Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

SAGE Open Medicine, Volume 9, Year 2021

Interpretação

Objective: Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach. Methods: This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019. Results: Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators. Conclusion: Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention. This is a descriptive cross-sectional case study that employed modified normative evaluation based on Donabedian’s model of healthcare quality. 1 The modified normative evaluation is an evaluation procedure where standards as per Ghana’s guidelines for HIV management are compared with the prevailing situation in the various study sites. The modified normative evaluation emphasizes context-specific evaluation approach as against a one-size-fits-all. 26 In this study, the approach was used to assess quality of HIV care in the selected ART sites using patient clinical records according to Ghana’s guidelines for HIV management. For the purpose of this paper, only the input and process indicators of healthcare quality are reported. The study was conducted in Ho, Hohoe and Jasikan districts in the Volta and Oti regions. Volta and Oti regions are 2 of the 16 administrative regions in Ghana. Per the 2010 population and housing census, the population of Jasikan, Hohoe and Ho Municipal were 59,181; 262,046 and 271,881 respectively. 27 Three HIV Sentinel sites offering ART services as at June, 2019 were purposively selected from the three administrative districts. The three purposively selected ART sites were Jasikan District Hospital (rural), Hohoe Municipal Hospital (peri-urban) and Ho Teaching Hospital (urban). All these facilities are national sentinel sites for HIV management with fully functioning ART clinics. The target population size is the of clinical records of 1,500 PLHIV from the three ART sites at the time of conducting this study. Thus, Ho Teaching Hospital (N = 745), Hohoe Municipal Hospital (N = 450), and Jasikan District Hospital (N = 305). This ART site is hosted in a 240-bed capacity tertiary hospital under the Ministry of Health. It serves as the regional referral health facility in its catchment area including neighbouring Republic of Togo. The hospital records are averagely 160 daily attendance. Healthcare services provided include outpatient/inpatient services, dental, eye, family planning, mental health, maternal and child health, surgical, physiotherapy, radiography, herbal Medicine, pharmacy, internal medicine, laboratory, ART clinic and mortuary services. This ART site is hosted in a 178-bed secondary referral hospital under the Ghana Health Service (GHS). Average daily attendance is 150. Services provided in this secondary hospital include outpatient/admissions, pharmacy, laboratory, dental, physiotherapy, medical imaging, antenatal, maternity, surgical, ART, eye and mortuary services. This ART site is hosted in a 53-bed secondary hospital also under the GHS. Average daily out-patient attendance is 165. Services provided include outpatient/admissions, pharmacy, laboratory, pharmacy, X-ray, antenatal, maternity, ART, eye and other specialized services. Target study population was all registered PLHIV above the age of 18 years enrolled in ART for at least six (6) months. Sample size for the clinical records review was 384 from all the three ART sites. The sample size was calculated using the formula: n = Z²PQ/d² where: n = sample size; Z = statistic for a 95% Confidence Interval; P = expected outcome; Q = complement of P and d = precision (fixed at 5%). Based on findings from a study conducted in Nigeria, 28 it was found that approximately 49% of PLHIV rated quality of service delivery as excellent. Thus, an expected outcome of 49% rated satisfaction was used for the sample size determination. At the time of conducting this study there was no known data on similar studies in Ghana hence reliance on evidence in Olowookere et al. 28 with the following assumed parameters: P (expected outcome = 0.487); Q (1 P = 1- 0.487 = 0.513); n = Z²PQ/d²; (1.96) 2 x 0.487 x 0.513/ (0.05); 2 = 383.84 ≈ 384. Final selection of the sample was done using multi-stage sampling to allocate sample sizes to the ART sites. Percentage share of PLHIV in the Ho Teaching Hospital, Hohoe Municipal Hospital and Jasikan District are 50%, 30% and 20% respectively. Based on these proportions, the sample size allocation through quota system was as follows: Ho Teaching Hospital (50/100*384 = 191), Hohoe Municipal Hospital (30/100*384 = 115), and Jasikan District Hospital (20/100*384 = 79). Subsequently, clinical record reviews were conducted on all the 384 sampled PLHIV in each of the ART sites. Healthcare providers (n = 16) directly involved in the care of PLHIV were also purposively sampled and engaged through interviews to ascertain the providers’ perspectives on the quality of ART services. PLHIV enrolled in ART for at least 6 months, age 18 years or more, access care in the three ART sentinel sites and voluntarily agreed to participate in the study. The study excluded PLHIV who were lost to follow-up for over a year; those who were transferred in or out of selected ART sites, and those who visited the clinic for the first time on the day of data collection. Patients with Tuberculosis co-morbidities were equally excluded. A modified normative evaluation tool based on an adapted Donabedian’s input–process–outcome model of health care quality. 