL Study) was conducted between 2007–2009, and found that coverage of nevirapine (NVP) among HIV-infected women delivering in health facilities with PMTCT services varied dramatically and was only 55% overall [5]. A better understanding of barriers to high PMTCT coverage is needed with the new 2010 World Health Organization (WHO) guidelines promoting more efficacious ARV combination regimens for women and extended infant prophylaxis during breastfeeding. Using data from the PEARL Study, we examine how facility and service characteristics predict maternal-infant coverage with NVP at the time of delivery. Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood
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