Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

Ahoua, Laurence; Arikawa, Shino; Tiendrebeogo, Thierry; Lahuerta, María; Aly, Dario; Becquet, Renaud; Dabis, François

doi:10.1186/s12889-020-8406-5

Cited by 9 publications

(14 citation statements)

References 15 publications

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“…Study findings on implementation of Option B+ guidelines are similar to previous studies confirming progress on HIV testing and lifelong ART for HIV-infected pregnant and breastfeeding women and persistent gaps in HIV testing for exposed infants 1 , 8 , 21 – 23 . One factor that may contribute to this gap is the finding that HIV+ women are more likely to be lost to follow up when they were started on ART in compliance with Option B+ guidelines (i.e, they are pregnant) as compared to those who are started on ART in response to physical symptoms 22 .…”

Section: Discussionsupporting

confidence: 84%

“…The study also identified salient contextual factors that influenced guideline implementation, many of which align with those identified in other implementation studies in low-resource settings 18 and in other studies of the implementation of Option B+ guidelines, such as periodic shortages of HIV testing kits and ART drugs 19 , 20 . In contrast to this study's focus on support providers and health centre staff, prior research also has identified factors at the community level that affect HIV positive women including lack of transportation, work conflicts, and stigma associated with HIV 20 , 21 . A distinct feature of this study is the focus on contextual factors that influenced not only guideline implementation but also the delivery of support strategies and the finding that transportation challenges played a central role in limiting the delivery of technical assistance to some of the health centres.…”

Section: Discussionmentioning

confidence: 85%

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Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

et al. 2021

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BackgroundHigh HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. MethodsA qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.ResultsFour categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.ConclusionsUnderstanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 85%

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

et al. 2021

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“…However, such mechanisms require rigorous planning, and their effect on the quality of service delivery must be carefully monitored [22]. Other initiatives have been designed to address the failure to retain HIV-positive pregnant women in cART, such as a review of retention (timeliness and regularity of antenatal care visits) in pregnant women at antenatal care services [23].…”

Section: Plos Onementioning

confidence: 99%

Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province—Mozambique

Osório¹,

Munyangaju²,

Nacarapa³

et al. 2021

PLoS ONE

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Background Mother-to-child transmission of HIV infection is a significant problem in Mozambique. This study aims to determine the risk factors associated with mother-to-child transmission of HIV in rural Mozambique. Methods Retrospective case-control study in a rural area of Bilene District, on the coast of southern Mozambique, performed from January 2017 to June 2018. The analysis considered the clinical data of HIV exposed children with definitive HIV positive results and their respective infected mothers (cases), and the data of HIV exposed children with definitive HIV negative results and their respective infected mothers (controls) registered in At Risk Child Clinics from 1st January 2017 to 30th June 2018 at the Macia and Praia de Bilene health facilities in Bilene district, Gaza province–Mozambique. Results Ninety pregnant women with HIV were involved in the study, including 30 who had transmitted the infection to their children and 60 who had not. Statistical analysis, adjusted for maternal age and gestational age at first antenatal care visit, showed that independent risk factors for transmission were gestational age at first visit (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.05–1.36), non-adherence to combination antiretroviral therapy (56.7% vs. 5%; aOR 14.12, 95% CI 3.15–63.41); a viral load of 1000 copies/mL or more (90% vs. 5%; aOR: 156, 95% CI 22.91–1,062) and female sex of the neonate (80% vs. 51.7%; aOR: 4.43, 95% CI 1.33–15.87). Conclusion A high viral load and non-adherence to antiretroviral therapy are important predictors of mother-to-child HIV transmission.

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“…This makes it challenging to develop interventions to improve engagement or evaluate whether they are having the intended effect [ 5 ]. Strategic decisions can also be made more challenging by inaccurate interpretation of programme successes [ 6 ], misunderstanding the magnitude of the challenge [ 3 ] or inaccurate justification of costs [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

et al. 2022

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Introduction:Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programmelevel decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. Methods: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. Results and discussion: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. Conclusions: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.

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Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

Cited by 9 publications

References 15 publications

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province—Mozambique

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

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