Assessment of utilization of provider-initiated HIV testing and counseling as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women in Gondar town, North West Ethiopia

  • BMC Public Health, Volume 12, No. 1, Year 2012

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Study Justification:
The study aimed to assess the utilization of provider-initiated HIV testing and counseling (PITC) as an intervention for the prevention of mother-to-child transmission (PMTCT) of HIV and associated factors among pregnant women in Gondar town, North West Ethiopia. The justification for this study is that early detection of maternal HIV infection is crucial for preventing transmission to the child. While voluntary counseling and testing (VCT) has been the primary method for HIV awareness, its uptake is low in many parts of sub-Saharan Africa, including Ethiopia. Provider-initiated HIV testing and counseling provides an opportunity to diagnose HIV infection, initiate chronic care, and prevent mother-to-child transmission. However, little is known about its acceptance and associated factors among pregnant women in Ethiopia, particularly in Gondar town.
Study Highlights:
– A total of 400 pregnant women participated in the study.
– 82.5% of the women accepted provider-initiated HIV testing and counseling, while 17.5% refused.
– Factors positively associated with acceptance of PITC included a greater number of antenatal care visits, residing in urban areas, comprehensive knowledge on HIV, positive partner’s reaction to HIV positive result, and knowledge on prevention of mother-to-child transmission of HIV.
– Factors negatively associated with acceptance of PITC included increased maternal age and education level.
Study Recommendations for Lay Reader and Policy Maker:
1. Strengthen couple counseling and HIV testing to promote provider-initiated HIV testing and counseling among male partners.
2. Reduce HIV-related violence against women from their partners.
3. Improve access to and consistent use of antenatal care to increase the uptake of provider-initiated HIV testing and counseling services.
Key Role Players Needed to Address Recommendations:
1. Health institutions providing antenatal care services.
2. Health workers, including PMTCT counselors, with training in PITC.
3. Government agencies responsible for HIV/AIDS prevention and control.
4. Non-governmental organizations working in the field of HIV/AIDS.
Cost Items to Include in Planning the Recommendations:
1. Training programs for health workers on PITC and couple counseling.
2. Development and dissemination of educational materials on HIV prevention and PMTCT.
3. Strengthening of health facilities to provide comprehensive antenatal care services.
4. Awareness campaigns targeting pregnant women and their partners.
5. Monitoring and evaluation activities to assess the impact of the recommendations.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is described as a health institution based cross-sectional quantitative study, which provides a good foundation for gathering data. The sample size of 400 pregnant women is also adequate. The study uses multiple logistic regression analysis to identify factors associated with acceptance of provider-initiated HIV testing and counseling. However, the abstract does not provide information on the representativeness of the sample or the response rate, which could impact the generalizability of the findings. Additionally, the abstract does not mention any limitations of the study. To improve the evidence, it would be helpful to include information on the representativeness of the sample, the response rate, and any limitations of the study. This would provide a more comprehensive understanding of the study’s findings and increase the confidence in the results.

Background: Detection of maternal HIV infection early in pregnancy is critical for prevention of mother to child transmission of HIV/AIDS. Most efforts have focused on VCT as the primary means of encouraging people to become aware of their HIV status. However, its uptake is low in many parts of sub-Saharan Africa including Ethiopia. Provider-initiated HIV testing and counseling provides a critical opportunity to diagnose HIV infection, to begin chronic care, and to prevent mother to child transmission. However, little is known about its acceptance and associated factors among pregnant women in the country and particularly in the present study area. Methods: Health institution based cross-sectional quantitative study was conducted in Gondar town from July 22- August 18, 2010. A total of 400 pregnant women were involved in the study using stratified sampling technique and multiple logistic regression analysis was employed using SPSS version 16. Results: A total of 400 pregnant women actively participated in this study and 330 (82.5%) of them accepted provider-initiated HIV testing and counseling to be tested for HIV and 70(17.5%) of them refused. Acceptance of provider-initiated HIV testing and counseling was positively associated with greater number of antenatal care visits [Adj. OR (95%CI) = 2.64(1.17, 5.95)], residing in the urban areas[Adj. OR (95%CI) = 2.85(1.10, 7.41)], having comprehensive knowledge on HIV [Adj. OR (95%CI) = 4.30(1.72, 10.73)], positive partner’s reaction for HIV positive result [Adj. OR (95%CI) = 8.19(3.57, 18.80)] and having knowledge on prevention of mother to child transmission of HIV[Adj. OR (95%CI) = 3.27(1.34, 7.94)], but negatively associated with increased maternal age and education level. Conclusion: Utilization of provider-initiated HIV testing and counseling during antenatal care was relatively high among pregnant women in Gondar town. Couple counseling and HIV testing should be strengthened to promote provider-initiated HIV testing and counseling among male partners and to reduce HIV related violence of women from their partner and access to and consistent use of antenatal care should be improved to increase the uptake of provider-initiated HIV testing and counseling service. © 2012 Tilahun and Degu; licensee BioMed Central Ltd.

