Prevention Of Mother-to-child Transmission Uptake Research Articles

Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality

BackgroundOver the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization’s (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda’s rapid uptake of these two EBIs developed or adapted during the study period.MethodsWe conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research.ResultsWe found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors.ConclusionImplementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis.

Prevention of mother-to-child transmission (PMTCT) of HIV service is conceptualized as a series of cascades that begins with all pregnant women and ends with the detection of a final HIV status in HIV-exposed infants (HEIs). A low rate of cascade completion by mothers' results in an increased risk of HIV transmission to their infants. Therefore, this review aimed to understand the uptake and determinants of key PMTCT services cascades in East Africa. We searched CINAHL, EMBASE, MEDLINE, Scopus, and AIM databases using a predetermined search strategy to identify studies published from January 2012 through to March 2022 on the uptake and determinants of PMTCT of HIV services. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. A random-effects model was used to obtain pooled estimates of (i) maternal HIV testing (ii) maternal ART initiation, (iii) infant ARV prophylaxis and (iv) early infant diagnosis (EID). Factors from quantitative studies were reviewed using a coding template based on the domains of the Andersen model (i.e., environmental, predisposing, enabling and need factors) and qualitative studies were reviewed using a thematic synthesis approach. The searches yielded 2231 articles and we systematically reduced to 52 included studies. Forty quantitative, eight qualitative, and four mixed methods papers were located containing evidence on the uptake and determinants of PMTCT services. The pooled proportions of maternal HIV test and ART uptake in East Africa were 82.6% (95% CI: 75.6-88.0%) and 88.3% (95% CI: 78.5-93.9%). Similarly, the pooled estimates of infant ARV prophylaxis and EID uptake were 84.9% (95% CI: 80.7-88.3%) and 68.7% (95% CI: 57.6-78.0) respectively. Key factors identified were the place of residence, stigma, the age of women, the educational status of both parents, marital status, socioeconomic status, Knowledge about HIV/PMTCT, access to healthcare facilities, attitudes/perceived benefits towards PMTCT services, prior use of maternal and child health (MCH) services, and healthcare-related factors like resource scarcity and insufficient follow-up supervision. Most of the identified factors were modifiable and should be considered when formulating policies and planning interventions. Hence, promoting women's education and economic empowerment, strengthening staff supervision, improving access to and integration with MCH services, and actively involving the community to reduce stigma are suggested. Engaging community health workers and expert mothers can also help to share the workload of healthcare providers because of the human resource shortage.

Determinants of uptake of PMTCT services by HIV positive mothers accessing care in Akure, Ondo State, Nigeria

BACKGROUND: Mother-to-child transmission (MTCT) of HIV remains a major public health challenge which account for substantial proportion of new HIV infections among children. Global interventional programme such as Prevention of mother to child transmission (PMTCT) of HIV has been initiated to protect children from the scourge of HIV pandemics. However, it is faced by multiple challenges in Africa. This study assessed the influencers of PMTCT services uptake among HIV-positive mothers in Akure.METHODS: A cross-sectional descriptive survey was employed using quantitative and qualitative design among 300 HIV positive pregnant and lactating mothers. Information on knowledge, awareness, and factors influencing uptake of PMTCT were collected using semi structured questionnaire. Data was analysed using SPSS v.20.RESULT: The average age of the respondents was 31.07 ±5.0 years with 77% being married. Majority (83%) were aware of PMTCT. The uptake level of PMTCT services was 89%. Knowledge on PMTCT (χ2 = 9.3, P value 0.002), Partner Support (χ2= 5.09, p=0.024), Religion (Christianity) (χ2=7.264, p=0.007), Occupation (unskilled) (χ2=12.6, p=0.002) were factors found to be significantly associated with the uptake of PMTCT services among HIV positive mothers.CONCLUSION: The uptake of PMTCT services among HIV positive mothers was high in Akure. Knowledge of the respondent on PMTCT, Partner Support, Religion and occupation were factors that influenced level of uptake of PMTCT service. Health workers should intensify quality counselling and health talks by taking time to explain extensively in English and their mother tongues

"I think this is the only challenge… the stigma" Stakeholder perceptions about barriers to Antenatal care (ANC) and Prevention of mother-to-child transmission (PMTCT) uptake in Kano state, Nigeria.

