Reithinger R, Megazzini K, Durako SJ, et al. Monitoring and evaluation of programmes to prevent mother to child transmission of HIV in Africa

Vanderbilt University, Нашвилл, Michigan, United States
BMJ (online) (Impact Factor: 17.45). 07/2007; 334(7604):1143-6. DOI: 10.1136/bmj.39211.527488.94
Source: PubMed


Many countries are expanding the coverage of programmes to prevent mother to child transmission of HIV. Although the need is unquestionable, Richard Reithinger and colleagues are concerned that without true measures of effectiveness we may not be making the best use of resources

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Available from: Sten H Vermund
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    • "• Mobile phones offer the promise of linking data from clinics or hospitals to CHWs. Current studies of loss to follow-up along the 'PMTCT cascade' are not based on linked data, only serial cross sections (Reithinger et al. 2007). Yet, as investments are made in health infrastructure, the types of information that need to be linked in integrated systems for health data are similar cross-nationally and regionally, including: tracking individuals or households' health visits over time, and anticipated, developmentally-linked or condition-linked Source: Mobenzi Researcher n.d., Philani Mentor Mothers Project, viewed from; "
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    ABSTRACT: Introduction: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC's), where the penetration rate approaches 100%. In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa. Methods: This paper is a descriptive one, drawing lessons from two Randomised Controlled Trials (RCT's), outlining how a mobile phone information system can be utilized to enhance the quality of health interventions. We organized our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilized by CHWs and a web-based interface utilized by CHW supervisors. Computerized algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs. Results: CHWs used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing, and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field. Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realized health gains for communities is yet to be tested.
    Full-text · Article · Feb 2013
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    • "Where there is no form of treatment to prevent MTCT, 15-30% of babies born to HIV positive mothers become infected during pregnancy and delivery, and a further 20% will be infected through breastfeeding [5]. This risk can however be reduced to less than 2% where the appropriate treatment is used and the mother adheres to her choice of infant feeding [6] as has been achieved in high income countries [7]. "
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    ABSTRACT: The rate of mother-to-child transmission of HIV, occurring during pregnancy, delivery/labour and breastfeeding, still remains high in Sub-Saharan Africa (SSA). The World Health Organization recommends HIV infected mothers exclusively breastfeed their infants, unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Health care workers are responsible for providing counselling to mothers on the risks and benefits of infant feeding options allowing mothers to make an 'informed choice', but this role is challenging and mostly subjective. The aim of this study was to develop and content validate an AFASS assessment tool that could be used for infant feeding counselling in SSA. An AFASS assessment tool was developed based on the evidence and tools available regarding why replacement feeding is not AFASS in SSA (15 questions). Fifty seven experts involved in PMTCT programmes in five SSA countries were approached to participate as members of the Delphi expert panel (purposive sampling and snowballing). A web-based survey, utilising a 4-point Likert scale, was employed to gain consensus (>75% agreement) from the expert panel following the Delphi technique. A final panel of 15 experts was obtained. Thirteen of the 15 questions in the tool achieved consensus agreement. Experts suggested some additional questions, and that double-barrelled questions were split. Consensus was achieved regarding the applicability and appropriateness of the tool within a SSA context. Experts all agreed that the tool will be useful for the purpose for which it was designed. Suggestions made by the expert panel were incorporated into the revised tool. The findings of this study confirm that this AFASS counselling tool may be appropriate and useful for SSA. Ideally the revised tool should be tested by providers of infant feeding advice with the aim of adoption into routine PMTCT programmes in SSA. Within the context of the 2010 WHO guidelines which advocate a public health rather than an individualised approach, it may inform the WHO process of improving counselling tools for health care workers involved in PMTCT programmes.
    Full-text · Article · Jun 2012 · BMC Public Health
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    • "Successful delivery of PMTCT relies on a cascade of successful steps including HIV counseling and testing, assessment of HAART eligibility through CD4+ testing and clinical staging, and ARV prophylaxis (including HAART) provision, infant testing, and HAART provision for HIVpositive infants [5] [6] [7] [8] [9]. Considerable challenges interfere with PMTCT delivery, particularly with respect to HAART uptake for qualifying women and infants. "
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    ABSTRACT: Many HIV-positive pregnant women and infants are still not receiving optimal services, preventing the goal of eliminating mother-to-child transmission (MTCT) and improving maternal child health overall. A Rapid Results Initiative (RRI) approach was utilized to address key challenges in delivery of prevention of MTCT (PMTCT) services including highly active antiretroviral therapy (HAART) uptake for women and infants. The RRI was conducted between April and June 2011 at 119 health facilities in five districts in Nyanza Province, Kenya. Aggregated site-level data were compared at baseline before the RRI (Oct 2010-Jan 2011), during the RRI, and post-RRI (Jul-Sep 2011) using pre-post cohort analysis. HAART uptake amongst all HIV-positive pregnant women increased by 40% (RR 1.4, 95% CI 1.2-1.7) and continued to improve post-RRI (RR 1.6, 95% CI 1.4-1.8). HAART uptake in HIV-positive infants remained stable (RR 1.1, 95% CI 0.9-1.4) during the RRI and improved by 30% (RR 1.3, 95% CI 1.0-1.6) post-RRI. Significant improvement in PMTCT services can be achieved through introduction of an RRI, which appears to lead to sustained benefits for pregnant HIV-infected women and their infants.
    Full-text · Article · Apr 2012 · AIDS research and treatment
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