Health institution based cross-sectional quantitative study was conducted from July 22 August 18, 2010. The study was conducted in Gondar town which is located about 750km northwest from Addis Ababa the capital city of Ethiopia. The town has 12 administrations and a population of 220,184 and of this 51,963 was females of reproductive age group (1549years) with in the area of 41.27 square Km. There is one referral hospital and five health centers which offer ANC, PITC and PMTCT services in the town. The source population was all pregnant women attending antenatal care in public health facilities since these health facilities serve the majority of the population in ANC service especially the rural and poor population. The study population was all pregnant women attending antenatal care during the data collection period in public health facilities of Gondar town, Northwest Ethiopia. Antenatal care services for all pregnant women include: At least four focused antenatal care visits (1st as early in pregnancy as possible, 2nd at 2832weeks, 3rd after 36weeks, and 4th before expected date of delivery or when woman needs to consult), Routine laboratory diagnostic tests (hemoglobin, syphilis, HIV, glucose, and blood pressure), Tetanus toxoid vaccination, Malaria prevention and treatment, Infant feeding counseling with emphasis on exclusive breastfeeding for the first six months and counseling on danger signs of obstetric complications. The Government of the Federal Democratic Republic of Ethiopia is committed to reduce the spread of HIV/AIDS and address the consequences of the epidemic in the population. The national HIV/AIDS policy was enacted in 1998; and in 2001, the National HIV/AIDS Council declared HIV a national emergency. The National HIV/AIDS strategic framework calls for a multi-sectorial response, guaranteeing rights of all people living with HIV/AIDS, and facilitating the supply and use of antiretroviral drugs. Ethiopia has adopted the WHO/UNICEF/UNAIDS 4-pronged PMTCT strategy as a key entry point to HIV care for women, men and families. Prevention of mother-to-child transmission services began in 2003, but suffers from low utilization of antenatal care and delivery services; and only 0.8% of HIV infections among births to HIV positive mothers were averted in 2005/6 through PMTCT programs [14]. Five health centers and one hospital which offer ANC, PITC and PMTCT were included in the study. Stratified sampling technique was used to select the study units in each health institution. Based on the number of customers who visited each health institution during the previous ten months (monthly report of each health institution), proportional allocation of the total sample size was carried out to attain the required sample size in each health institution. Finally, the determined sample for each health institution was achieved through exit interview from systematically sampled and voluntarily consenting pregnant women with in four weeks of working days. Pregnant women attending antenatal care in health institutions of Gondar Town, Northwest Ethiopia during the data collection period was included in the study. All pregnant women who are unable to communicate (having hearing problem and unable to communicate with sign languages) were excluded from the study. Clinic staff who provided pretest counseling (primarily dedicated PMTCT counselors with more than 1year of experience) were trained to conduct PITC sessions and were provided with scripts on how to introduce the HIV test as part of a package of routine antenatal services including data collection and interview techniques. The PITC session included basic information about HIV transmission, PMTCT, and ARV therapy; a brief explanation of all tests done during ANC (hemoglobin, syphilis, HIV, glucose, and blood pressure); and a statement that all tests are routine but that patients have the right to refuse tests they do not want. A structured questionnaire which had been previously pre-tested and subsequently finalized after modification was used to elicit the following information from the study participants: socio-demographic data, knowledge of PMTCT of HIV, acceptability of PITC, number of antenatal care visits, comprehensive knowledge on HIV/AIDS, attitude towards PITC, risk perception of HIV, perceived benefit of HIV test, attitude towards counselors, partners reaction for HIV positive test result and stigmatizing attitude towards people having HIV/AIDS. The completeness and consistency of data was established through direct and daily supervision by the supervisor and principal investigator. Data coding, cleaning and verification were performed to assure quality of data. Sample size was determined using the formula of a single population proportion estimation and calculated using software Epi-info stat calc. by taking 59% proportion, 5% of absolute precision and with 95% confidence interval. Non-response rate in this study was estimated to be 10% i.e. 38, and hence an overall sample size of 410 Pregnant women were recruited in the study. Data were entered and analyzed using SPSS software version 16. Descriptive statistics such as frequencies and proportion was used to describe the study population in relation to relevant variables. Explanatory variables found to be statistically significant in bivariate logistic regression analysis were entered into multiple logistic regression analysis (backward stepwise method) for adjustment of confounders. Odds ratio, confidence interval and P-value were computed to assess the presence and degree of association between dependent and independent variables. Ethical clearance to conduct the study was obtained from Ethical Review Board, School of public health, University of Gondar and permission to conduct the study in each health facilities was secured from the respective Health institutions in Gondar Town. Verbal informed consent from each study participants was obtained after clear explanation about the purpose of the study.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources related to maternal health, including antenatal care, prevention of mother-to-child transmission of HIV, and HIV testing and counseling. These apps could provide educational materials, appointment reminders, and access to healthcare providers through telemedicine.