BackgroundDespite the progress made so far in reducing mother-to-child transmission (MTCT), Nigeria still contributes significantly to the global burden of new pediatric HIV infections. The elimination target for MTCT has not been reached and the decline in new infections among all Global Plan countries from 2009 to 2015 was lowest in Nigeria. This qualitative study explores the barriers to uptake of prevention of mother-to-child transmission (PMTCT) intervention in Kano, the second most populous state in Nigeria.MethodsKey informant interviews (KIIs) were conducted among twelve stakeholders who were purposively selected based on their knowledge and involvement in PMTCT program activities in the state. The KII guide explored the status and challenges of PMTCT uptake in Kano state. Qualitative data analysis was managed using NVIVO 11 software and themes were analyzed using thematic analysis.ResultsWe found that the key barriers to uptake of PMTCT identified by stakeholders cut across the domains of the socio-ecological model. These include—fear of stigma associated with being seen accessing HIV related services, low male partner involvement, socio-cultural beliefs about the dangers of hospital-based delivery, poor attitude of health workers, distance/cost to facilities, issues with availability of HIV test kits and poor organization of health services.ConclusionThe implementation of effective PMTCT programs would require innovative strategies that leverage improvement of Antenatal care (ANC) uptake as an entry point for PMTCT. In addition, sustaining engagement in care requires creating a supportive stigma-free environment in the community as well as spousal support to ensure women can navigate the socio-cultural barriers that limit access to health services.

Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016.

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 of PMTCT.

"My Life is Spoiled Because of Him…" A Qualitative Study of Human Immunodeficiency Virus Disclosure and Male Involvement in Prevention of Mother-to-Child Transmission Program.

Background:India has the third largest human immunodeficiency virus (HIV) epidemic in the world, with 15,000 newborns infected every year. Prevention of mother-to-child transmission (PMTCT) services can eliminate new HIV infections. Nondisclosure of positive HIV status and nonoptimal uptake of PMTCT are related. Therefore, understanding different aspects of HIV disclosure are necessary for program managers and careproviders for prevention and support.Objective:The present research explores HIV disclosure narratives, the family's perspective, and theoretical framework in the context of PMTCT.Methods:A qualitative study was conducted among 31 (16 mothers and 15 fathers) utilizers of PMTCT at an urban antiretroviral therapy center. A semi-structured in-depth interview guide based on disclosure process model (DPM) was used to explore HIV disclosure goals and outcomes by both members of parental dyad. The recorded interviews were transcribed verbatim, translated into English, and analyzed with Atlas.ti software. Directed content analysis was used to code data according to “a priori” and emerging themes. Demographic data were analyzed using descriptive statistics.Results:Limited disclosure is a necessity for pregnant women and their male partners for approach coping with HIV diagnosis and pursuing positive support for PMTCT adherence. Interpersonal, society, and community contextual outcomes affect the care uptake and future likelihood of disclosure.Conclusions:DPM suggestions from the present study can be used to facilitate a goal-directed process that allows parents/PLWHA to selectively disclose their HIV status to family members and acquaintances for obtaining maximum support to eliminate newborn HIV infections while minimizing distress, stigma, and discrimination.

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria Ms. Iboro Nelson Abstract The global community has adopted Prevention of Mother-To- Child Transmission (PMTCT) of HIV as the first entry point of care to eliminating new pediatric infections. In the absence of any intervention, the possibility of HIV transmission often runs between 15 - 45% and can be reduced to below 5% with effective PMTCT intervention. However, not much attention is given to analyze the human resource requirements to scale up PMTCT services. Meanwhile, WHO‘s Alma Ata Declaration states that ―primary health care shall rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community‖. Over the years, this has been neglected and the results have been continued shortage of needed manpower to deliver health services to the people where it matters most. Using disaggregated data of frontline healthcare workers, TBAs‘ distribution as well as service utilization data across the State of Akwa Ibom of Nigeria between 2010-2015, the paper seeks to demonstrate the effectiveness of integration of traditional birth attendants (TBAs) into healthcare service delivery. Key findings from the analysis show that while ANC attendance has increased over the period under review, facility deliveries within the same period dwindled while non-facility deliveries on the otherhand increased. Secondly, with a nurse to population ratio of 1:2,067 compared with TBAs to population ratio of 1:1,883, there is a great shortage of manpower to meet the universal professional and skilled birth delivery targets especially in the face of dwindling resources for health in developing countries including Nigeria. Thus, engaging TBAs is achievable and effective in improving MNCH services and increasing PMTCT uptake. Full Text: PDF DOI: 10.15640/jeds.v6n2a5

