Factors influencing the delivery and uptake of early infant diagnosis of HIV services in Greater Accra, Ghana: A qualitative study

Background Early Infant Diagnosis (EID) of HIV and timely initiation of Antiretroviral Therapy (ART) can significantly reduce morbidity and mortality of HIV infected infants. Despite the benefits of early infant testing, the coverage of EID of HIV services is still low in Sub-Saharan Africa, including Ghana. Objectives To ascertain the factors that facilitate or hinder the delivery and uptake of EID of HIV services. Methods The study is a cross-sectional exploratory qualitative research conducted in two health facilities in the Greater Accra Region of Ghana. Respondents (n = 50) comprising health workers (n = 20) and HIV positive mothers (n = 30) were purposively sampled and engaged in in-depth interviews. The Nvivo 11 software and the Braun and Clarke’s stages of thematic analysis were used in coding data and data analysis respectively. Results The study found that health system factors such as inadequate Staff with sample collection skills, unavailability of vehicles to convey samples to the reference laboratory for analysis, the long turnaround time for receipt of Polymerase Chain Reaction (PCR) results, inadequate and frequent breakdown of PCR machine hindered EID service delivery. On the other hand, adequate knowledge of health workers on EID, availability of Dried Blood Spot (DBS) cards and the adoption of task shifting strategies facilitated EID service delivery. Factors such as the denial of HIV status, non-completion of the EID process due to frustrations encountered whiles accessing service and delay in receipt of PCR results served as barriers to mother’s utilisation of EID services for their exposed infants. The study also identified that adequate knowledge of EID, perceived importance of EID, financial stability as well as financial support from others and the positive attitudes of health workers facilitated HIV positive mother’s uptake of EID services for their exposed infants. Conclusion The factors attributing to the low coverage of EID of HIV services must be promptly addressed to improve service delivery and uptake.

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Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

BMJ Open ◽

10.1136/bmjopen-2020-043679 ◽

2020 ◽

Vol 10 (11) ◽

pp. e043679

Author(s):

Yasmin Mohamed ◽

Martha Kupul ◽

Janet Gare ◽

Steven G Badman ◽

Selina Silim ◽

...

Keyword(s):

Papua New Guinea ◽

Standard Care ◽

Health Workers ◽

Point Of Care ◽

Hiv Positive ◽

Early Infant Diagnosis ◽

Pmtct Programme ◽

Early Infant ◽

Qualitative Exploration ◽

Hiv 1

IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

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Barriers to early infant diagnosis of HIV in the Wa Municipality and Lawra District of Upper West Region, Ghana

Ghana Medical Journal ◽

10.4314/gmj.v54i2s.13 ◽

2020 ◽

Vol 54 (2) ◽

pp. 83-90

Author(s):

Robert Nuoh ◽

Kofi Nyarko ◽

Charles Noora ◽

Adolphina Addo-Lartey ◽

Priscillia Nortey ◽

...

Keyword(s):

Formal Education ◽

Transmission Rate ◽

Hiv Positive ◽

Early Infant Diagnosis ◽

Independent Source ◽

Positive Mother ◽

West Region ◽

Early Infant ◽

Exposed Infant ◽

Wa Municipality

Objective: We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana.Design: An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015.Setting: A public health facilityParticipants: We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014.Main outcome: EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction.Results: A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formallyemployed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent incomebsource was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27weeks).Conclusion: Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana.Keywords: Barriers; HIV; early infant diagnosis; DNA-PCR; GhanaFunding: This work was funded by the authors

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User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala

African Health Sciences ◽

10.4314/ahs.v21i1.32 ◽

2021 ◽

Vol 21 (1) ◽

pp. 248-53

Author(s):

Jane Namakula Katende ◽

Kizito Omona

Keyword(s):

Health Care Providers ◽

Health Workers ◽

Service Integration ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Care Providers ◽

Hiv Services ◽

Provider Perspectives ◽

Mulago National Referral Hospital ◽

National Referral Hospital

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. Objectives: To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital. Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services. Keywords: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.

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Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16050728 ◽

2019 ◽

Vol 16 (5) ◽

pp. 728

Author(s):

Saria Hassan ◽

Alexis Cooke ◽

Haneefa Saleem ◽

Dorothy Mushi ◽

Jessie Mbwambo ◽

...

Keyword(s):

Care Delivery ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Initiation Rate ◽

Hiv Services ◽

Art Initiation ◽

Care Integration ◽

Therapy Strategy ◽

Sub Saharan

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

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Disclosure, stigma of HIV positive child and access to early infant diagnosis in the rural communities of OR Tambo District, South Africa: a qualitative exploration of maternal perspective

BMC Pediatrics ◽

10.1186/s12887-015-0414-8 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 18

Author(s):

Vincent Oladele Adeniyi ◽

Elza Thomson ◽

Daniel Ter Goon ◽

Idowu Anthony Ajayi

Keyword(s):

South Africa ◽

Rural Communities ◽

Hiv Positive ◽

Early Infant Diagnosis ◽

Early Infant ◽

Qualitative Exploration

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Evaluation of different deoxyribonucleic acid (DNA) extraction methods using dried blood spot for early infant diagnosis of HIV1 in Sub-Saharan Africa

