An assessment of the Zimbabwe ministry of health and child welfare provider initiated HIV testing and counselling programme

Background Provider-initiated HIV testing and counselling (PITC) is widely recommended to ensure timely treatment of HIV. The Zimbabwe Ministry of Health introduced PITC in 2007. We aimed to evaluate institutional capacity to implement PITC and investigate patient and health care worker (HCW) perceptions of the PITC programme. Methods Purposive selection of health care institutions was conducted among those providing PITC. Study procedures included 1) assessment of implementation procedures and institutional capacity using a semi-structured questionnaire; 2) in-depth interviews with patients who had been offered HIV testing to explore perceptions of PITC, 3) Focus group discussions with HCW to explore views on PITC. Qualitative data was analysed according to Framework Analysis. Results Sixteen health care institutions were selected (two central, two provincial, six district hospitals; and six primary care clinics). All institutions at least offered PITC in part. The main challenges which prevented optimum implementation were shortages of staff trained in PITC, HIV rapid testing and counselling; shortages of appropriate counselling space, and, at the time of assessment, shortages of HIV test kits. Both health care workers and patients embraced PITC because they had noticed that it had saved lives through early detection and treatment of HIV. Although health care workers reported an increase in workload as a result of PITC, they felt this was offset by the reduced number of HIV-related admissions and satisfaction of working with healthier clients. Conclusion PITC has been embraced by patients and health care workers as a life-saving intervention. There is need to address shortages in material, human and structural resources to ensure optimum implementation

The reasons for low utilization of long acting contraceptives amongst HIV positive women at Harare post test services clinic, Zimbabwe

Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: The study sought to answer the question, what are the reasons for low utilization of long acting contraceptives among HIV positive women attending the Harare Post-test support services clinic. The study was conducted at Harare Post-test support services clinic from September to December 2012. Data was collected using respondent administered questionnaires. A sample of 30 respondents was used for the study. After data collection, data was grouped, analysed and presented in the form of tables, figures, charts and descriptive statistics. The major findings from the study were that the majority of the women who attend the Harare Post-test support services clinic are within the age groups 35-49yaers. Most of the women are not using and modern contraceptive method. Condoms are used by 17% of the respondents and the long acting contraceptives, Jadelle and IUCD and used by a very low number of women attending the clinic. Fear of side effects is one of the reasons why the women are not suing long acting contraception. Most of the women know that the Jadelle and IUCD are long acting methods of contraception which prevents unintended pregnancy for up to five years for Jadelle and up to ten years for the IUCD. The long acting contraceptives are not available at the post test-support services clinic since the set-up of the clinic is not ideal for the provision of these services, women who need the methods are refereed outside the clinic were the cost to access the services is not affordable for most of the respondents. The conclusion drawn from the study is that women living with HIV have limited knowledge and access the long acting contraceptives at Harare Post-test support services clinic hence are not utilizing the methods. The researcher recommends that all women attending the clinic should be educated on the benefits of using dual protection to protect against unintended pregnancy as well as HIV transmission. A proper referral system should be established so that women referred to other service providers do not pay extra fees to access family planning services at the referral centres. Any IEC material should address the myths and fears related to use of long acting contraception by HIV positive women. The young age group below 35years should also be encouraged to access family planning services through the Post-test support services clinic.AFRIKAANSE OPSOMMING: Die doel van die studie was om te bepaal wat die redes is vir die lae gebruik van langwerkende voorbehoeding onder MIV positiewe vroue wat die Harare Post-test ondersteuningsdienste kliniek besoek. Data is deur middel van vraelyste onder 30 deelnemers ingesamel. Die resultate het getoon dat die meerderheid van vroue wat die kliniek besoek het tussen die ouderdomme van 35 en 49 was. Meeste van hulle gebruik nie moderne voorbehoeding nie, slegs 17% het aangedui dat hul kondome gebruik. Die langwerkende voorbehoeding Jadelle en IUCD word deur min die van vroue gebruik. ‘n Vrees vir die nadelige uitwerking daarvan is een van die redes waarom hul nie die voorbehoeding gebruik nie. Meeste van die vroue is bewus dat Jadelle en IUCd langwerkede metodes is wat swangerskap voorkom en dat Jadell tot 5 jaar werk en IUCD tot 10 jaar effektief kan wees. Die langwerkende metodes is egter nie by die kliniek beskikbaar nie en vroue wat die metodes verkies word na ander diensverskaffers verwys waar wat vir meeste van die vroue nie bekostigbaar is nie. Daar kan dus van die studie afgelei word dat MIV positiewe vroue beperkte kennis en toegang rakende die langwerkende voorbehoeding het en daarom nie die metodes ten volle benut nie. Die navorser beveel aan dat alle vroue wie die klinkiek besoek ingelig moet word oor die voordele van die tweeledige vorm van beskerming, nie net teen swangerskap nie maar ook teen MIV-infeksie. ‘n Verwysingstelsel moet in plek gestel word sodat die vroue wat na ander diensverskaffers verwys word nie nodig het om ekstra daarvoor te betaal nie. Daar word verder ook voorgestel dat die klinkiek meer inligtig rakende die langwerkende voorbehoeding beskikbaar stel en ook gesinsbeplanningsdienste aanbied