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

Abstract

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.

Knowledge of mother-to-child transmission of HIV among women living with HIV in Malawi

“…3,4 In line with the recommendations by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) on MTCT of HIV, there have been initiatives by the Government of Malawi to eliminate all vertical transmissions of HIV. 5 In the third edition of the Guidelines for the Clinical Management of HIV Malawi, published by the Malawi Ministry of Health, the document endorsed a four-pronged approach to addressing MTCT of HIV, which included emphasis on the primary prevention of HIV infection among parents; prevention of unintended pregnancies among women who are living with HIV; preventing transmission of HIV from HIV positive parents to their children; and providing care, treatment and support for women living with HIV, including their children and families. 6 Central to this document and the four-pronged approach is making women living with HIV aware of the risk of vertical transmission of HIV and initiating steps, including enrolling them into antiretroviral therapy (ART) and providing them with clinically assisted births.…”