28 Ghana’s guideline for HIV management informed data collection instrument items for the process and outcome quality indicators. Inventory data extraction tool designed according to the national resource requirement for the management of HIV in Ghana was used to assess input quality indicators. Adherence to ARVs was measured by dividing the number of people enrolled in ART and consistently took their ARVs without default (through pill count) over the total number of enrolled patients and multiplied by 100. The authors, however, acknowledge the limitations of using pill counts as a proxy for ARVs adherence. Pill count is highly subject to bias and might not account for missed doses due to falls and stock piling at home. 29 Face validity was done by giving data collection tools/extraction forms to independent reviewers in the field of HIV to determine whether questions measured the indicators of interest as per Donabedian 1 validated test items for measuring medical technical quality. Tools were also pre-tested in a comparable health facility in the Volta region to address ambiguity in questions and typographical errors to enhance internal validity. Also, all tool items were developed based on the study objectives alongside strict monitoring during the data collection, entry, cleaning and analysis. Data collection in all the three ART sites lasted approximately 3 months from 11 March to 9 May 2019. In terms of the input quality indicators, availability of resources was assessed through inventory data extraction according to the national resource requirement for the management of HIV in Ghana. Health staff who were in-charge of various resources such as head of Pharmacy, Laboratory, Medical Superintendent and Health Services Administrators were interviewed for secondary data verification. Data collection technique entailed review of patient management records using data extraction tools. The steps were as follows: first, patient folder numbers (i.e manual folders or electronic folders through e-tracker) were used to retrieve medical records for data extraction on adherence to national guidelines and outcome of care. In addition, availability of resources was checked with requirements of the Ghana National AIDS and Sexually Transmitted Infections (STIs) Control Programme (NACP). Data on outcome indicators of quality care were from clients’ clinical records and client satisfaction survey tools administered on site. Field data were coded, cleaned and analysis done with SPSS-IBM Version 22. Descriptive Statistics were generated including Chi-square and Fisher’s Exact tests to ascertain associations between variables as appropriate. Summary statistics were generated for continuous variables, percentages and frequency distributions were generated for categorical variables. In addition, after an orthogonal unrotated Principal Component Analysis (PCA), 8 out of the 32 items were retained for final analysis. Subsequently, summary statistics (means and standard deviations) were used to ascertain the average responses of patients on the Likert-type scale items. Test for statistical significance was set at 95% confidence level. Normality testing of data was done in GraphPad Prism to check for distribution, skewness and kurtosis before analysis. Visual inspection of data was done on SPSS-IBM to check for missing data and normality. Data from the semi-structured interviews with health staff was captured, cleaned and coded using SPSS -IBM Version 22. Analysis strategy was mainly descriptive statistics to demonstrate staff perspectives on the quality of ART services in the three ART sites. Since the variables of interest were mainly quantitative measures in nature, the data collection approach was quantitative. Input indicators: Proxies for input indicators were centred on resource availability. For the purposes of this study the input factors were: resource availability including antiretroviral medicines, laboratory reagents, equipment, trained healthcare providers and logistics. Process indicators: On the other hand, process quality indicators were determined based on adherence to national guidelines for HIV diagnostic and treatment and Donabedian’s model for service quality. 1 These indicators were reviewed by clinicians working on the HIV control programme as well as those providing HIV care in the facilities to promote institutional relevance of the tool. Medication adherence as operationalized in this study ranged from treatment initiation to maintenance of a particular therapeutic medication regimen to control viral replication and improving immune system function. Discontinuity or cessation of part or all of the treatment in instances of missing doses, drug holidays, overdosing or under-dosing is referred to as non-adherence. Outcome indicators: Outcome quality indicators were measured using technical and functional quality proxies. The technical quality measures were patients’ adherence to medication and clinical improvement in functional status based on objective documentation in the clients’ clinical folders. Functional outcome quality care dimensions were client satisfaction scores on dimensions of healthcare quality. Total of 32 client perceived service quality indicators were developed based on national guidelines for HIV care and adapted Donabedian’s structure-process-outcome model of health care quality. After principal component analysis (PCA), the 32 factors were further scaled down to eight (8), comprising of patient satisfaction with general services; technical quality; interpersonal relations; communication; financial accessibility; time spent with clinical team; accessibility and convenience and other patient satisfaction factors. Five-point Likert-type scale used to measure satisfaction levels ranging from 1 = ‘Very dissatisfied’ – 5 ‘Very satisfied’. This study was granted ethical approval by the Ghana Health Service (GHS) Ethical Review Committee (ERC) (clearance number: GHS-ERC009/08/19). Administrative approvals were also sought from the respective health facility heads. To promote anonymity of the study sites, codes used in place of participants’ names to guarantee their privacy and confidentiality. Collated data was kept on a password protected computer and kept with the Principal Investigator. Participation in the study was voluntary and participants were told to discontinue from the study anytime they so wish without consequences. Only participants who voluntarily signed the informed consent form were allowed to participate in the study. Participation in the study was voluntary and were told to discontinue from the study anytime they so wish without consequences. Only participants who voluntarily signed the informed consent form were allowed to participate in the study. Written informed consent was obtained from all subjects. In the case of minors (persons below 18 years), written informed consent from legally authorized representatives (locus parentis) was obtained before they were included in the study. Please see Supplementary File 1 for Consent Forms for the various study respondents.

