Menu
Menu
Menu
Menu
Background: The prevention of mother-to-child transmission of human immunodeficiency virus (HIV) is lauded as one of the more successful HIV prevention measures. However, despite some gains in the prevention of mother-to-child transmission of HIV (PMTCT) in sub-Saharan Africa, mother-to-child transmission rates are still high. In Kenya, mother-to-child transmission is considered one of the greatest health challenges and scaling up PMTCT services is crucial to its elimination by 2015. However, guideline implementation faces barriers that challenge scale-up of services. The objective of this paper is to identify barriers to PMTCT implementation in the context of a randomized control trial on the use of structured mobile phone messages in PMTCT. Methods. The preliminary analysis presented here is based on survey data collected during enrolment in PMTCT services at one of two health facilities in Nairobi, Kenya, with overall number of antenatal care (ANC) visits determined from 48 hour follow up data. Results: Data was collected for 503 women. Despite significant differences in the type of facility and sample characteristics between sites, all women presented to care at 20 weeks gestation or later and 88.8% attended less than four ANC visits. PMTCT counselling at first visit had high coverage (86%), however less than a third of women (31.34%) reported receiving contraception counselling. Although 60.8% of women had reportedly disclosed their status to their partners, only 40% were aware of their partner’s status. Very few women had been tested for TB (10%) or received single dose nevirapine during their first antenatal care appointment (20%). Conclusion: Revised PMTCT guidelines aim to reduce the inequity between PMTCT services in high and low resource settings in efforts to eliminate mother-to-child transmission. However, guideline implementation in low resource settings continues to be confronted with challenges related to late presentation, less than four ANC visits, low screening rates for opportunistic infections, and limited contraception counselling. These challenges are further complicated by lack of disclosure to partners. Effective scale up and implementation of PMTCT services requires that such ongoing program challenges be identified and appropriately addressed within the local context. © 2014 du Plessis et al; licensee BioMed Central Ltd.
These results were obtained in the context of a randomized control trial (RCT) on the use of structured mobile phone messages in PMTCT. The goals of the study were to improve linkage to ANC, provide reminders to take PMTCT medications, and improve post-natal support and follow-up – even when mothers deliver elsewhere. In addition to benefits directly related to PMTCT, the study also aimed to demonstrate that mobile phone technology can be used as an effective tool for strengthening health information systems at a facility level by collecting better information, and thereby advance local health systems development. Women were recruited from the PMTCT clinic at Pumwani Maternity Hospital (PMH) and the ANC/PMTCT clinic at Baba Dogo Health Centre (BDHC) in Nairobi, Kenya and enrolled in the study during their first ANC visit, if they met the inclusion criteria. They were considered eligible if they were HIV positive, pregnant with a singleton pregnancy, had never had a preterm birth, were residing within 15 km of either study facility, and would be residing there for at least six months post-delivery, literate in Kiswahili or English, were willing to be contacted for follow up, and had regular access to a cell phone – either their own or that of their partner or a family member. Disclosure of HIV status to their partner was initially included as criteria but was eliminated at the request of key stakeholders who thought this would not be representative of women receiving PMTCT services in Kenya. Women who were considered eligible were approached by study nurses –not affiliated with either facility- who explained the objectives and procedures of the study and asked if they wanted to participate (one nurse was hired at each facility). Nurses had experience working in maternal health as well as previous experience working on research projects. If women agreed to participate, informed consent was obtained before conducting the baseline survey or collecting samples. Survey data was collected at enrollment, during routine ANC visits, and 48 hours and 6 weeks post-delivery. At enrollment, women completed a brief questionnaire collecting data on socio-demographic characteristics, cell phone history, HIV status history, previous pregnancy, current pregnancy, gender based violence, TB testing and care, and PMTCT knowledge. Subsequent data collection focused on ARV history, pregnancy complications, delivery and postpartum data, and perceptions of the mobile phone intervention (intervention clients only). The preliminary analysis presented here focuses on the survey data collected at enrolment with the exception of the number of ANC visits which was determined from data collected at the 48 hour-follow up. We compared variables of interest across the two hospital sites as we were interested in determining whether or not there were differences between sites, given the differences in populations served and clinical practice. Our assumption was that while there may be differences by site, there may also be broader structural barriers we could identify at both sites. Data was analysed using Stata 11 (College Station, TX) and descriptive analyses included comparisons between women recruited from the different hospitals. Chi-square tests of association were used to compare variables of interest across the two hospital sites. Ethics approval was obtained from the University of Manitoba’s Health Research Ethics Board (H2009-351) as well as the Kenyatta National Hospital/University of Nairobi – Ethics & Research Committee (P273/09/2009). Women provided signed informed consent to participate in the study.
N/A
