The effects of antenatal health education on postnatal care among HIV positive women in Francistown City, Botswana

The purpose of the study was to determine the effect of antenatal health education on postnatal care (PNC) among Human Immunodeficiency Virus (HIV) positive women in Francistown city, Botswana. This study followed a quantitative research paradigm. Data was collected with the aid of a questionnaire from eligible women who consented in writing to participate in the study. Forty-five percent (45%) (n=45) HIV positive women came with babies for 6 weeks PNC and 55% (n=55) brought 8 weeks old babies either for weighing or for the two months immunisation from 28 April to 10 June 2014. The responses regarding the source of health education received were as follows: 40% lay counselors, 31% midwives, 15% doctors, 5% nurses without midwifery, 5% cadre unknown, 2% both lay counselors and midwives, 1% by a health education assistant and 1% was not health educated at all. Conclusion: The study revealed that HIV positive pregnant women received health education from different cadres of health and mostly by lay counselors. Literature indicates that lay counselors may give health information but at a very superficial level.Health StudiesM. A. (Health Studies

Rapid antiretroviral therapy initiation in the Botswana Combination Prevention Project: a quasi-experimental before and after study.

BACKGROUND: Ensuring that individuals who are living with HIV rapidly initiate antiretroviral therapy (ART) is an essential step in meeting the 90-90-90 targets. We evaluated the feasibility and outcomes of rapid ART initiation in the Botswana Combination Prevention Project (BCPP). We aimed to establish whether simplified ART initiation with the offer of same-day treatment could increase uptake and reduce time from clinic linkage to treatment initiation, while maintaining rates of retention in care and viral suppression. METHODS: We did a quasi-experimental before and after study with use of data from the BCPP. The BCPP was a community-randomised HIV-prevention trial done in 30 communities across Botswana from Oct 1, 2013, to June 30, 2018. Participants in the 15 intervention clusters, who were HIV-positive and not already taking ART were offered universal HIV-treatment and same-day ART with a dolutegravir-based regimen at first clinic visit. This rapid ART intervention was implemented mid-way through the trial on June 1, 2016, enabling us to determine the effect of rapid ART guidelines on time to ART initiation and rates of retention in care and viral suppression at 1 year in the BCPP intervention group. FINDINGS: We assessed 1717 adults linked to study clinics before rapid ART introduction and 800 after rapid ART introduction. During the rapid ART period, 457 (57·1%, 95% CI 53·7-60·6) individuals initiated ART within 1 day of linkage, 589 (73·7%, 70·6-76·7) of 799 within 1 week, 678 (84·9%, 82·4-87·3) of 799 within 1 month, and 744 (93·5%, 91·6-95·1) of 796 within 1 year. Before the introduction of rapid ART, 163 (9·5%, 95% CI 8·2-11·0) individuals initiated ART within 1 day of linkage, 276 (16·1%, 14·4-17·9) within 1 week, 839 (48·9%, 46·5-51·3) within 1 month, and 1532 (89·2%, 87·7-90·6) within 1 year. 1 year after ART initiation, 1472 (90·5%, 87·4-92·8) of 1627 individuals who linked in the standard ART period were in care and had a viral load of less than 400 copies per mL, compared with 578 (91·6%, 88·1-94·1) of 631 in the rapid ART period (risk ratio 1·01, 95% CI 0·92-1·11). INTERPRETATION: Our findings provide support for the WHO recommendations for rapid ART initiation, and add to the accumulating evidence showing the feasibility, acceptability, and safety of rapid ART initiation in low-income and middle-income country settings. FUNDING: US President's Emergency Plan for AIDS Relief

Advanced HIV disease in the Botswana combination prevention project: prevalence, risk factors, and outcomes.

OBJECTIVE(S): To determine the proportion of individuals linking to HIV-care with advanced HIV-disease (CD4 cell counts ≤200 cells/μl) in the Botswana Combination Prevention Project, describe the characteristics of these individuals, and examine treatment outcomes. DESIGN: A subanalysis of a cluster-randomized HIV-prevention trial. HIV status was assessed in 16-64-year-olds through home and mobile testing. All HIV-positive persons not on antiretroviral therapy were referred to local Ministry of Health and Wellness clinics for treatment. METHODS: Analysis was restricted to the 15 intervention clusters. The proportion of individuals with advanced HIV disease was determined; associations between advanced HIV disease and sex and age explored; and rates of viral suppression determined at 1-year. Mortality and retention in care were compared between CD4 strata (CD4 cell counts ≤200 vs. >200 cells/μl). RESULTS: Overall, 17.2% [430/2499; 95% confidence interval (CI) 15.7-18.8%] of study participants had advanced HIV disease (CD4 cell counts ≤200 cells/μl) at time of clinic linkage. Men were significantly more likely to present with CD4 cell counts 200 cells/μl or less than women [23.7 vs. 13.4%, adjusted odds ratio 1.9, 95% CI 1.5-2.3]. The risk of advanced HIV disease increased with increasing age (adjusted odds ratio 2.2, 95% CI 1.4-3.2 >35 vs. <25 years). Patients with CD4 cell counts 200 cells/μl or less had significantly higher rates of attrition from care during follow-up (hazards ratio 1.47, 95% CI 1.1-2.1). CONCLUSION: Advanced HIV disease due to late presentation to or disengagement from antiretroviral therapy care remains common in the Treat All era in Botswana, calling for innovative testing, linkage, and treatment strategies to engage and retain harder-to-reach populations in care

The Effects of Antenatal Health Education on Postnatal Care of HIV-positive Women

This study was carried out in Botswana. The purpose of the study was to determine the effects of antenatal health education on postnatal care among human immunodeficiency virus (HIV) positive women in the city of Francistown, Botswana. The study followed a quantitative research paradigm. Data were collected using a questionnaire from 100 eligible women who consented in writing to participate in the study. A quantitative design and a descriptive cohort quantitative design were used. The researcher collected data from two of the busiest clinics in Francistown that have a workload of 100–150 patients a day. Any HIV-positive woman within the child-bearing age group (15–49 years) who visited the clinic 6–8 weeks postnatal was eligible. Forty-five per cent (n = 45) of women living with HIV who visited the clinic with babies for the 6-weeks postnatal care and 55 per cent (n = 55) brought 8-week old babies either for weighing or for immunisation. The majority (40%) of the women received health education from lay counsellors, 31 per cent from midwives, 15 per cent from doctors and 14 per cent from other sources. Qualified healthcare workers beyond lay counsellors should probably be providing antenatal health education given the expertise that is required to cope with the dynamic changes in healthcare delivery for HIV-positive women. Further studies in African settings are essential to identify the magnitude of utilising health workers that are inappropriately prepared for rendering certain healthcare services.Â