Background:The World Health Organization recommends that HIV-positive mothers should breastfeed for at least 1 year. There are people in the lives of these mothers who influence their decisions.Res...

The Voices That Influence HIV-Positive Mothers' Breastfeeding Practices in an Urban, Ghanaian Society.

Introduction: Ethiopia is one of the country’s most severely hit by HIV/AIDS epidemic. Besides the dominant heterosexual transmission, vertical virus transmission from mother-to-child accounts for more than 90% of pediatric AIDS. It is estimated that over 90% of childhood HIV infections result from the transmission of the virus from mothers to their children during and soon after birth. Objective: The objective of the study was to assess clients’ satisfaction on the quality of PMTCT services they received in Dessie referral hospital, Dessie city administration, Ethiopia. Methods: A hospital based cross-sectional study was used in Dessie referral hospital, Dessie administrative city. A total of 240 clients were participated in exit interviews to assess the quality of the services delivered based on informed consent. To achieve the desired sample size, the clients were included from the hospital consecutively. Data were collected by interviewer administered questionnaires. Data were cleaned, coded and fed to SPSS version 20. Descriptive statistics were computed to summarize the findings and presented using frequency tables. Result: Of 240 clients who accessed PMTCT services, 208 (86.7%) of the clients were overall satisfied with the PMTCT services they received. Two hundred ten (87.5%) of the respondents were satisfied with the waiting time of the services. Conclusion and recommendation: Even if clients were highly satisfied with the PMTCT services they received, there are clients who were not satisfied with the counselling services they received, privacy, waiting time they spent while accessing services. Inadequate confidentially was reported from th e participants. The hospital should renovate the PMTCT clinic to have additional rooms for maintaining privacy and reducing the waiting time of the services as a recommendation.

Quality of Prevention of Mother to Child Transmission (PMTCT) Servicesin Dessie Referral Hospital, Dessie City Administration, Ethiopia: ClientPerspective

This qualitative descriptive phenomenological study explored the experiences of HIV positive women utilising PMTCT services at a central hospital in Zimbabwe. Data was collected using in-depth interviews of fifteen participants. The interviews were audio recorded and transcribed verbatim. Using the Interpretive Phenomenological Analysis framework for data analysis, two super-ordinate themes emerged, namely resources for provision of PMTCT services and approaches and nature of PMTCT care. The study revealed challenges experienced by HIV positive women emanating from material, financial and human resource related constraints in the PMTCT setting. The resource challenges negatively affected access and utilisation of PMTCT services. A practice model, whose purpose is to enhance the quality and utilisation of PMTCT services, was developed and described. The model was evaluated using Chin and Krammer (2011) criteria plus a modified form of the Delphi technique. These findings have implications for effective PMTCT service provision. The key lessons learnt for programmatic improvement were that in order to provide quality and accessible PMTCT services the health care system will need to be well resourced. There is need to strengthen the health care system in line with HIV related programmatic changes.

Experiences of HIV positive women who utilised the PMTCT programme in one of the central hospitals in Bulawayo, Zimbabwe

Objective:To characterize human immunodeficiency virus (HIV)-positive infants among HIV-exposed infants (HEIs) in Nairobi County for public health action.Methods:We conducted a retrospective review...

https://journals.sagepub.com/doi/pdf/10.1177/1178633720948863

Epidemiology of HIV Infection Among HIV-Exposed Infants, Nairobi County, Kenya, 2015.

