Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya

  • AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, Volume 22, No. 6, Year 2010

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Study Justification:
The study aimed to determine the rates and factors influencing the access to HIV care by HIV-infected women who were transitioning from maternal care to continuing care. This is important because as prevention of mother-to-child transmission of HIV (PMTCT) programs and HIV treatment programs expand, it is crucial to understand the barriers and facilitators in accessing care for these women.
Highlights:
– 82% of the women referred to HIV care programs were successfully traced and interviewed.
– 50% of the participants had changed residence since referral.
– 74% of the participants reported going to the referral HIV program.
– Lack of money, confidentiality concerns, and dislike of the facility were identified as reasons for not accessing care.
– Women who did not access care were less likely to have informed their partner of the referral and had lower belief in the effectiveness of highly active antiretroviral therapy (HAART).
– Among those who accessed care, 33% discontinued care mainly due to not qualifying for HAART.
– Barriers to access included stigma, denial, poor services, and lack of money.
– Factors making care attractive included health education, counseling, free services, and compassion.
Recommendations:
1. Promote partner involvement: Encourage women to inform their partners about the referral to HIV care programs, as this was found to be associated with higher access to care.
2. Standardize the referral process: Implement a standardized referral process to ensure smooth transitions between PMTCT and HIV care programs.
3. Provide comprehensive HIV education: Offer more comprehensive HIV education specifically for mothers diagnosed with HIV during pregnancy to increase their understanding and belief in the effectiveness of HAART.
Key Role Players:
– Peer counselors: Traced and interviewed the women, providing crucial information for the study.
– Healthcare providers: Involved in the referral process and provision of HIV care.
– Policy makers: Responsible for implementing standardized referral processes and allocating resources for comprehensive HIV education.
Cost Items for Planning Recommendations:
– Training and support for peer counselors
– Development and implementation of standardized referral processes
– Resources for comprehensive HIV education materials and programs
– Staffing and infrastructure for HIV care programs
– Monitoring and evaluation of the effectiveness of the recommendations

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional survey, which provides valuable information on rates and co-factors of accessing HIV care by HIV-infected women exiting maternal care. The sample size is not mentioned, which could affect the generalizability of the findings. The use of Fisher’s exact test to assess the association between client characteristics and access to care is appropriate. The study identifies several factors that influence access to care, such as lack of money, confidentiality, dislike of the facility, partner involvement, and beliefs about the effectiveness of antiretroviral therapy. However, the abstract does not provide detailed information on the methodology, limitations, or implications of the findings. To improve the strength of the evidence, the abstract could include information on the sample size, recruitment process, data collection methods, and statistical analysis techniques used. Additionally, discussing the limitations of the study and potential implications for policy and practice would enhance the overall quality of the evidence.

Background. As prevention of mother-to-child transmission of HIV (PMTCT) programs and HIV treatment programs rapidly expand in parallel, it is important to determine factors that influence the transition of HIV-infected women from maternal to continuing care. Design. This study aimed to determine rates and co-factors of accessing HIV care by HIV-infected women exiting maternal care. A cross-sectional survey of women who had participated in a PMTCT research study and were referred to care programs in Nairobi, Kenya was conducted. Methods. A median of 17 months following referral, women were located by peer counselors and interviewed to determine whether they accessed HIV care and what influenced their care decisions. Fisher’s exact test was used to assess the association between client characteristics and access to care. Results. Peer counselors traced 195 (82%) residences, where they located 116 (59%) participants who provided information on care. Since exit, 50% of participants had changed residence, and 74% reported going to the referral HIV program. Reasons for not accessing care included lack of money, confidentiality, and dislike of the facility. Women who did not access care were less likely to have informed their partner of the referral (p=0.001), and were less likely believe that highly active antiretroviral therapy (HAART) is effective (p<0.01). Among those who accessed care, 33% subsequently discontinued care, most because they did not qualify for HAART. Factors cited as barriers to access included stigma, denial, poor services, and lack of money. Factors that were cited as making care attractive included health education, counseling, free services, and compassion. Conclusion. A substantial number of women exiting maternal care do not transit to HIV care programs. Partner involvement, a standardized referral process and more comprehensive HIV education for mothers diagnosed with HIV during pregnancy may facilitate successful transitions between PMTCT and HIV care programs. © 2010 Taylor & Francis.

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Innovation 1: Partner Involvement
Encourage and support women to inform their partners about the referral to HIV care programs. Partner involvement can help overcome barriers such as stigma and denial, and increase the likelihood of accessing care.

