Maternal Influences on Access to and Use of Infant ARVs and HIV Health Services in Uganda

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Study Justification:
– Vertical transmission of HIV is a significant contributor to new HIV cases in sub-Saharan Africa.
– Barriers to accessing and using antiretroviral medications (ARVs) for HIV-positive women and their infants perpetuate the epidemic.
– Understanding the influences on access to and use of infant HIV health services is crucial for developing effective interventions.
Study Highlights:
– 80% of HIV-positive women in Uganda administered nevirapine to their infants within 72 hours of birth.
– Factors associated with nevirapine administration included maternal adherence to ARVs and attending a support group.
– Non-health facility births were inversely related to nevirapine use.
– Focus group discussions identified four themes impacting access and use: attending a support group, health care worker attitudes, lack of partner support, and poor health messaging regarding ARVs.
Recommendations for Lay Reader and Policy Maker:
– Improve health care worker messaging regarding ARVs to ensure accurate and comprehensive information is provided to HIV-positive women.
– Provide women with the necessary support to access and use infant ARV prophylaxis, addressing barriers such as lack of partner support.
– Encourage HIV-positive women to attend support groups, as they have been found to be associated with increased nevirapine administration.
– Promote health facility births to increase the likelihood of nevirapine use.
Key Role Players:
– Health care workers: Responsible for providing accurate and comprehensive information about ARVs to HIV-positive women.
– Support group facilitators: Provide emotional support and education to HIV-positive women, encouraging nevirapine administration.
– Policy makers: Develop and implement policies that support access to and use of infant ARVs, addressing barriers identified in the study.
Cost Items for Planning Recommendations:
– Training programs for health care workers on effective messaging regarding ARVs.
– Support group resources, including facilitators and materials.
– Awareness campaigns to promote health facility births and increase nevirapine use.
– Monitoring and evaluation systems to assess the impact of interventions and ensure their effectiveness.

Vertical transmission of HIV is responsible for about 14 % of new HIV cases reported each year in sub-Saharan Africa. Barriers that prevent women from accessing and using antiretroviral medications (ARVs) for themselves and their infants perpetuate the epidemic. To identify influences on access to and use of infant HIV health services, specifically nevirapine administration, we conducted a mixed methods study among HIV-positive women in Uganda. This included a cross-sectional survey (n = 384) and focus group discussions (n = 6, 5–9 participants each). Of the 384 women, 80 % gave nevirapine to their infants within 72 h of birth. Factors independently associated with nevirapine administration were lack of maternal adherence to ARVs (AOR 3.55, 95 % CI 1.36–9.26) and attending a support group (AOR 2.50, 95 % CI 1.06–5.83). Non-health facility births were inversely related to nevirapine use (AOR 0.02, 95 % CI 0.003–0.09). Focus group discussions identified four themes impacting access and use: attending a support group, health care worker attitudes, lack of partner support, and poor health messaging regarding ARVs. Improving health care worker messaging regarding ARVs and providing women with needed support to access and use infant ARV prophylaxis is critical to overcoming access barriers. Eliminating these barriers may prevent numerous HIV infections each year saving the lives of many HIV-exposed infants.

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Based on the information provided, the following innovations can be developed to improve access to maternal health:

1. Strengthening Support Groups: Establish and expand support groups for HIV-positive women, specifically targeting pregnant women and new mothers. These support groups can provide a safe and supportive environment where women can share experiences, receive emotional support, and access information on maternal health, including the importance of nevirapine administration.

2. Enhancing Health Worker Training: Conduct comprehensive training programs for healthcare workers, focusing on improving their knowledge and attitudes towards ARVs and maternal health. This training should emphasize the importance of clear and accurate messaging to pregnant women and new mothers, ensuring they understand the benefits and procedures for nevirapine administration.

3. Partner Involvement Strategies: Develop strategies to actively involve partners in the maternal health process. This can include educational campaigns targeting partners, encouraging their support and understanding of the importance of ARV prophylaxis for both the mother and the infant.

4. Implementing Health Messaging Campaigns: Implement targeted health messaging campaigns to raise awareness about ARVs and their role in preventing vertical transmission of HIV. These campaigns should utilize various communication channels, including community outreach programs, radio broadcasts, and posters in healthcare facilities, to reach a wide audience of pregnant women and their families.