African Journal of Microbiology Research ◽

10.5897/ajmr11.1469 ◽

2012 ◽

Vol 6 (27) ◽

Author(s):

Ceffa Susanna

Keyword(s):

Dna Extraction ◽

Deoxyribonucleic Acid ◽

Extraction Methods ◽

Sub Saharan Africa ◽

Dried Blood Spot ◽

Early Infant Diagnosis ◽

Early Infant ◽

Sub Saharan ◽

Dna Extraction Methods ◽

Blood Spot

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A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa

AIDS Care ◽

10.1080/09540121.2016.1139041 ◽

2016 ◽

Vol 28 (6) ◽

pp. 778-794 ◽

Cited By ~ 11

Author(s):

Roseanne C. Schuster ◽

Devon E. McMahon ◽

Sera L. Young

Keyword(s):

Vertical Transmission ◽

Health Workers ◽

Sub Saharan Africa ◽

Comprehensive Review ◽

Hiv Services ◽

Vertical Transmission Of Hiv ◽

Sub Saharan

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Preparing for the delivery of PrEP: Lessons from the implementation of integrated reproductive health and HIV services in Kenya

10.21203/rs.2.21345/v1 ◽

2020 ◽

Author(s):

Emily McDonald Evens ◽

Theresa Hoke ◽

Margaret Eichleay ◽

Patrick Olsen ◽

Alice Olawo ◽

...

Keyword(s):

Service Delivery ◽

Hiv Testing ◽

Integrated Services ◽

Health Service Delivery ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Outpatient Services ◽

Structured Interviews ◽

Tuberculosis Screening ◽

Exposure Prophylaxis

Abstract Background: In 2015, the WHO issued guidelines recommending oral pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV. Given their role in health service delivery, ministries of health are assuming major responsibility for PrEP services in sub-Saharan Africa. However, these are often strained and under-resourced. We measured the delivery of selected integrated services and identified the factors that impede effective delivery of integrated services to prepare for the integration of PrEP into health services for women. Methods: Three services were examined: 1) HIV testing within family planning, 2) HIV testing within general outpatient services, and 3) care and prevention services for HIV-positive clients not eligible for antiretrovirals (“Pre-ART”). Descriptive, mixed-methods research was conducted in three Kenyan counties using: service delivery observations (n = 3246) and client exit interviews (n = 3257) in public facilities, and semi-structured interviews with providers, managers and officials (n = 112). Results: Integrated services were not consistently implemented. HIV testing was not systematically offered or received; most clients were not aware testing was available, and tests were largely unavailable. Pre-ART services did not systematically deliver mandated services. Rates of cervical cancer and tuberculosis screening were especially low; a concerning gap given the elevated risk for HIV-positive women. Supply-side challenges of staffing, infrastructure and commodity shortages were common. Conclusions: In an era of significant demands on treatment resources and decreasing funding for prevention, the identification of the technical, material, and human resources required for successful and sustainable delivery of integrated services must be addressed to support successful PrEP implementation. Key words: Pre-exposure prophylaxis, Kenya, Integrated health, HIV

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Trends in uptake of early infant diagnosis for HIV: implementation results of the Ugandan military PMTCT program

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20211978 ◽

2021 ◽

Vol 8 (6) ◽

pp. 2746

Author(s):

Paul Lubega ◽

Stephen Lawoko ◽

Filbert Akatukunda ◽

Gloria Seruwagi ◽

John Bosco Ninsima ◽

...

Keyword(s):

Positive Impact ◽

Data Extraction ◽

Statistical Significance ◽

Hiv Positive ◽

Early Infant Diagnosis ◽

Cross Sectional ◽

Early Infant ◽

Short Period ◽

Rapid Tests ◽

Military Facilities

Background: Early infant diagnosis (EID) is an important strategy of the Prevention of Mother-to-child transmission (PMTCT) and when implemented in combination with other strategies could eliminate HIV MTCT. We implemented a series of strategic interventions intended to improve EID at 9 Military facilities in Uganda and evaluated their impact on uptake of EID.Methods: A retrospective cross-sectional design was adopted, following-up HIV Exposed Infants (HEI) at the study sites over a 2 year period, and using a data extraction tool to capture4 indicators of EID namely; number of HIV-positive mothers, number of HEI enrolled, number of PCR and rapid tests performed on HEI, and number of HIV-positive results of HEI. Scatter plots and simple linear regression were applied to demonstrate trends in EID uptake and estimate intervention impact over time. Statistical significance was assumed at p<0.05.Results: We established incremental trends in numbers of first PCR (f [1,6]=2.8; p=0.15),third PCR (f [1,6]=8.4; p<0.05), rapid tests (f [1,6]=16.1; p<0.05) performed on HEI, and a modest decline in HIV-positivity among HEI over the study period. The intervention improved retention in PMTCT cascade to 80%, when contrasted with the national average of 70%.Conclusions: We have demonstrated that interventions invoking pre-booking HIV-positive pregnant mothers during antenatal care, follow up of mother-baby pairs using telephone and mentor mothers and integrating EID in immunization programs can improve uptake of EID in a relatively short period, and with a positive impact on EID indicators.

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