Programmes for the prevention of parent‐to‐child transmission of <scp>HIV</scp> in Papua New Guinea: Health system challenges and opportunities

Tynan, Anna; Vallely, Lisa M; Kupul, Martha; Neo, Ruthy; Fiya, Voletta; Worth, Heather; Kariwiga, Grace; Mola, Glen; Kaldor, John; Kelly‐Hanku, Angela

doi:10.1002/hpm.2450

Cited by 7 publications

(23 citation statements)

References 21 publications

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“…21 Importantly, these key drivers of sustainability have been reported by health workers as significant challenges within the current PMTCT programme in PNG. 38 Ensuring adequate resources to follow-up patients was identified in our study as an important component of sustainable scale-up of the Xpert HIV-1 Qualitative test.…”

Section: Discussionmentioning

confidence: 93%

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Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

et al. 2020

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IntroductionEarly infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy can significantly reduce morbidity and mortality among HIV-positive infants. Access to EID is limited in many low-income and middle-income settings, particularly those in which standard care involves dried blood spots (DBS) sent to centralised laboratories, such as in Papua New Guinea (PNG). We conducted a qualitative exploration of the feasibility and acceptability of implementing a point-of-care (POC) EID test (Xpert HIV-1 Qualitative assay) among health workers and key stakeholders working within the prevention of mother-to-child transmission of HIV (PMTCT) programme in PNG.MethodsThis qualitative substudy was conducted as part of a pragmatic trial to investigate the effectiveness of the Xpert HIV-1 Qualitative test for EID in PNG and Myanmar. Semistructured interviews were undertaken with 5 health workers and 13 key informants to explore current services, experiences of EID testing, perspectives on the Xpert test and the feasibility of integrating and scaling up POC EID in PNG. Coding was undertaken using inductive and deductive approaches, drawing on existing acceptability and feasibility frameworks.ResultsHealth workers and key informants (N=18) felt EID at POC was feasible to implement and beneficial to HIV-exposed infants and their families, staff and the PMTCT programme more broadly. All study participants highlighted starting HIV-positive infants on treatment immediately as the main advantage of POC EID compared with standard care DBS testing. Health workers identified insufficient resources to follow up infants and caregivers and space constraints in hospitals as barriers to implementation. Participants emphasised the importance of adequate human resources, ongoing training and support, appropriate coordination and a sustainable supply of consumables to ensure effective scale-up of the test throughout PNG.ConclusionsImplementation of POC EID in a low HIV prevalence setting such as PNG is likely to be both feasible and beneficial with careful planning and adequate resources.Trial registration number12616000734460.

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Section: Discussionmentioning

confidence: 93%

“…Tynan et al 38 also describe patient follow-up as a pervasive barrier to successful implementation of the PMTCT programme in PNG. It is, however, worth noting that the availability of POC EID testing is likely to reduce the need for active tracing of mother-infant pairs for results communication compared with standard care DBS testing.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

et al. 2020

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“…PNG-specific may not be generalisable to the Pacific region. 5 Tynan [45] 2018 PNG To examine healthcare worker perceptions of health system factors impacting on the performance of Prevention of Parent to Child (PPTCT) programmes. Descriptive study Qualitative – semi-structured interviews with healthcare workers involved in the program.…”

Section: Resultsmentioning

confidence: 99%

“…Other interventions included a contraceptive implant outreach service [44] , prevention of parent to child HIV transmission programs [45] , development of maternal and newborn health action plans [31] , reviews of national clinical policies and standards [29] , midwifery leadership programs [46] and the formation of Public Private Partnerships at regional and national levels [ 31 , 47 ]. Proportion of Australian and international participants who were knowledgeable and confident regarding management of perinatal deaths increased from pre-to post-workshop for all items and stations (p < 0.001).…”

Section: Overview Of Quality Improvement Interventionsmentioning

confidence: 99%

Improving the quality of maternal and newborn care in the Pacific region: A scoping review

