Integrating HIV and Maternal, Neonatal and Child Health Services in Rural Malawi: An Evaluation of the Implementation Processes and Challenges

Gunda, Andrews; Jousset, Aurelie; Tchereni, Timothy; Joseph, Jessica; Mwapasa, Victor

doi:10.1097/qai.0000000000001367

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…Two2,22 studies were conducted in Rwanda and reported on different aspects of the same study. Two50,51 were conducted in Malawi. Six records8,34–39 reported on different aspects of the same study that was conducted in Uganda and two studies43,44 were conducted in Nigeria.…”

Section: Resultsmentioning

confidence: 99%

“…The included studies reported on the following major approaches to mentoring: mentoring by mobile team,8,34–39 twining higher performing institution with lower performing institution,26,45,49 embedded mentor support,30,32 providing mentoring support through e-mails and phone calls,43 visits by a single mobile mentor,51 and within-facility mentorship provided by a focal person, experienced or senior person or a manager 50. The included studies assessed the effectiveness of mentorship interventions in three areas: a) clinical competence and performance, b) managerial competence and performance, and c) laboratory quality.…”

Section: Resultsmentioning

confidence: 99%

“…A before-and-after study51 that aimed to promote retention among infants and mothers through mother-infant pair clinic by providing integrated care for HIV, maternal and childhood illnesses evaluated the effect of mentorship support to clinics. The study reported an improvement in mentoring score from 3.0 at quarter one of 2015 to 4.2 at quarter one of 2016.…”

Section: Resultsmentioning

confidence: 99%

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<p>How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence</p>

Feyissa

2019

JMDH

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IntroductionMentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa.MethodsThis review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar.ResultsWe included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager.Implication for practiceMentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring.Implications for researchFurther research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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<p>How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence</p>

Feyissa

2019

JMDH

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“…[1,2] Option B+ was integrated into existing maternal, newborn and child health services [3,4], including antenatal and postpartum care, family planning, treatment of sexually transmitted infections, and cervical cancer screening. Within a year, Option B+ had more than doubled the number of HIV-positive pregnant and lactating women on ART [4–6], from 22% to 47%. [6] Malawi Population- based HIV Impact Assessment (MPHIA) estimated an HIV prevalence of 8.7% for pregnant women aged 15–49 years between 2015 and 2016.…”

Section: Introductionmentioning

confidence: 99%

“I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi

et al. 2019

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Malawi’s Option B+ program is based on a ‘test and treat’ strategy that places all HIV-positive pregnant and lactating women on lifelong antiretroviral therapy. The steep increase in patient load placed severe pressure on a health system that has struggled for decades with inadequate supply of health care workers (HCWs) and poor infrastructure. We set out to explore health system barriers to Option B+ by asking HCWs in Malawi about their experiences treating pregnant and lactating women. We observed and conducted semi-structured interviews (SSIs) with 34 HCWs including nine expert clients (ECs) at 14 health facilities across Malawi, then coded and analyzed the data. We found that HCWs implementing Option B+ are so overburdened in Malawi that it reduces their ability to provide quality care to patients, who receive less counseling than they should, wait longer than is reasonable, and have very little privacy. Interventions that increase the number of HCWs and upgrade infrastructure to protect the privacy of HIV-infected pregnant and lactating women and their husbands could increase retention, but facilities will need to be improved to support men who accompany their partners on clinic visits.

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“…The PRIME cluster randomised trial (CRT) was conducted and reported on the basis of Consolidated Standards of Reporting Trials (CONSORT) 2010 statement for cluster randomised trials [18,19]. The trial was performed between May 2013 and August 2016 across 30 healthcare facilities in rural and semirural Malawi (protocol previously outlined) [9,20]. All HIV-infected pregnant mothers in the districts of Salima and Mangochi across the Central and South regions of Malawi, respectively, and their infants on delivery were enrolled in PRIME, with clustering occurring from different health facilities stratified by region.…”

Section: Study Design and Study Sitementioning

confidence: 99%

Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi

et al. 2020

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Background Retention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant’s HIV PCR test result on maternal and infant study retention. Methods A quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother’s receiving an infant’s HIV test result and in particular, an infant’s HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression. Results Four hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant’s HIV test results < 5 months postpartum. Receiving an infant’s HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant’s result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up. Conclusions Receiving an infant’s HIV test result was a driving factor for reduced infant study retention, especially an infant’s HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities. Trial registration Pan African Clinical Trial Registry: PACTR201312000678196.

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Integrating HIV and Maternal, Neonatal and Child Health Services in Rural Malawi: An Evaluation of the Implementation Processes and Challenges

Cited by 7 publications

References 14 publications

<p>How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence</p>

<p>How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence</p>

“I do all I can but I still fail them”: Health system barriers to providing Option B+ to pregnant and lactating women in Malawi

Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi

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