Nutritional outcomes in HIV Exposed Infants in the Mingha Program, Dschang-Cameroon (2003-2011)

Background: Prevention of Mother to Child Transmission (PMTCT) is a set of interventions that contribute in reducing the risk of HIV transmission from mother (parents) to the child. The infant feeding choice in the HIV context remains a key item of PMTCT. This study aimed at evaluating the nutritional status of children followed by the Mingha / PMTCT program in the Dschang Health District (DHD) during 09 years of activities. We used a descriptive study based on retrospective data from an intervention conducted at the DHD between 2003 and 2011 on a group of mother-child pairs in the PMTCT (Mingha/PMTCT) facilitation program. The intervention was the formula feeding given to the children from birth till 18 months. The data collected was analyzed using SPSS Version 18 software. Results: Among 328 children accessed, we had a sex ratio of 0.83 with more boys than girls. Severe wasting was found only within 11 boys (3.26%) and only <6 months old children were concerned. Moderate wasting was found among 6 girls (1.74%) and 5 boys (1.52%) and <6 months old children were highly concerned 10 (3.17%). Overweight (3.26%) was highly predominant among 8 boys (2.24%) and except those of <6 months, all the other age groups were concerned. There were no cases of obesity or stunting. Conclusions: The nutritional status of the Mingha/PMTCT program children was quite satisfactory. It characterizes the hope for a suitable nutritional follow up of children in HIV context. Therefore programs like Mingha/PMTCT should be promoted and transferred to other Health Districts and even resource-limited countries

Male partners' involvement in prevention of mother-to-child HIV transmission in sub-Saharan Africa : a systematic review

In sub-Saharan Africa (SSA), male partners are rarely present during prevention of mother-to-child transmission (PMTCT) services. This systematic review aims to synthesize, from a male perspective, male partners' perceived roles, barriers and enablers of their involvement in PMTCT, and highlights persisting gaps. We carried out a systematic search of papers published between 2002 and 2013 in English on Google Scholar and PubMed using the following terms: men, male partners, husbands, couples, involvement, participation, Antenatal Care (ANC), PMTCT, SSA countries, HIV Voluntary Counseling and Testing and disclosure. A total of 28 qualitative and quantitative original studies from 10 SSA countries were included. Men's perceived role was addressed in 28% (8/28) of the studies. Their role to provide money for ANC/PMTCT fees was stated in 62.5% (5/8) of the studies. For other men, the financial responsibilities seemed to be used as an excuse for not participating. Barriers were cited in 85.7% (24/28) of the studies and included socioeconomic factors, gender role, cultural beliefs, male unfriendly ANC/PMTCT services and providers' abusive attitudes toward men. About 64% (18/28) of the studies reported enablers such as: older age, higher education, being employed, trustful monogamous marriages and providers' politeness. In conclusion, comprehensive PMTCT policies that are socially and culturally sensitive to both women and men need to be developed

"You Know You Are Sick, Why Do You Carry A Pregnancy Again?" Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya.

ObjectiveThroughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens.MethodsData were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use.ResultsBarriers to women's utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children.ConclusionThe findings of this study suggest that a woman's social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi-component interventions that combine strategies at different ecological levels

External Evaluation and Cost-Benefit Analysis of mothers2mothers' Mentor Mother Programme in Uganda

This external evaluation examines whether the core component of m2m's Mentor Mother Model -- peer education an psychosocial support services -- improves the uptake of Prevention of Mother-To-Child Transmission (PMTCT) services, as wel as the health and wellbeing of mothers and their infants. It also investigates the cost-benefit of scaling up the Mentor Mother Model nationally in Uganda. To determine this, the study examines the differences in mother and infant uptake of PMTC services and health outcomes, as well as women's psychosocial wellbeing at m2m-supported health facilities compared to similar facilities with no m2m presence (the control sites).The study was conducted across 62 health facilities divided into two groups: 31 intervention sites (with an m2m presence) and 31 control sites (without m2m presence). Approximately 1,150 mother-baby pair records of clients who received PMTCT services between January 2011 and March 2014 were reviewed in each group. Additionally, approximately 400 PMTCT clients in each group who received PMTCT services between June 2012 and March 2014 participated in a survey measuring their psychosocial wellbeing

Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana

Worldwide, it is estimated that two million children are infected with HIV (USAID 2005). The vast majority of these infections are the result of mother-to-child transmission (MTCT) of the virus during pregnancy, labor, or breastfeeding. However, there are effective methods for prevention of mother-to-child transmission (PMTCT). Botswana is one of the first countries in the developing world with a national PMTCT program that uses an efficacious and complex regimen to reduce vertical transmission. At the time of this evaluation (August - December 2005), the standard of care for prevention of MTCT of HIV in Botswana included three-drug antiretroviral therapy for HIV-infected women with a CD4 count of 200 (300 mg AZT in the morning and 300 mg AZT in the evening); four weeks of AZT for their infants; single-dose maternal and infant nevirapine (NVP); and 12 months of free infant formula. Botswana's PMTCT program also provided routine HIV testing for all pregnant women during antenatal care (ANC) to identify HIV-positive women for prophylaxis or treatment. While programs often report the number of individuals beginning AZT and receiving nevirapine for PMTCT, effectiveness is dependent on the level of adherence of individuals to these regimens. To describe adherence of pregnant women to the current PMTCT regimen, the Horizons Program of the Population Council, in collaboration with the Centers for Disease Control and Prevention (CDC) and Premiere Personnel in Botswana, conducted an evaluation to describe HIV-related services provided to women during their pregnancies, document the content of post-test counseling sessions for HIV-positive pregnant women, whether HIV-positive women remembered what had been discussed, the extent of AZT adherence based on self-reports, and the operational successes and barriers to adherence to AZT for PMTCT

Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited

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.

SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: 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. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: 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. CONCLUSIONS: 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

Tanzania: Logistic System Capacity and Site Readiness to expand PMTCT and Initiate ART

In September 2003, JSI/DELIVER conducted an assessment of the logistics system capacity and individual site readiness to provide PMTCT services and to initiate ART at selected public sector health facilities in Tanzania. The purpose of the assessment was to support government expansion of PMTCT from five pilot sites to 28 health facilities in five regions by addressing the logistics system constraints to ensuring a reliable and uninterrupted supply of the broad range of commodities required for PMTCT and ART, and by conducting an evaluation of the overall readiness of each site to provide these services. Several private providers, nongovernmental and faith-based organizations, and employer-based programs were included in the assessment to learn about PMTCT and ART in these sectors and to identify opportunities for public/private sector collaboration in expanding service delivery and ensuring effective commodity distribution. In addition, interviews with pharmaceutical company representatives and visits to retail pharmacies provided an overview of current commercial sector distribution of ARV drugs in Tanzania. The main findings showed an urgent need to build logistics management capacity within the central level MOH to—Coordinate multiple sources of rapidly increasing funding for commodity procurement. Strengthen commodity-forecasting capacity. Align procurement cycles and supplier lead times with the in-country supply pipeline and demand for services. At the facility level, assessment findings showed that individual site readiness is heavily constrained by the availability and quality of human resources; laboratory infrastructure and capacity; and lack of an established inventory control system and standardized pharmacy management procedures