2. Community Health Workers: Train and deploy community health workers to provide outreach and education on maternal health, including the importance of antenatal care, HIV testing, and prevention of mother-to-child transmission of HIV. These workers can also provide support and guidance to pregnant women in accessing healthcare services.

3. Integration of Services: Improve integration of antenatal care, HIV testing, and counseling services within healthcare facilities. This could involve co-locating services, streamlining processes, and ensuring that healthcare providers are trained to provide comprehensive care.

4. Peer Support Programs: Establish peer support programs for pregnant women, particularly those at risk of HIV infection or living with HIV. These programs can provide emotional support, education, and guidance on accessing healthcare services.

5. Health Information Systems: Implement electronic health information systems to improve data collection, monitoring, and reporting on maternal health indicators. This can help identify gaps in service delivery and inform decision-making for targeted interventions.

6. Public-Private Partnerships: Foster partnerships between public and private sectors to improve access to maternal health services. This could involve leveraging private sector resources and expertise to expand service delivery, improve infrastructure, and enhance the quality of care.

7. Transportation Solutions: Address transportation barriers by implementing innovative transportation solutions, such as mobile clinics or community-based transportation services, to ensure pregnant women can access healthcare facilities for antenatal care and HIV testing.

8. Financial Incentives: Explore the use of financial incentives, such as conditional cash transfers or vouchers, to encourage pregnant women to seek antenatal care and HIV testing services. This can help overcome financial barriers and increase utilization of services.

9. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of antenatal care, HIV testing, and prevention of mother-to-child transmission of HIV. These campaigns can use various media channels, including radio, television, and social media, to reach a wide audience.

10. Quality Improvement Initiatives: Implement quality improvement initiatives within healthcare facilities to ensure that antenatal care and HIV testing services are delivered in a timely and respectful manner. This can involve training healthcare providers, improving infrastructure, and strengthening referral systems.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to strengthen and promote provider-initiated HIV testing and counseling (PITC) during antenatal care. The study conducted in Gondar town, North West Ethiopia found that the utilization of PITC was relatively high among pregnant women, but there is still room for improvement.