Wilson

Spotswood

Hayman

et al. 2020

The Lancet Regional Health - Western Pacific

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Background: Quality care is essential for improving maternal and newborn health. Low-and middleincome Pacific Island nations face challenges in delivering quality maternal and newborn care. The aim of this review was to identify all published studies of interventions which sought to improve the quality of maternal and newborn care in Pacific low-and middle-income countries.Methods: A scoping review framework was used. Databases and grey literature were searched for studies published between January 20 0 0 and July 2019 which described actions to improve the quality of maternal and newborn care in Pacific low-and middle-income countries. Interventions were categorised using a four-level health system framework and the WHO quality of maternal and newborn care standards. An expert advisory group of Pacific Islander clinicians and researchers provided guidance throughout the review process.Results: 2010 citations were identified and 32 studies included. Most interventions focused on the clinical service or organisational level, such as healthcare worker training, audit processes and improvements to infrastructure. Few addressed patient experiences or system-wide improvements. Enablers to improving quality care included community engagement, collaborative partnerships, adequate staff education and training and alignment with local priorities. Conclusions:There are several quality improvement initiatives in low-and middle-income Pacific Island nations, most at the point of health service delivery. To effectively strengthen quality maternal and newborn care in this region, effort s must broaden to improve health system leadership, deliver sustaining education programs and encompass learnings from women and their communities.

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“…The healthcare system is largely decentralized in PNG, where religious organisations play a significant role in health service delivery in rural areas ( Grundy et al, 2019 ). Significant gaps in the number, diversity and distribution of the health workforce in PNG has been recognised, leading to staff taking on additional roles and responsibilities ( Grundy et al, 2019 , Tynan et al, 2017 ). Findings from our study showed that the number of staff trained in swabbing was not congruent with workforce needs in health centres.…”

Section: Discussionmentioning

confidence: 99%

Barriers and enablers experienced by health care workers in swabbing for COVID-19 in Papua New Guinea: A multi-methods cross-sectional study

Smaghi¹,

Collins

Dagina³

et al. 2021

International Journal of Infectious Diseases

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Objective We aimed to identify the barriers and enablers Papua New Guinean (PNG) Health Care Workers (HCWs) experienced in swabbing for COVID-19. Methods We conducted a cross-sectional multi-methods study; a qualitative scoping exercise and a telephone survey. The target population was COVID-19 trained HCWs from all provinces of PNG. A descriptive analysis of survey responses was conducted alongside a rapid qualitative analysis of interviews and open-ended survey questions. Results Four key thematic areas were identified; human resources, logistics, HCW attitudes and community attitudes. The survey response rate was 70.3% (407/579). Commonly reported barriers to COVID-19 swabbing were insufficient staff trained (74.0%, n = 301), inadequate staffing in general (64.9 %, n = 264), insufficient supply of personal protective equipment (PPE, 60.9%, n = 248) and no cold chain to store swabs (57.5%, n = 234). Commonly reported enablers to swabbing were increasing community awareness and risk communication (80.8 %, n = 329), consistent and sufficient supplies of PPE (67.8 %, n = 276), increasing surge workforce (63.9 %, n = 260) and having a fridge to store swabs (59.7 %, n = 243). Conclusions A comprehensive community and HCWs engagement strategy in combination with innovations to improve supply chain are needed to increase COVID-19 swabbing in Papua New Guinea to reach national testing targets.

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Programmes for the prevention of parent‐to‐child transmission of HIV in Papua New Guinea: Health system challenges and opportunities

Abstract: The study findings highlight an important need for investment in appropriately trained and supported HCWs and integration of services at each stage of the PPTCT programme. Lessons from the PPTCT experience in PNG may inform policy discussions and considerations in other similar contexts.

Cited by 7 publications

References 21 publications

Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

Feasibility and acceptability of implementing early infant diagnosis of HIV in Papua New Guinea at the point of care: a qualitative exploration of health worker and key informant perspectives

Improving the quality of maternal and newborn care in the Pacific region: A scoping review

Barriers and enablers experienced by health care workers in swabbing for COVID-19 in Papua New Guinea: A multi-methods cross-sectional study

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