Implementation of prevention of mother-to-child transmission of HIV and maternal syphilis screening and treatment programmes in Mwanza region, Tanzania : uptake and challenges

Doctoral thesis English OPEN
Balira, Rebecca

ABSTRACT\ud Literature\ud and\ud other\ud background\ud information\ud on\ud prevention\ud of\ud mother-to-child\ud transmission\ud of\ud HIV\ud (PMTCT)\ud and\ud maternal\ud syphilis\ud screening\ud programmes\ud in\ud Tanzania\ud reveal\ud that\ud little\ud has\ud been\ud documented\ud on\ud accessibility\ud and\ud utilization\ud of\ud these\ud services.\ud This\ud thesis\ud presents\ud the\ud results\ud from\ud a\ud research\ud conducted\ud in\ud Mwanza\ud city,\ud Tanzania\ud to\ud assess\ud the\ud operational\ud performance\ud of\ud PMTCT\ud and\ud maternal\ud syphilis\ud screening\ud and\ud treatment\ud during\ud pregnancy,\ud at\ud delivery\ud and\ud in\ud the\ud postnatal\ud period.\ud From\ud different\ud sub-studies\ud conducted\ud at\ud the\ud antenatal\ud clinics\ud (ANC)\ud and\ud in\ud the\ud maternity\ud ward\ud for\ud this\ud research,\ud a\ud number\ud of\ud missed\ud implementation\ud opportunities\ud were\ud identified.\ud A\ud review\ud of\ud records\ud found\ud that\ud 24%\ud of\ud pregnant\ud women\ud who\ud delivered\ud in\ud hospital\ud left\ud the\ud maternity\ud ward\ud with\ud unknown\ud HIV\ud status\ud and\ud 50%\ud of\ud HIV-positive\ud women\ud tested\ud at\ud ANC\ud did\ud not\ud receive\ud Antiretroviral\ud therapy\ud (ART)\ud for\ud PMTCT.\ud A\ud cross-sectional\ud study\ud at\ud the\ud maternity\ud ward\ud found\ud that\ud 12%\ud of\ud pregnant\ud women\ud who\ud were\ud not\ud screened\ud for\ud syphilis,\ud 27%\ud of\ud RPR-positive\ud women\ud who\ud were\ud not\ud treated\ud at\ud ANC,\ud and\ud all\ud infants\ud of\ud RPR-positive\ud women\ud did\ud not\ud receive\ud any\ud intervention\ud to\ud prevent\ud congenital\ud syphilis.\ud Forty-one\ud percent\ud of\ud HIV-positive\ud women\ud recruited\ud in\ud the\ud cohort\ud study\ud successfully\ud completed\ud all\ud PMTCT\ud interventions.\ud Only\ud 18%\ud of\ud HIV-positive\ud women\ud identified\ud through\ud PMTCT\ud were\ud successfully\ud referred\ud to,\ud and\ud attended\ud an\ud adult\ud care\ud and\ud treatment\ud clinic\ud (CTC).\ud Of\ud 403\ud HIV-\ud positive\ud women\ud in\ud the\ud cohort\ud study,\ud 50%\ud did\ud not\ud intend\ud to\ud get\ud pregnant\ud and\ud by\ud four\ud months\ud postpartum,\ud 20%\ud of\ud them\ud reported\ud to\ud have\ud not\ud received\ud any\ud counselling\ud on\ud family\ud planning.\ud HIV-positive\ud women\ud who\ud did\ud not\ud receive\ud counselling\ud on\ud FP\ud use\ud were\ud at\ud a\ud higher\ud risk\ud of\ud not\ud using\ud contraception\ud compared\ud to\ud those\ud who\ud were\ud counselled\ud (adj.\ud OR=6,\ud 95%\ud Cl;\ud 2.8-12.9).\ud About\ud 27%\ud of\ud HIV-positive\ud mothers\ud were\ud not\ud counselled\ud regarding\ud infant\ud feeding\ud and\ud 40.2%\ud of\ud women\ud who\ud were\ud not\ud counselled\ud on\ud infant\ud feeding\ud were\ud undecided\ud on\ud how\ud to\ud feed\ud their\ud infants\ud before\ud they\ud left\ud the\ud hospital\ud compared\ud to\ud only\ud 2.5%\ud of\ud women\ud who\ud were\ud counselled\ud (P<O.OOl)\ud It\ud was\ud found\ud that\ud pregnant\ud women\ud attending\ud ANC\ud for\ud the\ud first\ud time\ud during\ud pregnancy\ud spent\ud between\ud three\ud and\ud 5.5\ud hours\ud at\ud the\ud clinic,\ud on\ud average,\ud 78%\ud of\ud this\ud time\ud was\ud spent\ud waiting\ud for\ud services.\ud 6\ud Fewer\ud ANC\ud visits,\ud attending\ud private\ud or\ud rural\ud ANC\ud facilities,\ud failure\ud to\ud attend\ud a\ud CTC\ud prenatally,\ud and\ud lack\ud of\ud knowledge\ud among\ud users\ud and\ud provider\ud of\ud health\ud services\ud were\ud factors\ud found\ud to\ud hamper\ud the\ud performance\ud of\ud the\ud programmes.\ud Integration\ud of\ud these\ud programmes\ud at\ud all\ud levels\ud and\ud training\ud of\ud health\ud workers\ud in\ud basic\ud components\ud of\ud the\ud programmes\ud are\ud fundamental\ud to\ud the\ud successful\ud implementation\ud of\ud the\ud programmes
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