By implementing these innovations, it is expected that access to and use of infant ARVs and HIV health services will improve, leading to a reduction in vertical transmission of HIV and saving the lives of many HIV-exposed infants.
AI Innovations Description
Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health:

Title: Strengthening Support Systems and Health Worker Messaging to Improve Access to Maternal HIV Health Services in Uganda

Description: To address the barriers preventing women from accessing and using antiretroviral medications (ARVs) for themselves and their infants in Uganda, it is recommended to develop an innovation that focuses on strengthening support systems and improving health worker messaging. This innovation should aim to provide women with the necessary support and information to access and use infant ARV prophylaxis effectively.

Key Components of the Innovation:

1. Support Groups: Establish and expand support groups for HIV-positive women, specifically targeting pregnant women and new mothers. These support groups can provide a safe and supportive environment where women can share experiences, receive emotional support, and access information on maternal health, including the importance of nevirapine administration.

2. Health Worker Training: Conduct comprehensive training programs for healthcare workers, focusing on improving their knowledge and attitudes towards ARVs and maternal health. This training should emphasize the importance of clear and accurate messaging to pregnant women and new mothers, ensuring they understand the benefits and procedures for nevirapine administration.

3. Partner Involvement: Develop strategies to actively involve partners in the maternal health process. This can include educational campaigns targeting partners, encouraging their support and understanding of the importance of ARV prophylaxis for both the mother and the infant.

4. Health Messaging Campaigns: Implement targeted health messaging campaigns to raise awareness about ARVs and their role in preventing vertical transmission of HIV. These campaigns should utilize various communication channels, including community outreach programs, radio broadcasts, and posters in healthcare facilities, to reach a wide audience of pregnant women and their families.

By implementing this innovation, it is expected that access to and use of infant ARVs and HIV health services will improve, leading to a reduction in vertical transmission of HIV and saving the lives of many HIV-exposed infants.
AI Innovations Methodology
Methodology to Simulate the Impact of the Recommendations:

1. Study Design: Conduct a pre- and post-intervention study design to assess the impact of the recommendations on improving access to maternal health. This design will allow for a comparison of outcomes before and after the implementation of the innovation.

2. Sample Selection: Randomly select a representative sample of HIV-positive pregnant women and new mothers in Uganda. Ensure that the sample size is sufficient to detect significant changes in access to and use of infant ARVs and HIV health services.

3. Data Collection: Administer a structured questionnaire to collect quantitative data on key indicators such as nevirapine administration, attendance at support groups, partner involvement, and health worker messaging. Additionally, conduct focus group discussions to gather qualitative data on the experiences and perceptions of the participants regarding the barriers and facilitators to accessing and using infant ARVs.

4. Intervention Implementation: Implement the recommended innovation, including establishing and expanding support groups, conducting health worker training programs, involving partners in the maternal health process, and implementing health messaging campaigns.

5. Post-Intervention Data Collection: Repeat the data collection process after the implementation of the innovation using the same questionnaire and focus group discussion methodology.

6. Data Analysis: Analyze the quantitative data using appropriate statistical methods, such as chi-square tests or logistic regression, to assess the impact of the intervention on key indicators. Analyze the qualitative data using thematic analysis to identify common themes and patterns related to access to and use of infant ARVs.

7. Comparison of Pre- and Post-Intervention Results: Compare the results from the pre- and post-intervention data collection to determine the impact of the recommendations on improving access to maternal health. Assess changes in nevirapine administration rates, attendance at support groups, partner involvement, and health worker messaging.

8. Interpretation of Findings: Interpret the findings to determine the effectiveness of the recommendations in improving access to and use of infant ARVs and HIV health services. Identify any challenges or limitations encountered during the implementation of the innovation.

9. Recommendations for Scale-Up: Based on the findings, provide recommendations for scaling up the innovation to other regions or countries, if applicable. Consider the feasibility, cost-effectiveness, and sustainability of the intervention.

10. Dissemination of Results: Publish the findings in a peer-reviewed journal or present them at conferences to contribute to the existing knowledge on improving access to maternal health and preventing vertical transmission of HIV.

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