Abstract
BackgroundCôte d’Ivoire continues to struggle with one of the highest rates of mother-to-child HIV transmission in West Africa, previously thought to be in part due to suboptimal workforce patterns. This study aimed to understand the process through which workforce patterns impact prevention of mother-to child transmission of HIV (PMTCT) program success, from the perspective of healthcare workers in Côte d’Ivoire.MethodsA total of 142 semi-structured interviews were conducted with physicians, midwives, nurses, community counselors, social workers, pharmacists, management personnel and health aides from a nationally representative sample of 48 PMTCT sites across Côte d’Ivoire.ResultsHealthcare workers described three categories of workforce patterns that they perceived to be affecting PMTCT success: workforce inputs, healthcare roles and responsibilities, and facilitators of task performance. According to their descriptions, PMTCT success depends on the presence of an adequate and trained PMTCT workforce, with an interdisciplinary team of healthcare workers with flexible roles and expanded task responsibilities, and whose tasks are translated into patient care through collaboration, ongoing trainings, and appropriate motivators.ConclusionsThis study provides a model for understanding the impact of workforce patterns on PMTCT success in Côte d’Ivoire and provides insight into workforce-related facilitators and barriers of program performance that should be targeted in future research and interventions. It highlights the importance of workforce integration and collaboration between healthcare workers.
Highlights
Côte d’Ivoire continues to struggle with one of the highest rates of mother-to-child Human immunodeficiency virus (HIV) transmission in West Africa, previously thought to be in part due to suboptimal workforce patterns
A model of impact of workforce patterns on prevention of mother-to child transmission of HIV (PMTCT) When asked about major facilitators and barriers of Option B, participants described a broad variety of factors at multiple levels of influence, including at the health system, community, clinic, and interpersonal and individual levels
Based on these categorizations and the way in which Healthcare worker (HCW) described their impact on PMTCT success, the model presented in Fig. 1 and detailed further in Fig. 2 was developed
Summary
Côte d’Ivoire continues to struggle with one of the highest rates of mother-to-child HIV transmission in West Africa, previously thought to be in part due to suboptimal workforce patterns. This study aimed to understand the process through which workforce patterns impact prevention of mother-to child transmission of HIV (PMTCT) program success, from the perspective of healthcare workers in Côte d’Ivoire. HIV-positive mothers have up to a 45% chance of transmitting the infection to their children [1] With appropriate treatment, such as that delivered through prevention of mother-to-child transmission (PMTCT) programs, these odds can be reduced to nearly zero [2]. This simplifies the infant protocol, allowing all infants to be treated with the same 4–6 weeks of therapy (either nevirapine or azidothymidine) regardless of the feeding method
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