A Study Report On Infant Feeding Practices In The Context Of\ud HIV / AIDS

\ud \ud This report presents the findings of a study on infant feeding practices in the context of HIV/AIDS in Tanzania. The study was undertaken from 8th – 24th August 2004 in 3 regions implementing PMTCT activities namely Kagera, Mbeya and Kilimanjaro. In each region, two PMTCT and one Non-PMTCT implementing districts were involved. The study population included mothers of infants who are HIV negative, infected and those of unknown status. Others were health service providers dealing with mothers and children, men and women of reproductive age and key informants. A total of 471 and 95 mothers with their infants were interviewed in PMTCT and Non-PMTCT sites respectively. Also 211 health service providers and 16 key informants were interviewed. HIV positive and negative mothers were selected purposively whereas those of unknown status were selected randomly. The quantitative data from mothers and health workers were collected by using structured questionnaires. A checklist was used to collect qualitative data from key informants such as TBAs, CBOs, FBOs, VHWs and VGLs. Another checklist was also used for facilitation of focus group discussion which involved men and women of reproductive age. In addition, secondary data from various sources were collected. The collected data were edited manually before being captured using excel, cleaned and finally transferred into SPSS version 10 for analysis. The results show that mean age of the interviewed mothers was 25 years and 62.4% of them had more than one child. Most mothers (87.3%) were married and (76.7%) were primary school leavers. There were 40% housewives. Proportion of mothers who delivered at health facility was 76.6%. Many of health service providers interviewed were Nurse Midwives, (45.5%) and nursing officers (21.3%). As regard to knowledge about breastfeeding, 50% of mothers were able to recognize its nutritional role and 34% knew the importance of colostrums. About breastfeeding initiation, 67.5 percent of mothers reported that it is recommended to start within an hour after delivery. However, a small proportion of mothers (2.5%) and (2.7%) appreciated the advantage of exclusive breastfeeding in relation to family planning and reducing the risk of MTCT of HIV respectively. Furthermore, 34.5% of mothers mentioned appropriate age for complementation as 4-6 months, where as 32.0% mentioned at 6 months. On the other hand, 24.6% of mothers reported to complement their infants at the age below 4 months. Complementary food given were named as maize porridge (40%), Lishe porridge 2.5% and cow’s milk 24%. Findings also show that frequency of feedingfor infants aged 6-9 months as mentioned by 39.8% of mothers was 3 times. However, there were 31.3% mothers who fed their infants 1-2 times a day. With regard to infant aged 10-12 months, the data show that 29.9% and 26.3 percent are fed 3 and 4 times a day respectively. Moreover, 6.0 percent of mothers did not know feeding frequency for infants aged 6-9 months and 9.2% of them were not aware of feeding frequency of infants aged 10-12 months. As regards to knowledge of mothers on MTCT of HIV, most of the mothers (over 90%), were aware that there is a possibility of MTCT of HIV. The awareness was high (over 90%) among the HIB +ve and HIV-ve mothers within the PMTCT sites. The risk was equally known by majority of mothers even in non-PMTCT sites. The findings also show that 57% of mothers that the commonest mode of MTCT of HIV is through breastfeeding. Generally in both PMTCT and non PMTCT sites MTCT of HIV through breastfeeding was the way known by many mothers. Among the mentioned factors that increase the risk of MTCT of HIV were breastfeeding exposure (35.2%), and breast conditions (25.1%). Other factors were sharing clothes between infant and mother; mothers’ spits and sweat on the breast during breast-feeding. However, re-infection with HIV and poor breastfeeding technique were less known as they were mentioned factors by 0.3 and 3.6 percent of mothers respectively. Ways of reducing MTCT of HIV as mentioned by mothers were replacement feeding (62.3%) and avoiding the infants to suckle on a breast with some spits and sweat (16.6%). On the other hand 3.2% of mothers were not aware about any way of reducing MTCT of HIV. However, 1.7 percent and 3.6 percent knew that EBF and ARV respectively could reduce the risk. In PMTCT sites both HIV infected (69%) and non infected (89%) mothers breastfed their infants soon after delivery. HIV positive mothers who reported to give their infants replacement feed soon after delivery were only 4.8%. The proportion of infants fed on breast milk after delivery was as high 81.1% even among mothers with unknown status. On top of that the findings also show that health service providers are the important source of information on infant feeding to mothers. They are depended by almost 70% of mothers and their influence as reported by mothers is very high (60.6%). Family members were also mentioned as other source of information. The main constraints as regard to infant feeding as reported by HIV infected mothers were the refusal of infants to eat other foods, insufficient breast milk and women heavy workload. However, majority of them (71.7%) did not report way constraint. In additional, the findings revealed that infant feeding counseling was given to majority (76.1%) of HIV infected mothers and only few (24.9%) of HIV negative women. About49.6% of HIV infected women were counseled on infant feeding option during pregnancy. Those counseled during and after delivery were 21.8% and 28.6% respectively. The most preferred infant feeding option was early cessation of breast feeding, as it was used by 55.7% of HIV positive women. Other women (17.1 and 14.3%) used exclusive breastfeeding for six months and commercial infant formula respectively. Affordability of infant feeding option was the main motivation (22.9%) to choose and use the said option, as compared to HIV transmission risk reduction (11.0%). Majority of HIV infected mothers (58.7%) reported to face no constraint as regard to implementation of infant feeding option. However, some of them (12%) mentioned stigma from family and community members as a major constraint to successful implementation of infant feeding option of their choice. Some health service providers (26.5%) mentioned the 4-6 months duration of exclusive breastfeeding and 46.4% mentioned the WHO / UNICEF recommended duration of 6 months. Furthermore, 13% of HSP were unable to demonstrate proper positioning and attachment of a baby on the breast, and 0.9% were not ware of the appropriate age for complementation. The findings further show that Few HSP in PMTCT (23%) were aware that there is a possibility of MTCT of HIV during pregnancy. On top of that there were (32.9%) of HSP in PMTCT aware of the increased risk of MTCT of HIV were due to breast conditions, only (4%) of HSP recognized the risk of MTCT associated with poor positioning and attachment of baby on breast. Furthermore, 44% of HSP in PMTCT sites were trained on infant feeding in the context of HIV/AIDS. With regards to infant feeding options 21.3% of The HSP in PMTCT sites mentioned exclusive breastfeeding for 6 months 29.5% mentioned early cessation of breastfeeding. Home prepared infant formula 20.7% and commercial infant formula was given by 15%. According to HSP in PMTCT sites, the main constraints faced by HIV infected mothers when implementing IFO are stigma (51.1%), avoiding to be known by other family members that they are HIV positive (20%), and switching from one option to another without consultation (22%). Overall, the study findings show that there is limitation in terms of knowledge and skills on breastfeeding, complementation and infant feeding options among HSP and mothers. More training, sensitization and media campaigns on infant feeding are needed. Counseling services on infant feeding option need to be strengthened. Also more research need to be conducted to explore the risk of MTCT transmission of HIV through the various existing mode of infant feeding among HIV infected mothers.\u

Stakeholders' Participation in Planning and Priority Setting in the Context of a Decentralised Health Care system: the case of prevention of mother to child Transmission of HIV Programme in Tanzania.

In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery