Implementation of postnatal care for HIV-positive mothers in the Free State: Nurses’ perspectives

Mangoejane, Lumka; Ramukumba, Mokholelana Margaret

doi:10.4102/phcfm.v11i1.1776

“…Sustainability is a limitation of many programs (27) Previous assessments of the model reported concerns around sustainability due to the perception that it increased the workload for staff involved. Similar to our results, stakeholders relevant to implementation of the model into real world practice reported that the expansion of the PNC model could be jeopardized by human resource constraints attributed to strong dependency on externally-funded staff and minimal involvement of non-PNC focused staff (21). Lessons learned from other differentiated models of care provide suggestions on ways to ensure sustainability of the PNCs, including task shifting of some tasks, such as counselling, drug dispensing and administrative tasks, which may be delegated to PNC graduates or PNC members (20).…”

Section: Discussion and Recommendationssupporting

confidence: 87%

“…Our study described similar perceptions of effectiveness as previous studies on implementation of adherence clubs and postnatal groups (21,22). Adherence clubs were highly acceptable to stakeholders, given the observed bene ts, including decongestion of clinics, increased social support for clients and the low cost of implementation (23).…”

Section: Discussion and Recommendationssupporting

confidence: 74%

Postnatal Clubs for Integrated Postnatal Care in Johannesburg, South Africa: A Qualitative Assessment of Implementation

Makina-Zimalirana

¹

,

Dunlop

²

,

Jiyane

³

et al. 2022

Preprint

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Background South Africa has reported challenges in retaining women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs postnatally. Due to the success of PMTCT in the antenatal period, proportionally more infant transmissions now occur after delivery. The Médecins sans Frontières (MSF) Postnatal Club (PNC) model allows for integrated postnatal care and support. Anova Health Institute implemented the model in primary health facilities in Johannesburg as part of a planned national scale-up. We aimed to assess the implementation of these PNCs. Methods We used the RE-AIM (Reach, Adoption, Implementation, Maintenance) framework to assess implementation success and explore factors influencing implementation. In-depth interviews were conducted with 15 PNC staff, both clinicians and lay counsellors, using convenience sampling, from 12 facilities in Johannesburg. Data were analysed thematically using the RE-AIM framework. Results PNC were perceived to have many benefits for postnatal clients and their infants: providers reported reduced waiting times, reduced number of clinic visits and that PNC provided clients with a space to form cohesive group dynamics thereby contributing to retention and adherence to antiretroviral therapy. However, it was found that lacking resources (e.g., space, medical equipment, staff) negatively impacted reach, implementation and sustainability. At times the PNC model was altered to accommodate the availability of resources (e.g., counselling mothers individually). Additionally, providers expressed concerns about lack of stakeholder adoption and emphasized the importance of involving facility leadership for successful integration of the model into routine primary healthcare. Conclusion Our study found incomplete implementation of PNC in most of the participating facilities attributed to lack of resources and stakeholder buy-in. This underscores the need for increased support at management level to ensure sustainability. Effective collaboration between all stakeholders would allow better use of existing resources. Further studies are needed to evaluate whether all components of the model need to be implemented fully to ensure optimal outcomes, and to identify implementation strategies to facilitate scale-up.

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“…Our study described similar perceptions of effectiveness as previous studies on implementation of adherence clubs and postnatal groups [ 29 , 30 ]. Adherence clubs were highly acceptable to stakeholders, given the observed benefits, including decongestion of clinics, increased social support for clients and the low cost of implementation [ 30 , 31 ].…”

Section: Discussion and Recommendationssupporting

confidence: 78%

“…Our study described similar perceptions of effectiveness as previous studies on implementation of adherence clubs and postnatal groups [ 29 , 30 ]. Adherence clubs were highly acceptable to stakeholders, given the observed benefits, including decongestion of clinics, increased social support for clients and the low cost of implementation [ 30 , 31 ]. An MSF Project report showed that PNC have good early retention in care of the MIP and viral load suppression, as well as zero HIV seroconversion in the infants in similar setting [ 32 ].…”

Section: Discussion and Recommendationssupporting

confidence: 78%

Postnatal clubs for integrated postnatal care in Johannesburg, South Africa: a qualitative assessment of implementation