Antiretroviral drugs reduce viral replication in pregnant women either by lowering plasma viral load or through postexposure prophylaxis in their new born. Mother to child transmission is the predominant mode of transmission of HIV in infants and young children. This transmission occurs during pregnancy, labour and delivery and breastfeeding. Providing all HIV positive pregnant women with lifelong ARVs regardless of CD4 count/disease stage is an effective strategy to avert MTCT of HIV. Eliminating vertical transmissions globally is still a challenge. In Busia district, the uptake of antiretroviral drugs by HIV positive pregnant women is about 41%. Despite the varied interventions employed to avert MTCT a number of exposed babies have been seroconversion. Objective: Factors influencing utilization of ARVs by HIV positive pregnant women. Methods: Cross sectional study was done through Purposive and random sampling. The study area and the HIV positive pregnant women were purposively selected. Quantitative approach was employed using standardized questionnaires. Exploratory data analysis was preceded by monovariate analysis. Results were summarized using tables and text. The quantitative data was analyzed by Statistics package of social science. Results: Percentage (30.6%) of women started ARVs in the 3 rd trimester. Percentage (37.4%) hides while taking the drugs due to self-stigma and fear of husband. Percentage 57.9% took freely. Half of those who were not on ARVs indicated they were afraid of their husbands while the other half were not willing to take the ARVs. Conclusion: We found out 85% of the women had their first antenatal care visit in the second trimester while (30.6%) started ARVs in the 3rd trimester. ARVs taken for more than 17 weeks reduces the risk of MTCT. Disclosure of HIV status of pregnant women is essential. Male participation in antenatal care, treatment, counselling and testing for HIV, will increase use of interventions for eMTCT.

Factors Influencing the Utilization of Anti-Retroviral Drugs by HIV Positive Pregnant Women in

Background: The success of a PMTCT programme depends on the quality of services offered at health facilities.  Indicators of quality include the competence and attitude of the counsellor and uptake of ARV prophylaxis. Objective: This study looked at the relationship between quality of prevention of mother to child transmission of HIV (PMTCT) services and the maternal ARV prophylaxis uptake in Kakamega district, Kenya. Methods: The study was a cross-sectional study. Thirty health facilities and health care workers were sampled using multistage sampling. From these health facilities, 119 HIV positive pregnant women were sampled by convenience s ampling. The PMTCT counsellors and HIV positive pregnant were interviewed using a structured questionnaire. Statistical analysis: Descriptive data analysis was carried out on all variables. Categorical variables across groups were compared using the Fisher Exact test. Logistic regression was used to identify determinants of uptake of ARV prophylaxis at facility level Results: About 86.7% of the health facilities sampled had satisfactory quality of PMTCT services and 89% of HIV positive pregnant women reported that they received satisfactory PMTCT counselling services. About 90% of the counsellors have received PMTCT training and the mean score in a knowledge test was 77.2%. However, providers generally had a negative attitude towards their clients.  On regression analysis, there was no significant association between various aspects of quality and infant ARV prophylaxis uptake.  Uptake at facility level was determined by the district and type of health facility. Conclusion : The quality of service in the sampled facilities was generally good but this did not influence the level of uptake of maternal or infant ARV prophylaxis. Key words: Prevention of Mother to Child Transmission (PMTCT), ARV prophylaxis, HIV-positive pregnant women.

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The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya

Background: It is estimated that 2.1 million individuals worldwide became newly infected with HIV in 2013, and this included 240,000 children (<15 years).  Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Objective: This study sought to ascertain the different PMTCT approaches or regimens that mothers and infants receive, their Mother-To-Child Transmission of HIV (MTCT) rates and associated correlates in Western Kenya. Methods: A retrospective cohort study using prospectively collected data in Ministry of Health HIV-Exposed Infant (HEI) register from 24 health facilities.  The study population was HIV-positive mothers enrolled from January 2012 to June 2013. The main outcomes were infant HIV status at 6 weeks, 9 to <18 months and 18-24 months. The correlates were maternal haemoglobin levels, WHO staging, CD4 counts, duration between enrolment and delivery, duration between enrolment and ART initiation, TB status, place of delivery, mode of delivery, and infant feeding options at 6 weeks, 9 to <18 months and 18-24 months. Proportions were analyzed using Chi-square tests while associations between MTCT correlates and outcomes were established using logistic regression. Results: 1,751 HIV mother-baby pairs were enrolled in the 24 health facilities: 78.1% received Highly Active Antiretroviral Therapy (HAART), 14.2% received Zidovudine (AZT), 1.7% received Single-dose Nevirapine (SdNVP), and 4.3% received no prophylaxis. MTCT rates were 5.5%, 7.4% and 5.6% at 6 weeks, 9 to <18 months and 18-24 months, respectively. MTCT rate at 18-24 months showed a significant difference ( p <0.001) across PMTCT regimens. Women with CD4 cells between 350 to 500 cells/mm 3 were about twice as likely to have HIV-negative babies compared to those with CD4 cells count <350cells/mm 3 . Women on TB treatment are less likely to have HIV-negative babies compared to those without TB. Exclusive breastfeeding at 6 weeks was associated with lower MTCT rates.  Feeding option at 6 weeks is a strong predictor of HIV status ( p <0.001) as compared to babies on exclusive breastfeeding (EBF). Conclusion: Most of the mother-baby pairs received HAART. AZT depicted the lowest MTCT rate at 18-24 months.  Higher CD4 counts, no TB signs, and EBF at 6 weeks were associated with lower MTCT rates at 18-24 months Key words :  Antiretroviral prophylaxis, Mother-To-Child Transmission of HIV rates.

Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review - SUPPORTING INFORMATION

Omondi et al. Afr. J. Pharmacol. Ther. 2012 . 1 (2): 55-61 A KeSoBAP Publication ©2012 . All rights reserved. ISSN 2303-9841 55 The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya

Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review

Background: The World Health Organization report indicates that in 2013~35 million people worldwide lived with HIV and AIDS. Of these, 3.2 million were children age <15 years. The proportion of women living with HIV has remained stable, at slightly <52% of the global figure. There are 13 high burden countries which account for 75% of the estimated 1.5 million pregnant women living with HIV in lowand middle-income countries. Furthermore, most of the HIV-infected children live in sub-Saharan Africa and were infected by their mothers through mother-to-child transmission (MTCT). Despite these statistics, social and demographic characteristics that are associated with MTCT rate at 18-24 months remains unknown. This study aimed to describe the social and demographic characteristics of HIV mother-infant pair and their association with MTCT rate at 18-24 months in Vihiga, Kakamega, Bungoma and Busia Counties, Kenya. Method: A retrospective cohort study using prospectively collected data in Kenyan Ministry of Health (MOH)HIV Exposed Infant (HEI) register from 24 health facilities sampled across the four counties were sampled. The study population was HIV mother-baby pairs enrolled from January 2012 to June 2013. The social (marital status) and demographic (maternal age, maternal weight, baby’s sex, baby’s birth weight, level of health facility, county name) characteristics were assessed. The main outcome measure was infant HIV status at 18-24 months. Proportions were analyzed using Chi-square tests while associations between social and demographic characteristics and outcome were established using multiple logistic regression while controlling for possible confounders such as type of ARV prophylaxes, feeding options and CD4 count. P-values ≤0.05 were considered statistically significant. Results: A total of 1751 HIV mother-baby pairs were enrolled in 24 health facilities. About 79.3% (1389/1751)mothers were legally married, 5.4% (95/1751) single, 5.4% (94/1751) widowed, 3.5% (62/1751) divorced, 1.8% (31/1751) cohabiting 0.9% (15/1751)separated and 3.7% (65/1751) had not stated. The MTCT rate at 18-24 months showed variations with marital status since the rates were highest amongst women in separated (26.7%), single (10.5%) and cohabiting (9.7%) relationships and lowest amongst divorced (3.2%) and legally married (4.9%) women. Separated women were about 7 times more likely to have HIV-negative babies as compared to widowed women (OR, 7.517, 95%CI, 1.344 – 42.031, p=0.022). Conclusion: Separated HIV positive women are more likely to have HIV negative babies at 18-24 months as opposed to widowed women.

Social and Demographic Characteristics of HIV-Positive Mother-Infant Pair and Their Association with Mother-To-Child Transmission of HIV in Vihiga, Kakamega, Bu...

Maxwell P Omondi

Papers

The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya

Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review - SUPPORTING INFORMATION

Omondi et al. Afr. J. Pharmacol. Ther. 2012 . 1 (2): 55-61 A KeSoBAP Publication ©2012 . All rights reserved. ISSN 2303-9841 55 The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya

Mother-To-Child HIV Transmission using Single, Dual and Triple ARV Prophylaxis Regimens and their Correlates in Western Kenya: Chart Review

Social and Demographic Characteristics of HIV-Positive Mother-Infant Pair and Their Association with Mother-To-Child Transmission of HIV in Vihiga, Kakamega, Bu...