To increase the uptake of PITC, the following actions can be taken:

1. Strengthen couple counseling and HIV testing: Encourage male partners to participate in the counseling and testing process. This can help increase awareness and support for HIV testing among pregnant women.

2. Address HIV-related violence: Take measures to reduce HIV-related violence against women from their partners. This can help create a safe and supportive environment for women to access and utilize PITC services.

3. Improve access to and consistent use of antenatal care: Enhance the availability and accessibility of antenatal care services. This includes ensuring that pregnant women have regular and timely access to comprehensive antenatal care visits, which can facilitate the integration of PITC services.

4. Increase knowledge on HIV and prevention of mother-to-child transmission (PMTCT): Provide comprehensive education and information on HIV and PMTCT to pregnant women. This can help increase their knowledge and understanding of the benefits of PITC, leading to higher acceptance rates.

By implementing these recommendations, it is expected that access to maternal health, specifically through the utilization of PITC, will be improved, leading to better prevention of mother-to-child transmission of HIV/AIDS.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Strengthening provider-initiated HIV testing and counseling (PITC) services: Based on the study findings, the acceptance of PITC among pregnant women in Gondar town was relatively high. To further improve access to maternal health, it is recommended to continue and expand the implementation of PITC services in health facilities. This can be done by training healthcare providers on PITC protocols, ensuring the availability of necessary testing equipment and supplies, and promoting the benefits of early HIV detection and prevention of mother-to-child transmission.

2. Enhancing couple counseling and involvement: The study found that positive partner’s reaction to HIV positive results was associated with higher acceptance of PITC. To improve access to maternal health, it is important to involve male partners in the antenatal care process and encourage their participation in HIV testing and counseling. This can be achieved through targeted education and awareness campaigns, as well as providing support and resources for couple counseling services.

3. Improving knowledge on HIV and prevention of mother-to-child transmission: The study identified comprehensive knowledge on HIV and knowledge on prevention of mother-to-child transmission as factors positively associated with acceptance of PITC. To enhance access to maternal health, it is crucial to prioritize education and awareness programs that provide accurate and up-to-date information on HIV, its transmission, and prevention methods. This can be done through community-based initiatives, health promotion campaigns, and integration of HIV education into antenatal care services.

Methodology to simulate the impact of these recommendations on improving access to maternal health:

1. Define the target population: Identify the specific population group that will be the focus of the simulation, such as pregnant women attending antenatal care in Gondar town.

2. Collect baseline data: Gather relevant data on the current utilization of maternal health services, including PITC acceptance rates, number of antenatal care visits, knowledge levels on HIV and prevention of mother-to-child transmission, and other relevant factors.

3. Develop a simulation model: Create a mathematical or statistical model that incorporates the identified recommendations and their potential impact on improving access to maternal health. This model should consider factors such as the increase in PITC acceptance rates, changes in antenatal care utilization, and improvements in knowledge levels.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the potential impact of the recommendations. Vary the input parameters to explore different scenarios and assess the sensitivity of the model to changes in these parameters.

5. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. Assess the changes in PITC acceptance rates, antenatal care utilization, and knowledge levels, and identify any potential barriers or challenges that may arise.

6. Validate the model: Validate the simulation model by comparing the simulated results with real-world data, if available. This will help ensure the accuracy and reliability of the model in predicting the impact of the recommendations.

7. Communicate findings and make recommendations: Summarize the findings of the simulation and present them in a clear and concise manner. Use the results to make evidence-based recommendations for improving access to maternal health, taking into account the potential impact of the identified recommendations.

8. Monitor and evaluate: Implement the recommended interventions and closely monitor their implementation and impact. Continuously evaluate the progress and make adjustments as needed to ensure the desired improvements in access to maternal health are achieved.


Statistics:
Citations: 23
Identifiers:
DOI: 10.1186/1471-2458-12-226
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory, randomised-control-trial
Study Approach:
Quantitative
Participants Gender:
Male & Female
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