Manzi M, Zachariah R, Teck R, et al. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting

Ministry of Health, Malawi, Lilongwe, Central Region, Malawi
Tropical Medicine & International Health (Impact Factor: 2.33). 01/2006; 10(12):1242-50. DOI: 10.1111/j.1365-3156.2005.01526.x
Source: PubMed


Thyolo District Hospital, rural Malawi.
In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district.
Cohort study.
Review of routine antenatal, VCT and PMTCT registers.
Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.
In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.

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    • "Despite the potential of increased HIV testing among males who accompany their pregnant spouses to ANC, much more remains to be achieved as our results show that only 55% of men with partners who visited ANC in the past 2 years reported being HIV-tested. In one Zimbabwean study,[26]encouragement of women receiving HIV testing in ANC to bring their male partners, showed that only 7% of men attended ANC and likewise in a Malawi study[30], 8% of HIV-infected partners undertook HIV testing. This low proportion of HIV testing among male partners may be linked to ANC settings being female centred environments and therefore alternative arrangements such as provision of places for men to congregate while their partners are giving birth or extending opening hours for clinics to allow men to attend after work may be innovative strategies to lure more men into getting tested. "
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    ABSTRACT: Zimbabwe has a high human immunodeficiency virus (HIV) burden. It is therefore important to scale up HIV-testing and counseling (HTC) as a gateway to HIV prevention, treatment and care. To determine factors associated with being HIV-tested among adult men and women in Zimbabwe. Secondary analysis was done using data from 7,313 women and 6,584 men who completed interviewer-administered questionnaires and provided blood specimens for HIV testing during the Zimbabwe Demographic and Health Survey (ZDHS) 2010-11. Factors associated with ever being HIV-tested were determined using multivariate logistic regression. HIV-testing was higher among women compared to men (61% versus 39%). HIV-infected respondents were more likely to be tested compared to those who were HIV-negative for both men [adjusted odds ratio (AOR) = 1.53; 95% confidence interval (CI) (1.27-1.84)] and women [AOR = 1.42; 95% CI (1.20-1.69)]. However, only 55% and 74% of these HIV-infected men and women respectively had ever been tested. Among women, visiting antenatal care (ANC) [AOR = 5.48, 95% CI (4.08-7.36)] was the most significant predictor of being tested whilst a novel finding for men was higher odds of testing among those reporting a sexually transmitted infection (STI) in the past 12 months [AOR = 1.86, 95%CI (1.26-2.74)]. Among men, the odds of ever being tested increased with age ≥20 years, particularly those 45-49 years [AOR = 4.21; 95% CI (2.74-6.48)] whilst for women testing was highest among those aged 25-29 years [AOR = 2.01; 95% CI (1.63-2.48)]. Other significant factors for both sexes were increasing education level, higher wealth status and currently/formerly being in union. There remains a high proportion of undiagnosed HIV-infected persons and hence there is a need for innovative strategies aimed at increasing HIV-testing, particularly for men and in lower-income and lower-educated populations. Promotion of STI services can be an important gateway for testing more men whilst ANC still remains an important option for HIV-testing among pregnant women.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "Successful implementation of PMTCT is often problematic in low-resource settings (Aizire et al. 2013). Common obstacles include lack of qualified staff, limited infrastructure, low antenatal care attendance and high losses to follow-up (Manzi et al. 2005; WHO 2010b; Lozano et al. 2011). Identifying such obstacles for specific regions may enable successful implementation of PMTCT in these areas. "
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    ABSTRACT: To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every three months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardized form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53,1%) had an unclear HIV status because their negative test result was more than three months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39,1%) had tested negative within the last three months. In this last group 79 (24,5%) had been tested twice or more during pregnancy. During the study period none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Nov 2014 · Tropical Medicine & International Health
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    • "Acquired immune deficiency syndrome (AIDS) has now become the leading cause of under five deaths in sub Saharan Africa. It has further worsened the morbidity and mortality of infants and children, pertaining to its MTCT [4]. So, PMTCT programs provide an opportunity for both prevention of HIV transmission from mother to child and enrolment of infected pregnant women and their families into antiretroviral treatment [5,6]. "
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    ABSTRACT: Male partner participation is a crucial component to optimize antenatal care/prevention of mother to child transmission of HIV(ANC/PMTCT) service. It creates an opportunity to capture pregnant mothers and their male partners to reverse the transmission of HIV during pregnancy, labour and breast feeding. Thus involving male partners during HIV screening of pregnant mothers at ANC is key in the fight against mother to child transmission of HIV(MTCT).So, the aim of this study is to determine the level of male partner involvement in PMTCT and factors that affecting it. A Cross-sectional study was conducted among 473 pregnant mothers attending ANC/PMTCT in Mekelle town health facilities in January 2011. Systematic sampling was used to select pregnant mothers attending ANC/PMTCT service after determination of the client load at each health facility. Clinic exit structured interviews were used to collect the data. Finally multiple logistic regression was used to identify factors that affect male involvement in ANC/PMTCT. Twenty percent of pregnant mothers have been accompanied by their male partner to the ANC/PMTCT service. Knowledge of HIV sero status [Adj.OR (95% CI) = 0.43 (0.18- 0.66)], maternal willingness to inform their husband about the availability of voluntary counselling and testing services in ANC/PMTCT [Adj.OR (95% CI) =3.74(1.38-10.17)] and previous history of couple counselling [Adj.OR (95% CI) =4.68 (2.32-9.44)] were found to be the independent predictors of male involvement in ANC/PMTCT service. Male partner involvement in ANC/PMTCT is low. Thus, comprehensive strategy should be put in place to sensitize and advocate the importance of male partner involvement in ANC/PMTCT in order to reach out male partners.
    Full-text · Article · Feb 2014 · BMC Pregnancy and Childbirth
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