Innovation 2: Standardized Referral Process
Establish a standardized referral process between maternal care and HIV care programs. This process should ensure that women receive clear and consistent information about the importance of accessing HIV care, the services available, and the steps to follow for a smooth transition.

Innovation 3: Enhanced HIV Education
Provide more comprehensive HIV education specifically tailored for mothers diagnosed with HIV during pregnancy. This education should address common misconceptions about HIV treatment, such as the effectiveness of highly active antiretroviral therapy (HAART), and emphasize the benefits of early and continuous care.

Innovation 4: Addressing Financial Barriers
Develop strategies to address financial barriers that prevent women from accessing HIV care. This could include providing financial assistance or subsidies for transportation, medication, and other related costs.

Innovation 5: Improved Services
Enhance the quality of HIV care services by addressing factors such as stigma, poor services, and lack of compassion. This could involve training healthcare providers to provide non-judgmental and supportive care, improving facility infrastructure, and ensuring confidentiality.

Innovation 6: Health Education and Counseling
Offer ongoing health education and counseling services to women accessing HIV care. This can help address concerns, provide emotional support, and reinforce the importance of continued engagement in care.
AI Innovations Description
Based on the study mentioned, here is a recommendation that can be used to develop an innovation to improve access to maternal health:

Title: Enhancing Transitions from Maternal Care to HIV Care Programs: A Comprehensive Approach

Recommendation: Implement a comprehensive approach to improve access to HIV care for HIV-infected women transitioning from maternal care. This approach should include the following components:

1. Partner Involvement: Encourage and support women to inform their partners about the referral to HIV care programs. Partner involvement can help overcome barriers such as stigma and denial, and increase the likelihood of accessing care.

2. Standardized Referral Process: Establish a standardized referral process between maternal care and HIV care programs. This process should ensure that women receive clear and consistent information about the importance of accessing HIV care, the services available, and the steps to follow for a smooth transition.

3. Enhanced HIV Education: Provide more comprehensive HIV education specifically tailored for mothers diagnosed with HIV during pregnancy. This education should address common misconceptions about HIV treatment, such as the effectiveness of highly active antiretroviral therapy (HAART), and emphasize the benefits of early and continuous care.

4. Addressing Financial Barriers: Develop strategies to address financial barriers that prevent women from accessing HIV care. This could include providing financial assistance or subsidies for transportation, medication, and other related costs.

5. Improved Services: Enhance the quality of HIV care services by addressing factors such as stigma, poor services, and lack of compassion. This could involve training healthcare providers to provide non-judgmental and supportive care, improving facility infrastructure, and ensuring confidentiality.

6. Health Education and Counseling: Offer ongoing health education and counseling services to women accessing HIV care. This can help address concerns, provide emotional support, and reinforce the importance of continued engagement in care.

By implementing this comprehensive approach, it is expected that more women will successfully transition from maternal care to HIV care programs, leading to improved access to maternal health and better health outcomes for both mothers and their children.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, you could consider the following methodology:

1. Study Population: Select a representative sample of HIV-infected women who have recently transitioned from maternal care to HIV care programs in Nairobi, Kenya.

2. Data Collection: Conduct interviews with the selected women to gather information on their experiences and factors influencing their access to HIV care. This can include questions about partner involvement, knowledge about HIV treatment, referral process, financial barriers, quality of services, and other relevant factors.

3. Quantitative Analysis: Analyze the collected data using statistical methods such as Fisher’s exact test to assess the association between client characteristics and access to care. This will help identify the factors that significantly influence access to HIV care.

4. Qualitative Analysis: Conduct thematic analysis of the interviews to gain a deeper understanding of the barriers and facilitators to accessing care. This can involve identifying common themes and patterns in the women’s experiences and perceptions.

5. Simulation: Use the findings from the quantitative and qualitative analysis to simulate the impact of implementing the main recommendations. This can involve creating hypothetical scenarios where the recommendations are implemented and assessing the potential improvements in access to maternal health.

6. Evaluation: Evaluate the simulated impact by comparing the outcomes of the hypothetical scenarios with the current situation. This can include measuring the percentage of women accessing HIV care, identifying any improvements in partner involvement, referral process, HIV education, financial barriers, service quality, and overall satisfaction with care.

By following this methodology, you can gain insights into the potential impact of implementing the main recommendations on improving access to maternal health for HIV-infected women transitioning from maternal care to HIV care programs.

Statistics:
Citations: 48
Authors: 6
Identifiers:
DOI: 10.1080/09540120903373565
ISSN: 09540121
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Kenya
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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