Prevention-of-Mother-To-Child-Transmission of HIV Services in Sub-Saharan Africa: A Qualitative Analysis of Healthcare Providers and Clients Challenges in Ghana

Laar, Amos; Amankwa, Belynda; Asiedu, Charlotte

doi:10.21106/ijma.31

Cited by 7 publications

(8 citation statements)

References 10 publications

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“…The 27 studies included in the review consisted of 17 qualitative studies [1, 8, 13, 16, 18, 19, 21, 27–36], 9 cross-sectional studies [9, 14, 15, 17, 37–41], and 1 cohort study [42]. Most study populations were based in South Africa [16, 18, 29, 30, 36, 37], Kenya [21, 32–34, 41] and Nigeria [9, 14, 15, 40]; other countries included Ethiopia [27, 38], Malawi [8, 19], Tanzania [17, 35], Uganda [42], Botswana [39], Democratic Republic of Congo [31], Ghana [28], Zambia [1], and one study was generalised over Sub-Saharan Africa [13].…”

Section: Resultsmentioning

confidence: 99%

“…When multiple counselling sessions were provided, many mothers received mixed messages that negatively affected their understanding. This occurred, in particular, when counselling was received from two or more HCPs in the PMTCT treatment cascade; this lead to confusion and potential distrust around infant feeding counselling messages [13, 28–30, 37, 39, 42]. “Regarding this… [formula feeding] there is confusion.…”

Section: Resultsmentioning

confidence: 99%

“…Grandmothers in particular had a lot of power when it came to make infant feeding decisions, especially in contexts where women were young, inexperienced, unmarried or with no partner support. Mixed feeding was often carried out without consent of the infant’s mother [9, 19, 28, 33].…”

Section: Resultsmentioning

confidence: 99%

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A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

et al. 2019

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Background The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. Methods Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson’s five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. Results From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. Conclusion The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF. Electronic supplementary material The online version of this article (10.1186/s12889-019-6949-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

et al. 2019

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“…Views of HIV-positive women would be particularly relevant in this. To this end, a related study that explored the challenges that health workers face implementing PMTCT counseling, as well as the experiences of HIV-positive clients receiving these services at seven health facilities in the Greater Accra Region of Ghana show that providers face various challenges including lack of counseling acumen, inadequate logistics, inadequate training, and uncertainty about the credibility of counseling information [29]. The challenges presented in this paper may therefore not be unique to only the service providers of the three facilities, but may be experienced by other in various parts of Ghana.…”

Section: Discussionmentioning

confidence: 99%

Reproductive rights and options available to women infected with HIV in Ghana: perspectives of service providers from three Ghanaian health facilities

Laar

2013

BMC Women's Health

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BackgroundOwing to improved management of HIV and its associated opportunistic infections, many HIV-positive persons of reproductive age are choosing to exercise their right of parenthood. This study explored the knowledge of health workers from two Ghanaian districts on the reproductive rights and options available to HIV-positive women who wish to conceive.MethodsFacility-based cross-sectional in design, the study involved the entire population of nurse counselors (32) and medical officers (3) who provide counseling and testing services to clients infected with HIV. Both structured and in-depth interviews were conducted after informed consent.ResultsTwo main perspectives were revealed. There was an overwhelmingly high level of approbation by the providers on HIV-positive women’s right to reproduction (94.3%). At the same time, the providers demonstrated a lack of knowledge regarding the various reproductive options available to women infected with HIV. Site of facility, and being younger were associated with practices that violated client’s right to contraceptive counseling (p < 0.05) in each case. Some of the providers openly expressed their inability to give qualified guidance to HIV-positive women on the various reproductive options.ConclusionsTaken together, these findings suggest that many HIV-positive clients do not receive comprehensive information about their reproductive options. These findings highlight some of the problems that service providers face as HIV counselors. Both service providers and policy makers need to recognize these realities and incorporate reproductive health issues of HIV-persons into the existing guidelines.

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“…[2] Efforts have been made over the past few years to improve PMTCT in some sub-Sahara African countries. [3-5] One of the major ways of reducing the scourge of HIV/AIDS is by ensuring early infant diagnosis (EID). The World Health Organization (WHO) recommends that infants of HIV positive mothers should have polymerase chain reaction (PCR) done between 4 to 6 weeks of life for early infant diagnosis and commencement of antiretroviral therapy in HIV positive infants below 24 months of age.…”

Section: Introductionmentioning

confidence: 99%

PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014

2014

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Background:Early infant diagnosis (EID) of human immunodeficiency virus (HIV) infection in pediatrics with the use of DNA polymerase chain reaction (PCR) is a way of assessing the retroviral status of HIV-exposed infant with the view of early commencement of treatment for infected infants. It also serves as a way of assessing the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) in health care facilities.Methods:This was a 5-year prospective cross-sectional study at the Ekiti State University Teaching Hospital, (EkSUTH) Ado-Ekiti, Nigeria. Babies delivered to HIV-positive mothers who presented at EkSUTH between January 2010 and December 2014 were enrolled in the present study. PCR was done twice for all HIV-exposed infants. Statistical analysis was done using SPSS version 16.0.Results:One hundred and fifty eight infants were HIV exposed; 72 males and 86 females (M:F= 0.84:1). Eighty eight (55.7%) of the mothers had commenced highly active anti-retroviral therapy (HAART) before pregnancy, 56 (35.4%) during pregnancy, and 14 (8.9%) after delivery. Ten (6.3%) babies tested positive. Four (28.6%) of 14 exposed babies whose mothers commenced HAART after delivery tested positive to HIV compared to 3 (5.4%) of 56 babies whose mother commenced HAART during pregnancy and 3 (3.4%) of 88 babies whose mother commenced HAART before pregnancy. The difference was statistically significant (c2 = 13.28, df = 4, p = 0.01).Conclusions and Global Health Implications:There is significant reduction in transmission of HIV from mothers to children with commencement of antiretroviral drugs before pregnancy in mothers and use of Nevirapine for all exposed babies for the first 6 weeks of life. Infants of HIV positive mothers can live healthy life free of HIV infection if their mothers participate in PMTCT program.

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Prevention-of-Mother-To-Child-Transmission of HIV Services in Sub-Saharan Africa: A Qualitative Analysis of Healthcare Providers and Clients Challenges in Ghana

Cited by 7 publications

References 10 publications

A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts

Reproductive rights and options available to women infected with HIV in Ghana: perspectives of service providers from three Ghanaian health facilities

PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014

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