Makina-Zimalirana

¹

,

Dunlop

²

,

Jiyane

³

et al. 2022

BMC Health Serv Res

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Background South Africa has reported challenges in retaining women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs postnatally. Due to the success of PMTCT in the antenatal period, proportionally more infant transmissions now occur after delivery. The Médecins sans Frontières (MSF) Postnatal Club (PNC) model allows for integrated postnatal care and support. Anova Health Institute implemented the model in primary health facilities in Johannesburg as part of a planned national scale-up. We aimed to assess the implementation of these PNCs. Methods We used the RE-AIM (Reach, Adoption, Implementation, Maintenance) framework to assess implementation success and explore factors influencing implementation. In-depth interviews were conducted with 15 PNC staff, both clinicians and lay counsellors, using convenience sampling, from 12 facilities in Johannesburg. Data were analysed thematically using the RE-AIM framework. Results PNC were perceived to have many benefits for postnatal clients and their infants: providers reported reduced waiting times, reduced number of clinic visits and that PNC provided clients with a space to form cohesive group dynamics thereby contributing to retention and adherence to antiretroviral therapy. However, it was found that lacking resources (e.g., space, medical equipment, staff) negatively impacted reach, implementation and sustainability. At times the PNC model was altered to accommodate the availability of resources (e.g., counselling mothers individually). Additionally, providers expressed concerns about lack of stakeholder adoption and emphasized the importance of involving facility leadership for successful integration of the model into routine primary healthcare. Conclusion Our study found incomplete implementation of PNC in most of the participating facilities attributed to lack of resources and stakeholder buy-in. This underscores the need for increased support at management level to ensure sustainability. Effective collaboration between all stakeholders would allow better use of existing resources. Further studies are needed to evaluate whether all components of the model need to be implemented fully to ensure optimal outcomes, and to identify implementation strategies to facilitate scale-up.

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“…The proportion of participants with prior immunization counseling experience in the context of HIV (19.5%) was low, but similar to the figures from Nigerian centers (7.1%-9.1%), 10 , 29 parts of Africa (22-48%) 15 , 30 and elsewhere (36.9%-57.4%). 31 With reports of sub-optimal vaccine responsiveness among HIV-infected infants on ART, 32 health care workers need to pay special attention when counseling women living with HIV on infant immunization.…”

Section: Discussionsupporting

confidence: 65%

Correlates of Health Care Workers’ Knowledge and HIV-Exposed Infant Immunization Counseling Practice in Northern Nigeria

Iliyasu

¹

,

Hassan-Hanga

²

,

Ajuji

³

et al. 2020

Int J MCH AIDS

0

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Background: Human Immunodeficiency Virus (HIV)-exposed and HIV-infected infants are at increased risk of vaccine-preventable diseases. However, little is known about health care workers’ knowledge and immunization counseling practices in this population. We determined the predictors of health care workers’ knowledge of vertical transmission risks, HIV exposed/infected infant immunization, and counseling practices in a tertiary center in Northern Nigeria. Methods: A cross-section of 297 health workers were interviewed using a structured, validated questionnaire. Knowledge and HIV-exposed infant immunization counseling practices were analyzed, and adjusted odds ratios for predictors were derived from logistic regression models. Results: Of the 297 participating health care workers, (32.3%, n=96) had adequate knowledge of HIVexposed/infected infant immunization. Two-thirds (67%, n=199) of the participants appropriately identified the timing of infant diagnosis, while (73%, n=217) and (56.2%, n=167) correctly categorized infants as HIV-exposed and HIV-infected, respectively. Only (19.5%, n=58) participants had ever counselled a HIVpositive mother on infant immunization. Knowledge was predicted by work unit (HIV clinic vs. Obstetrics & Gynecology clinic), (Adjusted Odds Ratio (AOR) =3.78, 95% CI: 1.27-5.54), age (30-39 vs. <30 years), (AOR=2.24, 95% CI:1.19-5.67), years of experience (≥10 vs. <5), (AOR=1.76, 95% CI: 1.15-6.04), number of children (1 vs. 0), (AOR=1.73, 95% CI:1.14-4.23), infant immunization training (yes vs. no), (AOR=1.57, 95% CI:1.12-5.43), female sex (AOR = 1.17, 95% CI:1.06-2.21), profession (nurse/midwife vs. physician), (AOR=0.44, 95% CI:0.21-0.94) and previous HIV test (no vs. yes), (AOR=0.67, 95% CI:0.21-0.83). Conclusion and Global Health Implications: Knowledge of HIV-exposed infant immunization was low and counseling practices were sub-optimal. Both immunization knowledge and counseling practices were predicted by demographic, professional, and training variables. Our findings indicate the need for educating health care workers on HIV exposed/infected infant immunization policy and improving counseling skills through capacity-building programs. Key words: • Knowledge • Health care workers • HIV • Infant • Immunization • Nigeria Copyright © 2021 Iliyasu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Implementation of postnatal care for HIV-positive mothers in the Free State: Nurses’ perspectives

Cited by 4 publications

References 12 publications

Postnatal Clubs for Integrated Postnatal Care in Johannesburg, South Africa: A Qualitative Assessment of Implementation

Postnatal Clubs for Integrated Postnatal Care in Johannesburg, South Africa: A Qualitative Assessment of Implementation

Postnatal clubs for integrated postnatal care in Johannesburg, South Africa: a qualitative assessment of implementation

Correlates of Health Care Workers’ Knowledge and HIV-Exposed Infant Immunization Counseling Practice in Northern Nigeria

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