Adolescent Access to Care and Risk of Early Mother-to-Child HIV Transmission

PurposeAdolescent females aged 15–19 account for 62% of new HIV infections and give birth to 16 million infants annually. We quantify the risk of early mother-to-child transmission (MTCT) of HIV among adolescents enrolled in nationally representative MTCT surveillance studies in South Africa. MethodsData from 4,814 adolescent (≤19 years) and 25,453 adult (≥20 years) mothers and their infants aged 4–8 weeks were analyzed. These data were gathered during three nationally representative, cross-sectional, facility-based surveys, conducted in 2010, 2011–2012, and 2012–2013. All infants were tested for HIV antibody (enzyme immunoassay), to determine HIV exposure. Enzyme immunoassay-positive infants or those born to self-reported HIV-positive mothers were tested for HIV infection (total nucleic acid polymerase chain reaction). Maternal HIV positivity was inferred from infant HIV antibody positivity. All analyses were weighted for sample realization and population live births. ResultsAdolescent mothers, compared with adult mothers, have almost three times less planned pregnancies 14.4% (95% confidence interval [CI]: 12.5–16.5) versus 43.9% (95% CI: 42.0–45.9) in 2010 and 15.2% (95% CI: 13.0–17.9) versus 42.8% (95% CI: 40.9–44.6) in 2012–2013 (p < .0001), less prevention of MTCT uptake (odds ratio [OR] in favor of adult mothers = 3.36, 95% CI: 2.95–3.83), and higher early MTCT (adjusted OR = 3.0, 95% CI: 1.1–8.0), respectively. Gestational age at first antenatal care booking was the only significant predictor of early MTCT among adolescents. ConclusionsInterventions that appeal to adolescents and initiate sexual and reproductive health care early should be tested in low- and middle-income settings to reduce differential service uptake and infant outcomes between adolescent and adult mothers.

Prevention of mother-to-child transmission of HIV services in China: A conversation between healthcare professionals and migrant women with HIV

ABSTRACTIn China, the access to prevention of mother-to-child transmission (PMTCT) of HIV services is particularly low among migrant population, which remains a challenge in the fight against HIV/AIDS. The study is aimed to investigate the PMTCT continuum for migrant women with HIV (MWHIV) and to identify barriers and potential strategies to improve the service delivery. The study started with a first round of focus group discussions with 20 healthcare professionals to map out the local PMTCT service cascade, followed by in-depth interviews with 20 recently delivered MWHIV to explore their perceived barriers along each step of the cascade, and a final round of focus groups with healthcare professionals to identify potential strategies to improve the PMTCT continuum. Lack of knowledge of antenatal care, stigma and discrimination in healthcare settings, inadequate provider–patient communication were major barriers hindering the PMTCT service utilization. Potential strategies to enhance the PMTCT uptake included broader publicity to the general population and using mobile phone application for health education. The issues of HIV-designated hospital and integration of postpartum and neonatal care were also discussed. The study allowed the healthcare professionals to recognize the service gaps along the PMTCT continuum and identified potential solutions for service improvement.

Modeling the Impact of Retention Interventions on Mother-to-Child Transmission of HIV: Results From INSPIRE Studies in Malawi, Nigeria, and Zimbabwe.

