6 research outputs found
Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal
OBJECTIVES To explore the roles of community cadres
in improving access to and retention in care for PMTCT
(prevent mother-to-child transmission of HIV) services
in the context of PMTCT Option B+ treatment scale-up
in high burden low-income and lower-middle income
countries.
DESIGN/METHODS Qualitative rapid appraisal study
design using semistructured in-depth interviews and
focus group discussions (FGDs) between 8 June and 31
July 2015.
SETTING AND PARTICIPANTS Interviews were conducted
in the offices of Ministry of Health Staff, Implementing
partners, district offices and health facility sites across
four low-income and lower-middle income countries: Cote
D’Ivoire, Democratic Republic of Congo (DRC), Malawi and
Uganda. A range of individual interviews and FGDs with
key stakeholders including Ministry of Health employees,
Implementation partners, district management teams,
facility-based health workers and community cadres. A
total number of 18, 28, 31 and 83 individual interviews
were conducted in Malawi, Cote d’Ivoire, DRC and Uganda,
respectively. A total number of 15, 9, 10 and 16 mixed
gender FGDs were undertaken in Malawi, Cote d’Ivoire,
DRC and Uganda, respectively.
RESULTS Community cadres either operated solely
in the community, worked from health centres or in
combination and their mandates were PMTCT-specific
or included general HIV support and other health issues.
Community cadres included volunteers, those supported
by implementing partners or employed directly by the
Ministry of Health. Their complimentary roles along the
continuum of HIV care and treatment include demand
creation, household mapping of pregnant and lactating
women, linkage to care, infant follow-up and adherence
and retention support.
CONCLUSIONS Community cadres provide an integral link
between communities and health facilities, supporting
overstretched health workers in HIV client support and
follow-up. However, their role in health systems is neither
standardised nor systematic and there is an urgent need to
invest in the standardisation of and support to community
cadres to maximise potential health impacts
Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis
Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here
Improving iron and folic acid supplementation among pregnant women : an implementation science approach in east-central Uganda
Introduction: To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies. Methods: To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process. Results: The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to interviewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system. Discussion: The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC-inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality