scholarly journals The effect of weekly interactive text-messaging on early infant HIV testing in Kenya: a randomised controlled trial (WelTel PMTCT)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Björn Nordberg ◽  
Winfred Mwangi ◽  
Mia Liisa van der Kop ◽  
Edwin Were ◽  
Eunice Kaguiri ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Pregnant Women ◽  
Hiv Testing ◽  
Healthcare Workers ◽  
Text Messages ◽  
Control Group ◽  
Child Transmission ◽  
Western Kenya ◽  
Early Infant ◽  
Mother To Child

AbstractMother-to-child transmission of HIV remains a significant concern in Africa despite earlier progress. Early infant diagnosis (EID) of HIV is crucial to reduce mortality among infected infants through early treatment initiation. However, a large proportion of HIV-exposed infants are still not tested in Kenya. Our objective was to investigate whether weekly interactive text-messages improved prevention of mother-to-child transmission (PMTCT) of HIV care outcomes including EID HIV testing. This multicentre, parallel-group, randomised, open-label trial included six antenatal care clinics across western Kenya. Pregnant women living with HIV, aged 18 years or older, with mobile phone access, were randomised in a 1:1 ratio to weekly text messages that continued until 24 months postpartum, asking “How are you?” (“Mambo?”) to which they were asked to respond within 48 h, or a control group. Healthcare workers contacted participants reporting problems and non-responders by phone. Participants in both groups received routine PMTCT care. The prespecified secondary outcome reported in this paper is EID HIV testing by eight weeks of age (blinded outcome assessment). Final 24-months trial results will be published separately. We estimated risk ratios using Poisson regression with robust standard errors. Between June 2015–July 2016, we screened 735 pregnant women, of whom 600 were enrolled: 299 were allocated to the intervention and 301 to the control group. By eight weeks of age, the uptake of EID HIV testing out of recorded live births was 85.5% in the intervention and 84.7% in the control group (71.2% vs. 71.8% of participants randomised, including miscarriages, stillbirths, etc.). The intention-to-treat risk ratio was 0.99; 95% CI: 0.90–1.10; p = 0.89. The proportion of infants diagnosed with HIV was 0.8% in the intervention and 1.2% in the control group. No adverse events were reported. We found no evidence to support that the WelTel intervention improved EID HIV testing. A higher uptake of EID testing than expected in both groups may be a result of lower barriers to EID testing and improved PMTCT care in western Kenya, including the broader standard use of mobile phone communication between healthcare workers and patients. (ISRCTN No. 98818734. Funded by the European-Developing Countries Clinical Trial Partnership and others).

scholarly journals Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Deogratius Bintabara ◽  
Athanase Lilungulu ◽  
Shakilu Jumanne ◽  
Mzee M. Nassoro ◽  
Bonaventura C. Mpondo
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
High Quality ◽  
Hiv Testing And Counseling ◽  
Mother To Child ◽  
Facility Readiness ◽  
Testing And Counseling

Abstract Background Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. Results Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.

scholarly journals Testing strategies for couple engagement in prevention of mother-to-child transmission of HIV and family health in Kenya: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zachary Kwena ◽  
Liza Kimbo ◽  
Lynae A. Darbes ◽  
Abigail M. Hatcher ◽  
Anna Helova ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Standard Care ◽  
Family Health ◽  
Child Transmission ◽  
Home Based ◽  
Self Testing ◽  
The Cost ◽  
Mother To Child ◽  
Testing And Counseling

Abstract Background HIV-related maternal deaths and HIV infection among infants remain unacceptably high across sub-Saharan Africa despite increased antenatal care attendance and provision of antiretroviral therapy to pregnant women. In the Jamii Bora (“Better Family” in Swahili) Study, we seek to test the efficacy of an interdependence theory-based couple intervention. The intervention reaches pregnant women and male partners through home visits by male-female pairs of lay health workers. The aim is to increase access to home-based couples’ HIV testing and counseling services to improve family health. Methods This is a three-arm randomized control trial among 1080 pregnant women 15 years of age or older, living with their male partners, and who have not undergone couples’ HIV testing and counseling in Kisumu and Migori Counties in Kenya. Couples will be randomized into three groups: home-based couple visits, HIV self-testing kits for couple use, or standard care (male partner clinic invitation letters). Participants will be followed up to 18 months postpartum. The study has three aims: in aim 1, we will determine the effects of the intervention on our primary outcome of couple HIV testing, compared to HIV self-testing kits and standard care; in aim 2, we will examine the intervention impact on HIV prevention behaviors, facility delivery, and postnatal healthcare utilization, as well as secondary health outcomes of maternal viral suppression and HIV-free child survival up to 18 months for couples living with HIV; and in aim 3, we will compare the cost-effectiveness of the home-based couple intervention to the less resource-intensive strategies used in the other two study arms. Assessments with couples are conducted at baseline, late pregnancy, and at months 3, 6, 12, and 18 after birth. Discussion The results from this study will inform decision-makers about the cost-effective strategies to engage pregnant couples in the prevention of mother-to-child transmission and family health, with important downstream benefits for maternal, paternal, and infant health. Trial registration ClinicalTrials.gov NCT03547739. Registered on May 9, 2018

scholarly journals Barriers and opportunities for implementing prevention of mother to child transmission (PMTCT) in Bangli District

2017 ◽  
Vol 5 (1) ◽  
pp. 67
Author(s):  
Ketut Espana Giri ◽  
Ni Made Sri Nopiyani ◽  
Ketut Tuti Parwati Merati
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Health Centre ◽  
Community Leaders ◽  
Pmtct Program ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Public Health Centre ◽  
Mother To Child ◽  
Village Health

Background and purpose: HIV testing among pregnant women can reduce the risk of mother to child HIV transmission. The implementation of prevention of mother to child transmission (PMTCT) program in Bangli District is suboptimal. This study aims to explore challenges and opportunities for implementing PMTCT program from both user and provider perspectives.Methods: A qualitative approach was conducted in Bangli District between April and May 2016. Data were collected using in-depth interviews with 18 informants. All informants were purposively selected and covered of 10 pregnant women, two counsellors, two laboratory analysts, two head of community health centres, one disease control officer from Bangli District Health Office and one officer from Bangli District AIDS Commission. Data were analysed using thematic method.Results: Pregnant women chose to have ANC service at private midwife and obstetrician instead of  public health centre. From health providers’ perspectives barrier of PMTCT implementation included lack of health human resources and a high level of stigma and discrimination related to HIV/AIDS in the community. This study revealed that there was an opportunity for PMTCT implementation in Bangli District due to positive attitudes and supports from husband and health provider toward HIV testing. Another opportunity is to involve village health cadres and community leaders in promoting HIV testing among pregnant women.Conclusions: Implementation of PMTCT program in health centre should include network of private practitioner and enhance village health cadres’ and community leaders’ participation.

scholarly journals Effectiveness of interventional package on knowledge and attitude towards prenatal HIV testing and mother to child transmission among antenatal mothers

2020 ◽  
Vol 11 (2) ◽  
pp. 1729-1733
Author(s):  
Priyadarsini A ◽  
Priya O S
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
The Body ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Teaching Programme ◽  
Structured Teaching ◽  
Post Test ◽  
Knowledge And Attitude ◽  
Mother To Child