Six implementation research studies in Malawi, Nigeria, and Zimbabwe tested approaches for improving retention in care among women living with HIV. We simulated the impact of their interventions on the probability of HIV transmission during pregnancy and breastfeeding. A computer-based state-transition model was developed to estimate the impact of the retention interventions. Patient-level data from the 6 studies were aggregated and analyzed, and weighted averages of mother-to-child transmission (MTCT) of HIV probabilities were presented. The average MTCT probability of the more successful interventions was applied to national estimates to calculate potential infections averted if these interventions were taken to scale. Among the total cohort of 5742 HIV-positive women, almost 80% of all infant infections are attributed to the roughly 20% of HIV-positive pregnant and breastfeeding women not retained on antiretroviral therapy. Higher retention in the arms receiving interventions resulted in an overall lower estimated MTCT probability of 9.9% compared with 12.3% in the control arms. In the 2 studies that showed a statistically significant effect, Prevention of MTCT Uptake and Retention (PURE) and Mother Mentor (MoMent), the difference in transmission rates between intervention and control arms was 4.1% and 7.3%, respectively. Scaling up retention interventions nationally in the 3 countries could avert an average of almost 3000 infant infections annually. Linking HIV-positive pregnant women to antiretroviral therapy and retaining them is essential for addressing the remaining gaps and challenges in HIV/AIDS care and the elimination of MTCT. At national level, even modest improvements in retention translates into large numbers of infant infections averted.

The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

Scale up use of family planning services to prevent maternal transmission of HIV among discordant couples: a cross-sectional study within a resource-limited setting.

BackgroundIntegration of family planning services (FPS) into human immunodeficiency virus (HIV) care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT) strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services.MethodsWe conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART) use, delivery option, and infant nourishment to be adopted. P-values below 0.05 were considered statistically significant in the statistical analyses.ResultsOf 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported abortions, 65% had tried to avoid the current pregnancy, and 12% of women were ART naïve. Several predictors such as education, abortion rate, unplanned pregnancies, and partners’ decision were associated with the nonuse of effective contraceptive methods. Moreover, barriers including sex inequity, lack of partner support, ART shortages, and lack of HIV viral load monitoring were prevalent among the participants (P=0.001). However FPS use, ART compliance, and safe options to PMTCT significantly increased after the educational counseling interventions (P=0.001).ConclusionScaling up the FPS by incorporating routine PMTCT services into reproductive health care should contribute to preventing both horizontal and vertical transmission of HIV.

Experience of HIV voluntary counseling and testing in antenatal women at a tertiary health centre of North India

Background: Integrating routine HIV counseling and testing as a mandatory part of antenatal care in India has led all pregnant women enter into the prevention of mother to child transmission (PMTCT) of HIV program. Despite such strategies, the effective execution and uptake of these programs remains a major obstacle. It is thus, important to understand the experiences of pregnant women undergoing HIV testing to detect the flaws on the part of the provider and the benefiter and eliminate them to strengthen the PMTCT services. Aim: We studied the acceptability of HIV voluntary counseling and testing (VCT) in antenatal women attending a tertiary health center of the North India. The impact of the sociodemographic factors on HIV prevalence and uptake of PMTCT was also studied, and the possible reasons for dropouts were determined. Methods: Pretest counseling was performed, and sociodemographic data and blood samples were collected from the consenting antenatal pregnant women. Samples were tested for HIV antibodies as per the World Health Organization guidelines. Data were analyzed and presented as mean, percentages, and tables. Results: Of 30,150 pregnant women counseled, 23,464 (77.82%) underwent testing. 136/23,464 women tested seropositive. The prevalence of HIV in antenatal women was found to be 0.58%. The majority of these women were young and belonged to the age group 20–24 years (0.23%). 22% refused testing, the reasons for which were sought. Strong associations were found between the HIV seroreactive status and marital status, low education status, low social class, high parity, and unemployment. Conclusion: To eliminate pediatric transmission of HIV and to create more awareness regarding HIV infection and MTCT, there is a need to make VCT and PMTCT programs more acceptable to the population. The observations found in the study were consistent with the national projections.

Shame, guilt, and stress: Community perceptions of barriers to engaging in prevention of mother to child transmission (PMTCT) programs in western Kenya.

