Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

Fowkes, Freya J. I.; Draper, Bridget; Hellard, Margaret; Stoové, Mark

doi:10.1186/s12916-016-0753-9

Cited by 31 publications

(27 citation statements)

References 59 publications

(70 reference statements)

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“…Although WHO has endorsed an integrated disease approach to service delivery of antenatal care [ 60 , 61 ], development assistance for HIV activities has risen disproportionately since 2000 compared to assistance for other sexual reproductive health activities [ 62 ], shifting agendas and priorities away from strengthening systems and building linkages between programmes [ 44 , 59 , 63 – 65 ]. Funds are often earmarked for specific purposes with deliverables defined by coverage and uptake, creating strong incentives for focused vertical programmes that result in rapid outputs rather than overall health system improvement [ 63 , 66 , 67 ]. In Kenya, less than half of the pregnant women attending ANC are tested for syphilis or haemoglobin concentrations [ 37 – 39 , 68 ], even though antenatal screening is a major country policy and over 90% of pregnant women attend ANC [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study

et al. 2018

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BackgroundIn sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women.MethodsA longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence.FindingsFor first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin–piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses.ConclusionsIntegrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.

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Section: Discussionmentioning

confidence: 99%

Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study

et al. 2018

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“…Besides those infectious diseases, maternal and child mortality is an additional headache to the region. 5,6 According to 2016's report, the global fund had spent US $32.6 billion to support programs for HIV, TB, and malaria. Such a considerable amount of spending needs appropriate management to reduce the burden of those diseases and the associated wastage.…”

Section: Introductionmentioning

confidence: 99%

<p>Assessment of Inventory Management Practices at the Ethiopian Pharmaceuticals Supply Agency, Addis Ababa, Ethiopia</p>

Boche

Mulugeta

Gudeta

2020

IPRP

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Background: Maintaining an adequate level of inventory is critical since an enormous amount of capital tied up with it. Having excess inventory leads to wastage. On the contrary, insufficient commodity leads to stock out. Hence, this study aimed to assess inventory management practices of program commodities at Ethiopian Pharmaceutical Supply Agency. Methods: A descriptive cross-sectional study complemented with a qualitative method was conducted from February 21 to April 20/2019. Order fill rate, wastage rate, frequency of emergency order, acceptable storage condition met, and stock out were the metrics we used to measure the inventory management practices of the agency. Quantitative data were collected through physical observation of the warehouses and review of logistics management tools. Seventeen in-depth interviews were conducted to explore the challenges of inventory management. Results: From the total 70 program commodities managed by the agency, 2.1% wasted due to expiration and damage. These resulted in a loss of over US $2 million. The highest wastage was recorded for antimalarials which accounted for 13.1% of the malaria commodities' total inventory value. Only 14.8% of the orders were fulfilled above 80%. Thirty-seven items were stock out on average for 8.5 average days. Longer duration of stock out (260 days) was recorded for TB commodities. Seventeen items from different programs were purchased through emergency orders with a higher frequency of levonorgestrel purchase. Only 6 (60%) warehouses met acceptable storage conditions. Space deficit, outdated warehouse designs, shortage of warehouse equipment, lack of precise data, and capacity building gaps were the inventory management challenges identified. Conclusion: Though the wastage rate was near to the acceptable range, there were lesser order fill rates, storage condition inadequacy, and significant stock-outs of program commodities. The finding implies the need for an improvement in inventory management practice of the agency.

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“…For the intervention to be feasible, adequate health system support is needed to ensure resources, such as trained healthcare workers and commodities, are available. Despite the prominent health burden of syphilis, malaria and anaemia and the availability of simple cost-effective solutions, interventions to address these illnesses at ANC have been poorly delivered in Kenya and elsewhere in SSA, compared to HIV programmes [27, 28, 35, 40, 71, 72]. International advocates play a significant role in norm promotion and shaping countries’ policy preferences [73, 74].…”

Section: Discussionmentioning

confidence: 99%

Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility

Young

Achieng

Desai

et al. 2019

BMC Health Serv Res

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BackgroundHIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (POCTs) at rural antenatal health facilities (dispensaries) has the potential to improve access and timely treatment. Fundamental to the adoption of and adherence to new diagnostic approaches are healthcare workers’ and pregnant women’s (end-users) buy-in. A qualitative approach was used to capture end-users’ experiences of using POCTs for HIV, syphilis, malaria and anaemia to assess the appropriateness, acceptability and feasibility of integrated testing for ANC.MethodsSeven dispensaries were purposively selected to implement integrated point-of-care testing for eight months in western Kenya. Semi-structured interviews were conducted with 18 healthcare workers (14 nurses, one clinical officer, two HIV testing counsellors, and one laboratory technician) who were trained, had experience doing integrated point-of-care testing, and were still working at the facilities 8–12 months after the intervention began. The interviews explored acceptability and relevance of POCTs to ANC, challenges with testing, training and supervision, and healthcare workers’ perspectives of client experiences. Twelve focus group discussions with 118 pregnant women who had attended a first ANC visit at the study facilities during the intervention were conducted to explore their knowledge of HIV, syphilis, malaria, and anaemia, experience of ANC point-of-care testing services, treatments received, relationships with healthcare workers, and experience of talking to partners about HIV and syphilis results.ResultsHealthcare workers reported that they enjoyed gaining new skills, were enthusiastic about using POCTs, and found them easy to use and appropriate to their practice. Initial concerns that performing additional testing would increase their workload in an already strained environment were resolved with experience and proficiency with the testing procedures. However, despite having the diagnostic tools, general health system challenges such as high client to healthcare worker volume ratio, stock-outs and poor working conditions challenged the delivery of adequate counselling and management of the four conditions. Pregnant women appreciated POCTs, but reported poor healthcare worker attitudes, drug stock-outs, and fear of HIV disclosure to their partners as shortcomings to their ANC experience in general.ConclusionThis study provides insights on the acceptability, appropriateness, and feasibility of integrating POCTs into ANC services among end-users. While the innovation was desired and perceived as beneficial, future scale-up efforts would need to address health system weaknesses if integrated testing and subsequent effective management of the four conditions are to be achieved.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3844-9) contains supplementary material, which is available to au...

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Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

Cited by 31 publications

References 59 publications

Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study

Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study

<p>Assessment of Inventory Management Practices at the Ethiopian Pharmaceuticals Supply Agency, Addis Ababa, Ethiopia</p>

Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility

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