AI Digest

Study Justification:

– The study aimed to determine the quality of antiretroviral therapy (ART) services in selected ART sites in Ghana.
– The study used the input-process-outcome approach to assess the quality of HIV care.
– The study focused on resource-constrained settings, such as Ghana, where the number of People Living with HIV (PLHIV) is high and the unmet need for ART is significant.
– The study aimed to identify gaps in the quality of care and provide recommendations to improve the HIV response in Ghana.

Study Highlights:

– Resources for managing HIV clients were largely available, but there were shortages of viral load machines, reagents for CD4 counts, and antifungals.
– The study found that 71% of patients were enrolled on ART within 2 weeks, and 90% of clients were retained in care within 2 weeks of enrollment.
– Approximately 26% of enrolled clients achieved viral load suppression.
– 33% of PLHIV who were not insured with the National Health Insurance Scheme had to pay for some antiretrovirals and cotrimoxazole.
– Adherence to ART and cotrimoxazole were high, with 95% and 88% adherence rates, respectively.
– Patients rated time spent with the clinical team as one of the worst quality indicators, while interpersonal relationships with health providers were among the best rated indicators.

Recommendations:

– Address the shortages of viral load machines, CD4 count reagents, and antifungals to ensure comprehensive HIV care.
– Promote policy dialogue on the inclusion of medications for prophylaxis in ART on the National Health Insurance Scheme to improve adherence and retention.
– Improve the quality of patient-provider interactions and increase the time spent with the clinical team to enhance patient satisfaction and overall quality of care.

Key Role Players:

– Ministry of Health: Responsible for policy development and resource allocation.
– Ghana Health Service: Oversees the implementation of healthcare services, including HIV care.
– National AIDS Control Program: Provides guidance and support for HIV prevention and treatment programs.
– Health facility heads: Responsible for the management and coordination of HIV care services at the facility level.
– Healthcare providers: Involved in the direct care of PLHIV and play a crucial role in delivering quality ART services.

Cost Items for Planning Recommendations:

– Procurement of viral load machines, CD4 count reagents, and antifungals.
– Training and capacity building for healthcare providers.
– Patient education and awareness campaigns.
– Infrastructure and equipment upgrades to improve patient-provider interactions.
– Monitoring and evaluation activities to assess the impact of interventions.
Please note that the provided cost items are examples and may vary depending on the specific context and needs of the healthcare system in Ghana.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study employed a descriptive cross-sectional case study design and used a modified normative evaluation approach to assess the quality of antiretroviral therapy services in Ghana. The study included a sample size of 384 People Living with HIV and 16 healthcare providers. The study collected data on input, process, and outcome indicators of healthcare quality. However, the abstract does not provide information on the validity and reliability of the data collection tools used, and there is no mention of statistical analysis methods employed. To improve the strength of the evidence, future studies could consider using a larger sample size, ensuring the validity and reliability of data collection tools, and employing appropriate statistical analysis methods.

Resumo

This is a descriptive cross-sectional case study that employed modified normative evaluation based on Donabedian’s model of healthcare quality. 1 The modified normative evaluation is an evaluation procedure where standards as per Ghana’s guidelines for HIV management are compared with the prevailing situation in the various study sites. The modified normative evaluation emphasizes context-specific evaluation approach as against a one-size-fits-all. 26 In this study, the approach was used to assess quality of HIV care in the selected ART sites using patient clinical records according to Ghana’s guidelines for HIV management. For the purpose of this paper, only the input and process indicators of healthcare quality are reported. The study was conducted in Ho, Hohoe and Jasikan districts in the Volta and Oti regions. Volta and Oti regions are 2 of the 16 administrative regions in Ghana. Per the 2010 population and housing census, the population of Jasikan, Hohoe and Ho Municipal were 59,181; 262,046 and 271,881 respectively. 27 Three HIV Sentinel sites offering ART services as at June, 2019 were purposively selected from the three administrative districts. The three purposively selected ART sites were Jasikan District Hospital (rural), Hohoe Municipal Hospital (peri-urban) and Ho Teaching Hospital (urban). All these facilities are national sentinel sites for HIV management with fully functioning ART clinics. The target population size is the of clinical records of 1,500 PLHIV from the three ART sites at the time of conducting this study. Thus, Ho Teaching Hospital (N = 745), Hohoe Municipal Hospital (N = 450), and Jasikan District Hospital (N = 305). This ART site is hosted in a 240-bed capacity tertiary hospital under the Ministry of Health. It serves as the regional referral health facility in its catchment area including neighbouring Republic of Togo. The hospital records are averagely 160 daily attendance. Healthcare services provided include outpatient/inpatient services, dental, eye, family planning, mental health, maternal and child health, surgical, physiotherapy, radiography, herbal Medicine, pharmacy, internal medicine, laboratory, ART clinic and mortuary services. This ART site is hosted in a 178-bed secondary referral hospital under the Ghana Health Service (GHS). Average daily attendance is 150. Services provided in this secondary hospital include outpatient/admissions, pharmacy, laboratory, dental, physiotherapy, medical imaging, antenatal, maternity, surgical, ART, eye and mortuary services. This ART site is hosted in a 53-bed secondary hospital also under the GHS. Average daily out-patient attendance is 165. Services provided include outpatient/admissions, pharmacy, laboratory, pharmacy, X-ray, antenatal, maternity, ART, eye and other specialized services. Target study population was all registered PLHIV above the age of 18 years enrolled in ART for at least six (6) months. Sample size for the clinical records review was 384 from all the three ART sites. The sample size was calculated using the formula: n = Z²PQ/d² where: n = sample size; Z = statistic for a 95% Confidence Interval; P = expected outcome; Q = complement of P and d = precision (fixed at 5%). Based on findings from a study conducted in Nigeria, 28 it was found that approximately 49% of PLHIV rated quality of service delivery as excellent. Thus, an expected outcome of 49% rated satisfaction was used for the sample size determination. At the time of conducting this study there was no known data on similar studies in Ghana hence reliance on evidence in Olowookere et al. 28 with the following assumed parameters: P (expected outcome = 0.487); Q (1 P = 1- 0.487 = 0.513); n = Z²PQ/d²; (1.96) 2 x 0.487 x 0.513/ (0.05); 2 = 383.84 ≈ 384. Final selection of the sample was done using multi-stage sampling to allocate sample sizes to the ART sites. Percentage share of PLHIV in the Ho Teaching Hospital, Hohoe Municipal Hospital and Jasikan District are 50%, 30% and 20% respectively. Based on these proportions, the sample size allocation through quota system was as follows: Ho Teaching Hospital (50/100*384 = 191), Hohoe Municipal Hospital (30/100*384 = 115), and Jasikan District Hospital (20/100*384 = 79). Subsequently, clinical record reviews were conducted on all the 384 sampled PLHIV in each of the ART sites. Healthcare providers (n = 16) directly involved in the care of PLHIV were also purposively sampled and engaged through interviews to ascertain the providers’ perspectives on the quality of ART services. PLHIV enrolled in ART for at least 6 months, age 18 years or more, access care in the three ART sentinel sites and voluntarily agreed to participate in the study. The study excluded PLHIV who were lost to follow-up for over a year; those who were transferred in or out of selected ART sites, and those who visited the clinic for the first time on the day of data collection. Patients with Tuberculosis co-morbidities were equally excluded. A modified normative evaluation tool based on an adapted Donabedian’s input–process–outcome model of health care quality. 28 Ghana’s guideline for HIV management informed data collection instrument items for the process and outcome quality indicators. Inventory data extraction tool designed according to the national resource requirement for the management of HIV in Ghana was used to assess input quality indicators. Adherence to ARVs was measured by dividing the number of people enrolled in ART and consistently took their ARVs without default (through pill count) over the total number of enrolled patients and multiplied by 100. The authors, however, acknowledge the limitations of using pill counts as a proxy for ARVs adherence. Pill count is highly subject to bias and might not account for missed doses due to falls and stock piling at home. 29 Face validity was done by giving data collection tools/extraction forms to independent reviewers in the field of HIV to determine whether questions measured the indicators of interest as per Donabedian 1 validated test items for measuring medical technical quality. Tools