While global scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has been expansive, only half of HIV-infected pregnant women receive antiretroviral regimens for PMTCT in sub-Saharan Africa. To evaluate social factors influencing uptake of PMTCT in rural Kenya, we conducted a community-based, cross-sectional survey of mothers residing in the KEMRI/CDC Health and Demographic Surveillance System (HDSS) area. Factors included referrals and acceptability, HIV-related stigma, observed discrimination, and knowledge of violence. Chi-squared tests and multivariate regression analyses were used to detect stigma domains associated with uptake of PMTCT services. Most HIV-positive women (89%) reported blame or judgment of people with HIV, and 46% reported they would feel shame if they were associated with someone with HIV. In multivariate analyses, shame was significantly associated with decreased likelihood of maternal HIV testing (Prevalence Ratio 0.91, 95% Confidence Interval 0.84-0.99), a complete course of maternal antiretrovirals (ARVs) (PR 0.73, 95% CI 0.55-0.97), and infant HIV testing (PR 0.86, 95% CI 0.75-0.99). Community perceptions of why women may be unwilling to take ARVs included stigma, guilt, lack of knowledge, denial, stress, and despair or futility. Interventions that seek to decrease maternal depression and internalization of stigma may facilitate uptake of PMTCT.

Community health workers to improve antenatal care and PMTCT uptake in Dar es Salaam, Tanzania: a quantitative performance evaluation.

Background:Home visits by community health workers (CHW) could be effective in identifying pregnant women in the community before they have presented to the health system. CHW could thus improve the uptake of antenatal care (ANC), HIV testing, and prevention of mother-to-child transmission (PMTCT) services.Methods:Over a 16-month period, we carried out a quantitative evaluation of the performance of CHW in reaching women early in pregnancy and before they have attended ANC in Dar es Salaam, Tanzania.Results:As part of the intervention, 213 CHW conducted more than 45,000 home visits to about 43,000 pregnant women. More than 75% of the pregnant women identified through home visits had not yet attended ANC at the time of the first contact with a CHW and about 40% of those who had not yet attended ANC were in the first trimester of pregnancy. Over time, the number of pregnant women the CHW identified each month increased, as did the proportion of women who had not yet attended ANC. The median gestational age of pregnant women contacted for the first time by a CHW decreased steadily and significantly over time (from 21/22 to 16 weeks, P-value for test of trend <0.0001).Conclusions:A large-scale CHW intervention was effective in identifying pregnant women in their homes early in pregnancy and before they had attended ANC. The intervention thus fulfills some of the conditions that are necessary for CHW to improve timely ANC uptake and early HIV testing and PMTCT enrollment in pregnancy.

"Barriers to Uptake and Effective Integration of PMTCT into SRH Services in Selected Health Facilities in Nairobi County, Kenya"

Introduction: Prevention of Mother to child transmission (PMTCT) of HIV for a long time has been implemented as standalone programs. Recently, there has been increasing awareness and discussion on possible benefits of integrating Sexual and Reproductive Health (SRH) and PMTCT services to reduce mother to child transmission of HIV. Aims and objectives: To identify barriers to PMTCT uptake and assesses challenges experienced in integration of PMTCT with SRH services. Material and methods: The study employed mixed methods of study design and three stage cluster sampling strategy to recruit 340 HIV positive postnatal mothers. Twelve key informants were purposively selected from all selected study facilities. A structured questionnaire and a focus group discussion guide were used to obtain information from postnatal HIV infected mothers on barriers to PMTCT uptake. Key informants interview guides (KIIs) were used to obtain information from hospitals administrators and PMTCT staff on barriers to effective intergration of SRH and PMTCT services. Data collected using questionnaires was analysed using Statistical Package for Social Sciences (SPSS) version 17. Qualitative data from key informants was analysed using Microsoft office excel. Observation and results: Lack of partners support, stigma and discrimination were reported as the main hindrances to PMTCT uptake. Inadequate staffing and lack of specialized training was reported as a barrier to PMTCT and SRH services integration. Conclusion: Barriers to PMTC integration with SRH programme can be eliminated by addressing shortage of staff, equipping staff with specialized knowledge and skills on SRH and PMTCT.

Stakeholders' perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi.

BackgroundMale Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively.MethodsAn exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face to face Key Informant Interviews (KIIs) with health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analysed using thematic content analysis.ResultsParticipants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman’s domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors.ConclusionsThe factors that may hinder or promote MI arise from different sources. The success of MI lies on recognizing sources of barriers and averting them. Factors that promote MI need to be implemented at different levels of health care.

Timing of Maternal HIV Testing and Uptake of Prevention of Mother-to-Child Transmission Interventions Among Women and Their Infected Infants in Johannesburg, South Africa

By 2011, South African prevention of mother-to-child transmission (PMTCT) of HIV programs had reduced perinatal HIV transmission at 6 weeks of age to 2.7%. We investigated the profile of newly diagnosed vertically infected children and their mothers to identify shortfalls in the PMTCT program. In this operational follow-up study, fieldworkers enrolled mothers of newly diagnosed HIV-infected children up to 2 years of age at 5 major health care facilities in Johannesburg. Structured questionnaires and clinical record reviews were conducted and analyzed to describe the population and assess factors associated with PMTCT uptake. Two hundred eighty-nine mother-child pairs were enrolled. Timing of maternal HIV diagnosis influenced PMTCT access and feeding choices and was associated with infants' age at HIV diagnosis (7 vs. 11 vs. 31 weeks where mothers tested before, during, or after the pregnancy, respectively; P < 0.0001). Women diagnosed before pregnancy (12%) were older (median, 31 years) than those diagnosed during the index pregnancy (53%; median, 27 years). Women diagnosed after delivery (35%) were younger (median, 25 years, P < 0.0001), of lower parity, and less likely to be South African citizens. In 81 cases (29%), late maternal diagnosis precluded any PMTCT access. Where women were diagnosed during or before pregnancy, the recommended PMTCT guidelines for mother and infant were followed in 86 (61%) pairs. Failure to diagnose maternal HIV infection before delivery was the main reason for missing PMTCT prophylaxis and early infant testing. Timely maternal diagnosis enables PMTCT uptake, but implementation and follow-up gaps require attention to improve infant outcomes.

Monitoring prevention of mother-to-child transmission in Botswana

Background In Botswana, the prevention of mother-to-child transmission (PMTCT) programme has succeeded in reducing rates of transmission of HIV from mother to child since the start of the national antiretroviral (ARV) programme in 2002. Methods Data on PMTCT interventions for women who delivered at Nyangabgwe Referral Hospital (NRH), the second largest hospital in Botswana, from 2003 to 2012 were collected from maternity registers. Results Of 46 354 women, 33% were HIV-positive, 58% were HIV-negative, and 9% were not tested. The percentage of women with a known HIV status increased from 50% in 2003 to 97% in 2012. PMTCT uptake for women on any ARV increased from 61% in 2003 to 86% in 2012. Infants given azidothymidine (AZT) and nevirapine prophylaxis increased from 61% to 85%. Conclusions Review of maternity registers demonstrated improvement of multiple PMTCT interventions at NRH. This is a useful approach for monitoring programme quality and guiding strategic planning.

Barriers to male involvement in uptake of Prevention-of-Motherto-Child-Transmission (PMTCT) of HIV in Sub-Saharan Africa

Sub-Saharan Africa continues to bear the burden of HIV/AIDS in the world, with countries like Ethiopia, Congo, Eritrea, and Nigeria constituting the highest percentages of the burden. Women and children are the most affected. Nigeria was reported second on the list of countries with the highest number of people living with HIV/AIDS (PLWHA) which was 3.5 million in 2011 including pregnant women. Despite the fact that the prevention of mother-to-child-transmission of HIV/AIDS (PMTCT) services is provided free in Sub-Saharan Africa, research shows inadequate uptake. This study identifies reasons for low uptake of PMTCT associated with male involvement and provides evidence from the literature on best practices to overcome low male involvement. A literature search was conducted and 22 articles were selected for this review. Findings revealed that if men participated in PMTCT programs and supported their wives, uptake could increase. Important barriers to male involvement identified were fear of stigmatization and the belief that men should not participate in female reproductive health.