Implementation of prevention of mother-to-child transmission of HIV and maternal syphilis screening and treatment programmes in Mwanza region, Tanzania : uptake and challenges
ABSTRACT
Literature
and
other
background
information
on
prevention
of
mother-to-child
transmission
of
HIV
(PMTCT)
and
maternal
syphilis
screening
programmes
in
Tanzania
reveal
that
little
has
been
documented
on
accessibility
and
utilization
of
these
services.
This
thesis
presents
the
results
from
a
research
conducted
in
Mwanza
city,
Tanzania
to
assess
the
operational
performance
of
PMTCT
and
maternal
syphilis
screening
and
treatment
during
pregnancy,
at
delivery
and
in
the
postnatal
period.
From
different
sub-studies
conducted
at
the
antenatal
clinics
(ANC)
and
in
the
maternity
ward
for
this
research,
a
number
of
missed
implementation
opportunities
were
identified.
A
review
of
records
found
that
24%
of
pregnant
women
who
delivered
in
hospital
left
the
maternity
ward
with
unknown
HIV
status
and
50%
of
HIV-positive
women
tested
at
ANC
did
not
receive
Antiretroviral
therapy
(ART)
for
PMTCT.
A
cross-sectional
study
at
the
maternity
ward
found
that
12%
of
pregnant
women
who
were
not
screened
for
syphilis,
27%
of
RPR-positive
women
who
were
not
treated
at
ANC,
and
all
infants
of
RPR-positive
women
did
not
receive
any
intervention
to
prevent
congenital
syphilis.
Forty-one
percent
of
HIV-positive
women
recruited
in
the
cohort
study
successfully
completed
all
PMTCT
interventions.
Only
18%
of
HIV-positive
women
identified
through
PMTCT
were
successfully
referred
to,
and
attended
an
adult
care
and
treatment
clinic
(CTC).
Of
403
HIV-
positive
women
in
the
cohort
study,
50%
did
not
intend
to
get
pregnant
and
by
four
months
postpartum,
20%
of
them
reported
to
have
not
received
any
counselling
on
family
planning.
HIV-positive
women
who
did
not
receive
counselling
on
FP
use
were
at
a
higher
risk
of
not
using
contraception
compared
to
those
who
were
counselled
(adj.
OR=6,
95%
Cl;
2.8-12.9).
About
27%
of
HIV-positive
mothers
were
not
counselled
regarding
infant
feeding
and
40.2%
of
women
who
were
not
counselled
on
infant
feeding
were
undecided
on
how
to
feed
their
infants
before
they
left
the
hospital
compared
to
only
2.5%
of
women
who
were
counselled
(P<O.OOl)
It
was
found
that
pregnant
women
attending
ANC
for
the
first
time
during
pregnancy
spent
between
three
and
5.5
hours
at
the
clinic,
on
average,
78%
of
this
time
was
spent
waiting
for
services.
6
Fewer
ANC
visits,
attending
private
or
rural
ANC
facilities,
failure
to
attend
a
CTC
prenatally,
and
lack
of
knowledge
among
users
and
provider
of
health
services
were
factors
found
to
hamper
the
performance
of
the
programmes.
Integration
of
these
programmes
at
all
levels
and
training
of
health
workers
in
basic
components
of
the
programmes
are
fundamental
to
the
successful
implementation
of
the
programme