were also pre-tested in a comparable health facility in the Volta region to address ambiguity in questions and typographical errors to enhance internal validity. Also, all tool items were developed based on the study objectives alongside strict monitoring during the data collection, entry, cleaning and analysis. Data collection in all the three ART sites lasted approximately 3 months from 11 March to 9 May 2019. In terms of the input quality indicators, availability of resources was assessed through inventory data extraction according to the national resource requirement for the management of HIV in Ghana. Health staff who were in-charge of various resources such as head of Pharmacy, Laboratory, Medical Superintendent and Health Services Administrators were interviewed for secondary data verification. Data collection technique entailed review of patient management records using data extraction tools. The steps were as follows: first, patient folder numbers (i.e manual folders or electronic folders through e-tracker) were used to retrieve medical records for data extraction on adherence to national guidelines and outcome of care. In addition, availability of resources was checked with requirements of the Ghana National AIDS and Sexually Transmitted Infections (STIs) Control Programme (NACP). Data on outcome indicators of quality care were from clients’ clinical records and client satisfaction survey tools administered on site. Field data were coded, cleaned and analysis done with SPSS-IBM Version 22. Descriptive Statistics were generated including Chi-square and Fisher’s Exact tests to ascertain associations between variables as appropriate. Summary statistics were generated for continuous variables, percentages and frequency distributions were generated for categorical variables. In addition, after an orthogonal unrotated Principal Component Analysis (PCA), 8 out of the 32 items were retained for final analysis. Subsequently, summary statistics (means and standard deviations) were used to ascertain the average responses of patients on the Likert-type scale items. Test for statistical significance was set at 95% confidence level. Normality testing of data was done in GraphPad Prism to check for distribution, skewness and kurtosis before analysis. Visual inspection of data was done on SPSS-IBM to check for missing data and normality. Data from the semi-structured interviews with health staff was captured, cleaned and coded using SPSS -IBM Version 22. Analysis strategy was mainly descriptive statistics to demonstrate staff perspectives on the quality of ART services in the three ART sites. Since the variables of interest were mainly quantitative measures in nature, the data collection approach was quantitative. Input indicators: Proxies for input indicators were centred on resource availability. For the purposes of this study the input factors were: resource availability including antiretroviral medicines, laboratory reagents, equipment, trained healthcare providers and logistics. Process indicators: On the other hand, process quality indicators were determined based on adherence to national guidelines for HIV diagnostic and treatment and Donabedian’s model for service quality. 1 These indicators were reviewed by clinicians working on the HIV control programme as well as those providing HIV care in the facilities to promote institutional relevance of the tool. Medication adherence as operationalized in this study ranged from treatment initiation to maintenance of a particular therapeutic medication regimen to control viral replication and improving immune system function. Discontinuity or cessation of part or all of the treatment in instances of missing doses, drug holidays, overdosing or under-dosing is referred to as non-adherence. Outcome indicators: Outcome quality indicators were measured using technical and functional quality proxies. The technical quality measures were patients’ adherence to medication and clinical improvement in functional status based on objective documentation in the clients’ clinical folders. Functional outcome quality care dimensions were client satisfaction scores on dimensions of healthcare quality. Total of 32 client perceived service quality indicators were developed based on national guidelines for HIV care and adapted Donabedian’s structure-process-outcome model of health care quality. After principal component analysis (PCA), the 32 factors were further scaled down to eight (8), comprising of patient satisfaction with general services; technical quality; interpersonal relations; communication; financial accessibility; time spent with clinical team; accessibility and convenience and other patient satisfaction factors. Five-point Likert-type scale used to measure satisfaction levels ranging from 1 = ‘Very dissatisfied’ – 5 ‘Very satisfied’. This study was granted ethical approval by the Ghana Health Service (GHS) Ethical Review Committee (ERC) (clearance number: GHS-ERC009/08/19). Administrative approvals were also sought from the respective health facility heads. To promote anonymity of the study sites, codes used in place of participants’ names to guarantee their privacy and confidentiality. Collated data was kept on a password protected computer and kept with the Principal Investigator. Participation in the study was voluntary and participants were told to discontinue from the study anytime they so wish without consequences. Only participants who voluntarily signed the informed consent form were allowed to participate in the study. Participation in the study was voluntary and were told to discontinue from the study anytime they so wish without consequences. Only participants who voluntarily signed the informed consent form were allowed to participate in the study. Written informed consent was obtained from all subjects. In the case of minors (persons below 18 years), written informed consent from legally authorized representatives (locus parentis) was obtained before they were included in the study. Please see Supplementary File 1 for Consent Forms for the various study respondents.

Materiais

Inovações

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

1. Mobile health (mHealth) applications: Develop mobile applications that provide pregnant women with information on prenatal care, nutrition, and common pregnancy concerns. These apps can also include appointment reminders and allow women to communicate with healthcare providers.

2. Telemedicine services: Implement telemedicine services that allow pregnant women in remote areas to consult with healthcare providers through video calls. This can help address the issue of limited access to healthcare facilities.

3. Community health workers: Train and deploy community health workers to provide basic prenatal care and education to pregnant women in underserved areas. These workers can conduct regular check-ups, provide health education, and refer women to healthcare facilities when necessary.

4. Transportation support: Establish transportation services or partnerships to ensure that pregnant women have access to transportation for prenatal visits and emergency obstetric care. This can help overcome the barrier of distance and improve timely access to healthcare.

5. Maternal health clinics: Set up dedicated maternal health clinics in areas with high maternal mortality rates. These clinics can provide comprehensive prenatal care, delivery services, and postnatal care, ensuring that women receive the necessary care throughout their pregnancy journey.

6. Maternal health insurance coverage: Advocate for the inclusion of maternal health services in national health insurance schemes to reduce financial barriers and improve access to quality care for pregnant women.

7. Maternal health education campaigns: Launch public awareness campaigns to educate communities about the importance of maternal health and encourage women to seek prenatal care. These campaigns can address cultural beliefs, myths, and misconceptions surrounding pregnancy and childbirth.

8. Partnerships with non-governmental organizations (NGOs): Collaborate with NGOs that specialize in maternal health to provide additional resources, funding, and expertise to improve access to maternal healthcare services.

9. Maternal health monitoring systems: Implement electronic health records and monitoring systems to track the progress of pregnant women and ensure continuity of care. These systems can help healthcare providers identify high-risk pregnancies and provide appropriate interventions.

10. Maternal health task forces: Establish task forces or committees dedicated to improving maternal health outcomes. These groups can bring together stakeholders from the healthcare sector, government agencies, NGOs, and community organizations to develop and implement strategies for improving access to maternal healthcare services.

AI Innovations Description

The study described in the provided text focuses on assessing the quality of antiretroviral therapy (ART) services in selected ART sites in Ghana. While the study does not specifically address maternal health, it provides valuable insights into the quality of healthcare services for people living with HIV (PLHIV) in resource-constrained settings.

Based on the findings of the study, here are some recommendations that can be developed into innovations to improve access to maternal health:

1. Strengthen availability of resources: Ensure that essential resources for maternal health, such as medications, laboratory reagents, and equipment, are consistently available in healthcare facilities. This includes ensuring the availability of antiretroviral medicines, which are crucial for preventing mother-to-child transmission of HIV.

2. Improve healthcare provider training: Provide comprehensive training to healthcare providers on maternal health, including HIV management during pregnancy. This will enhance their knowledge and skills in providing quality care to pregnant women living with HIV.

3. Enhance adherence support: Develop innovative strategies to improve adherence to antiretroviral therapy and other medications among pregnant women living with HIV. This can include the use of mobile health technologies, such as text message reminders and virtual support groups, to promote medication adherence and provide ongoing support.

4. Strengthen healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in rural and peri-urban areas, to ensure that pregnant women living with HIV have access to quality maternal health services. This includes expanding the availability of ART clinics and ensuring that they are adequately equipped to provide comprehensive care.

5. Promote integration of services: Foster collaboration and integration between HIV services and maternal health services. This can be achieved through the establishment of integrated clinics or the implementation of task-shifting approaches, where healthcare providers are trained to provide both HIV and maternal health services.

6. Enhance patient-provider communication: Improve communication between healthcare providers and pregnant women living with HIV to ensure that they receive the information and support they need. This can be achieved through training healthcare providers in effective communication skills and promoting patient-centered care.

7. Address financial barriers: Advocate for the inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme. This will help reduce financial barriers and promote adherence to treatment among pregnant women living with HIV.

By implementing these recommendations, it is possible to improve access to maternal health services for pregnant women living with HIV in resource-constrained settings, ultimately contributing to better health outcomes for both mothers and their babies.

AI Innovations Methodology

The provided description is a research study on the quality of antiretroviral therapy (ART) services in Ghana. It aims to assess the quality of ART services in selected ART sites using the input-process-outcome approach. The study employed a descriptive cross-sectional case study design and collected data from People Living with HIV (PLHIV) and healthcare providers.

To improve access to maternal health, some potential recommendations could include:

1. Strengthening healthcare infrastructure: Investing in the development and improvement of healthcare facilities, particularly in rural areas, can enhance access to maternal health services. This includes ensuring the availability of well-equipped maternity wards, skilled healthcare providers, and essential medical supplies.

2. Increasing community-based healthcare services: Implementing community-based healthcare programs can improve access to maternal health services, especially for women in remote areas. This can involve training and deploying community health workers who can provide antenatal care, postnatal care, and education on maternal health to women in their communities.

3. Enhancing transportation services: Improving transportation infrastructure and services can help pregnant women reach healthcare facilities more easily. This can include providing ambulances or other means of transportation for emergency cases and ensuring reliable public transportation options for routine check-ups and deliveries.

4. Promoting maternal health education: Conducting awareness campaigns and educational programs can empower women with knowledge about maternal health, including the importance of antenatal care, nutrition, and safe delivery practices. This can be done through community workshops, radio programs, and mobile health applications.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the number of antenatal care visits, percentage of deliveries attended by skilled birth attendants, or distance to the nearest healthcare facility.

2. Collect baseline data: Gather data on the current state of access to maternal health services in the target area. This can include information on the number of healthcare facilities, availability of skilled healthcare providers, transportation options, and utilization rates of maternal health services.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. This can be done using statistical software or simulation tools.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the impact of the recommendations. This can involve adjusting variables such as the number of healthcare facilities, availability of transportation services, or the reach of community-based healthcare programs.

5. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This can include comparing the simulated outcomes with the baseline data and identifying areas of improvement.

6. Refine and validate the model: Refine the simulation model based on the analysis and feedback from stakeholders. Validate the model by comparing the simulated outcomes with real-world data, if available.

7. Communicate findings and make recommendations: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community leaders. Use the results to make evidence-based recommendations for improving access to maternal health services.

It is important to note that the methodology described above is a general framework and can be adapted based on the specific context and resources available for the simulation study.

Autores & Coautores

Statistics:

Citations: 2

Authors: 7

Identifiers:

DOI: 10.1177/20503121211036142

Research Areas:

Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ghana, Multi-Countries, Nigeria, Togo

Study Design:

Case Study, Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review

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