Human Immunodeficiency Virus (HIV) is an infection that assaults immune cells called CD4 cells, which are a kind of T cell. These are white platelets that move around the body, recognizing flaws and inconsistencies in cells just as contaminations. The present study aimed to effectiveness of interventional package on knowledge and attitude towards prenatal HIV testing and parent to child transmission among pregnant women in selected settings.60 pregnant women sample in Quantitative approach with Pre experimental one group pre-test and post-test design, sample selection was done by Non Probability – Purposive Sampling Technique, Effectiveness of structured teaching programme in meaning pregnant women gained 35% etiology and effects gained 31% in management and precautions in PCT pregnant women gained 41% prevention 36.8% overall they gained 37.28% and Attitude gained 23.3% after intervention. Pre-existing knowledge was assessed by using semi structured teaching programme, pregnant mothers gained 23.3% more knowledge score than pretest score and the mean difference is 12.80 by using generalized McNamara’s chi-square test, it is statistically significant. In pretest, mothers were having 10.77score whereas, in post-test they were having 23.57 score. Difference score is 12.80.The difference is large and it is statistically significant. Successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection is highly dependent on everyone; especially, women of child-bearing age should have accurate and up-to-date knowledge about HIV transmission, risk of transmission to babies, and possible interventions.

scholarly journals Radio role models for the prevention of mother-to-child transmission of HIV and HIV testing among pregnant women in Botswana

2008 ◽  
Vol 23 (3) ◽  
pp. 260-268 ◽  
Author(s):  
A. K. Sebert Kuhlmann ◽  
J. M. Kraft ◽  
C. Galavotti ◽  
T. L. Creek ◽  
M. Mooki ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Role Models ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child

scholarly journals The yield of HIV testing during pregnancy and postnatal period, Uganda, 2015–2018: analysis of surveillance data

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Yvette Wibabara ◽  
Ivan Lukabwe ◽  
Irene Kyamwine ◽  
Benon Kwesiga ◽  
Alex R. Ario ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Hiv Testing ◽  
Postnatal Period ◽  
Surveillance Data ◽  
Hiv Positive ◽  
Health Management Information System ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child

Abstract Background Uganda has registered a reduction in new HIV infections among children in recent years. However, mother-to-child transmission of HIV still occurs, especially among pregnant women who present late. To eliminate this transmission, all HIV-positive pregnant women should be identified during antenatal HIV testing. We described women newly identified HIV-positive during pregnancy and postnatal period 2015–2018. Methods We extracted surveillance data for women identified as HIV-positive during pregnancy and the postnatal period reported through the Health Management Information System from 2015–2018. We calculated proportions newly positive at antenatal, labor, and postnatal periods nationally and at district levels. We disaggregated data into ‘tested early’ (during antenatal care) and ‘tested late’ (during labor or postnatal period) and calculated the proportion positive. We evaluated trends in these parameters at national and district levels. Results Overall, 8,485,854 mothers were tested for HIV during this period. Of these, 2.4% tested HIV-positive for the first time. While the total number of mothers tested increased from 1,327,022 in 2015 to 2,514,212 in 2018, the proportion testing HIV-positive decreased from 3.0% in 2015 to 1.7% in 2018 (43% decline over the study period, p < 0.001). Of 6,781,047 tested early, 2.2% tested HIV-positive. The proportion positive among those tested early dropped from 2.5% in 2015 to 1.7% in 2018. Of 1,704,807 tested late, 3.2% tested HIV-positive. The proportion positive among those tested late dropped from 5.2% in 2015 to 1.6% in 2018. At the district level, Kalangala District had the highest proportion testing positive at 13% (909/11,312) in 2015; this dropped to 5.2% (169/3278) in 2018. Conclusion The proportion of women newly testing HIV-positive during pregnancy and postnatal declined significantly during 2015–2018. A higher proportion of mothers who tested late vs early were HIV-positive. Failure to identify HIV early represents an increased risk of transmission. Ministry of Health should strengthen Elimination of Mother to Child Transmission (eMTCT) services to sustain this decrease through targeted interventions for poorly-performing districts. It should strengthen community-based health education on antenatal care and HIV testing and enhance the implementation of other primary prevention strategies targeting adolescents and young women.

