Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study

Ekouévi, Didier K.; Stringer, Elizabeth M.; Coetzee, David; Tih, Pius; Creek, Tracy; Stinson, Kathryn; Westfall, Andrew O.; Welty, Thomas K.; Chintu, Namwinga; Benjamin, H.; Wilfert, Cathy; Shaffer, Nathan; Stringer, Jeff; Dabis, François

doi:10.1371/journal.pone.0029823

Cited by 38 publications

(38 citation statements)

References 7 publications

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“…Low perception of personal risk, poor access to testing sites, cost, confidentiality, and HIV-related stigma have all been identified as barriers to HIV testing [11-14]. Barriers to optimal PMTCT exist at the level of the patients and providers, but barriers at the health systems level appear to have more adverse impact on healthcare in general [15-17]. Most women in Nigeria do not access prenatal care early in pregnancy, and only 35% of pregnant women deliver in a health facility where just 2.9% have an established PMTCT program [9,18,19].…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial

Ezeanolue

Obiefune²,

Yang

et al. 2013

Implementation Sci

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BackgroundA total of 22 priority countries have been identified by the WHO that account for 90% of pregnant women living with HIV. Nigeria is one of only 4 countries among the 22 with an HIV testing rate for pregnant women of less than 20%. Currently, most pregnant women must access a healthcare facility (HF) to be screened and receive available prevention of mother-to-child HIV transmission (PMTCT) interventions. Finding new approaches to increase HIV testing among pregnant women is necessary to realize the WHO/ President's Emergency Plan for AIDS Relief (PEPFAR) goal of eliminating new pediatric infections by 2015.MethodsThis cluster randomized trial tests the comparative effectiveness of a congregation-based Healthy Beginning Initiative (HBI) versus a clinic-based approach on the rates of HIV testing and PMTCT completion among a cohort of church attending pregnant women. Recruitment occurs at the level of the churches and participants (in that order), while randomization occurs only at the church level. The trial is unblinded, and the churches are informed of their randomization group. Eligible participants, pregnant women attending study churches, are recruited during prayer sessions. HBI is delivered by trained community health nurses and church-based health advisors and provides free, integrated on-site laboratory tests (HIV plus hemoglobin, malaria, hepatitis B, sickle cell gene, syphilis) during a church-organized ‘baby shower.’ The baby shower includes refreshments, gifts exchange, and an educational game show testing participants’ knowledge of healthy pregnancy habits in addition to HIV acquisition modes, and effective PMTCT interventions. Baby receptions provide a contact point for follow-up after delivery. This approach was designed to reduce barriers to screening including knowledge, access, cost and stigma. The primary aim is to evaluate the effect of HBI on the HIV testing rate among pregnant women. The secondary aims are to evaluate the effect of HBI on the rate of HIV testing among male partners of pregnant women and the rate of PMTCT completion among HIV-infected pregnant women.DiscussionResults of this study will provide further understanding of the most effective strategies for increasing HIV testing among pregnant women in hard-to-reach communities.Trial RegistrationClinicaltrials.gov, NCT01795261

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Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial

Ezeanolue

Obiefune²,

Yang

et al. 2013

Implementation Sci

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“…In Zambia, improvements in PMTCT service delivery have the potential to increase the number of women receiving ART and reduce the number of infants born with HIV [9,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities

Kim

Chilila²,

Shasulwe³

et al. 2013

BMC Health Serv Res

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BackgroundThe Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers.MethodsFour ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities’ infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations.ResultsAmong 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers’ PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers’ ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites.ConclusionsThese findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.

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“…One study had a prospective cohort design (Sangsari et al, 2012), and eight studies did not explicitly state their design strategy. Most of the studies had taken place in the USA (n = 12) (Anaya et al, 2004;Backus et al, 2010;Chu et al, 2010;Horberg et al, 2007;Kerr et al, 2012;Kitahata et al, 2003;Landon et al, 2005;Rodriguez, Marsden, Landon, Wilson, & Cleary, 2008;Saha et al, 2013;Solomon et al, 2005;Wilson, Landon, Hirschhorn, et al, 2005) and countries in sub-Saharan Africa (n = 13) (Assefa et al, 2012;Balcha & Jeppsson, 2010;Boyer et al, 2010Boyer et al, , 2011Chan et al, 2011;Ekouevi et al, 2012;Fatti et al, 2010;Fatti, Grimwood, Mothibi, & Shea, 2011;McGuire et al, 2012;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Reidy et al, 2014;Sherr et al, 2010). The remaining studies were situated in Brazil (Nemes et al, 2009), India (Shet et al, 2011), and Canada (Sangsari et al, 2012) (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…These studies assessed the impact of private versus public funding (Boyer et al, 2011;Ekouevi et al, 2012;Shet et al, 2011), level of care (primary/secondary/tertiary; hospital/clinic; or centralized/decentralized) (Assefa et al, 2012;Balcha & Jeppsson, 2010;Boyer et al, 2010Boyer et al, , 2011Chan et al, 2011;Ekouevi et al, 2012;Fatti et al, 2010;McGuire et al, 2012;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Reidy et al, 2014), and location of care site (urban/rural) (Anaya et al, 2004;Balcha & Jeppsson, 2010;Boyer et al, 2010;Ekouevi et al, 2012).…”

Section: Structural Factorsmentioning

confidence: 99%

Structure and quality of outpatient care for people living with an HIV infection

et al. 2016

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Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers.ARTICLE HISTORY

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Health Facility Characteristics and Their Relationship to Coverage of PMTCT of HIV Services across Four African Countries: The PEARL Study

Cited by 38 publications

References 7 publications

Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial

Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities

Structure and quality of outpatient care for people living with an HIV infection

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