scholarly journals Progress and Challenges of Implementing Decentralized HIV Testing For Prevention of Mother-to-Child Transmission of HIV – Myanmar

2019 ◽  
Vol 8 (1) ◽  
pp. 44-53
Author(s):  
San Hone ◽  
Li Li ◽  
Sung-Jae Lee ◽  
W. Scott Comulada ◽  
Roger Detels
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Hiv Testing ◽  
Service Providers ◽  
Point Of Care ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Stigma And Discrimination ◽  
Testing Uptake ◽  
Mother To Child

Background: Myanmar has adopted point-of-care (POC) HIV testing for its prevention of mother-to-child transmission of HIV program, and was initiated in 84 townships in 2013. This study assessed the progress of HIV testing uptake from 2012, one year prior to POC testing, to 2015, and the challenges faced by service providers during the rapid rollout of this testing strategy. Methods: This serial cross-sectional study included 23 townships randomly selected from the 84 townships. An open-question survey was used to collect information on the challenges faced by service providers. A random effects logistic model was used for assessing the progress of HIV testing uptake among urban and rural health center groups. Results: HIV testing uptake for antenatal care (ANC) attendees increased from 60% to 90% for rural and from 70% to 90% for urban attendees. The proportion of ANC attendees who were tested at their first visit increased from 70% to 80% for rural and from 70% to 90% for urban attendees. In addition, the proportion receiving same-day test results increased from less than 10% to 90% for both groups. Major challenges faced during the initial rollout included low health awareness among pregnant women, fear of stigma and discrimination, long travel times and costs, and increased workloads of providers in rural settings. Conclusions and Global Health Implications: The program should consider recruiting local volunteers to help reduce the workloads of service providers. Professional education based on need and continued mentoring and quality control schemes for HIV testing need to be in place. This decentralized strategy would be applicable to other resource-limited countries. Key words:  • HIV/AIDS • Pregnant Women • Point-of-Care (POC) HIV Testing • Antenatal Care (ANC) • Prevention of Mother-to-Child Transmission of HIV (PMCT) • Service Cascade • Stigma and Discrimination   Copyright © 2019 Hone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Challenges to delivering quality care in a prevention of mother-to-child transmission of HIV programme in Soweto, South Africa

2013 ◽  
Vol 14 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Coceka Nandipha Mnyani ◽  
James McIntyre
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Pregnant Women ◽  
Support Group ◽  
Healthcare Workers ◽  
Antenatal Visit ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child

Objectives: There has been little focus on quality of care provided in prevention of mother-to-child transmission of HIV (PMTCT) services in South Africa. We assessed quality of care in PMTCT services in Soweto, South Africa, focusing on knowledge and experiences of healthcare workers and HIV-infected pregnant women accessing the services. Methods: A cross-sectional survey was conducted between November and December 2009. A total of 201 HIV-infected pregnant women and 80 healthcare workers, from 10 antenatal clinics, were interviewed using standardised questionnaires. Results: The median gestational age at first antenatal visit was 20 weeks and 32 weeks at the time of the interview. The majority of the women, 71.5%, discovered that they were HIV-infected in the index pregnancy, and 87.9% disclosed their HIV status. Overall, 97.5% received counselling and 33.5% were members of a support group. Knowledge of antenatal and intrapartum PMTCT interventions was correct in 62.7% and 43.3% of the women, respectively. Support group membership and current use of antiretroviral prophylaxis did not impact on the quality of knowledge. Of the healthcare workers, 43.8% were professional nurses and 37.5% were lay counsellors. The majority, 80.0%, felt satisfied with their knowledge of PMTCT guidelines and 96.3% felt competent in managing HIV-infected pregnant women. Yet, there were important deficiencies in knowledge of the guidelines. Conclusion: In our study, knowledge of PMTCT interventions was low in both clients and healthcare workers. These findings point to a need to improve quality of care in PMTCT services, especially with increasingly complex PMTCT interventions recommended by international policies.

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