Community Health Workers to Improve Antenatal Care and PMTCT Uptake in Dar es Salaam, Tanzania

Lema, Irene Andrew; Sando, David; Magesa, Lucy; Machumi, Lameck; Mungure, Esther; Sando, Mary Mwanyika; Geldsetzer, Pascal; Foster, Dawn W.; Kajoka, Deborah; Naburi, Helga; Ekström, Anna Mia; Spiegelman, Donna; Li, Nan; Chalamilla, Guerino; Fawzi, Wafaie W.; Bärnighausen, Till

doi:10.1097/qai.0000000000000371

Cited by 31 publications

(37 citation statements)

References 13 publications

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“…In Tanzania, for example, a community health worker programme contacted more than 42,000 pregnant women over the course of 16 months. Of these, 75% had not yet attended antenatal care (including 40% of whom were in the first trimester) and were actively referred [101]. When the programme was formally evaluated via a cluster‐randomized trial, however, the proportion of women who reported fewer than four antenatal visits over the course of pregnancy did not differ between the intervention and standard‐of‐care arms (59.1% vs. 60.7%, RR: 0.97, 95% CI: 0.82 to 1.15).…”

Section: Resultsmentioning

confidence: 99%

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

et al. 2020

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Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

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Section: Resultsmentioning

confidence: 99%

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

et al. 2020

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“…With the increased evidence of higher risk of infection among pregnant and postpartum women [33] and poor implementation of repeat HIV testing during pregnancy [34,35], the findings show the feasibility [36] and cost-effectiveness [18] of home-based HIV counselling and testing. Beneficiaries of this study are national and sub-national stakeholders working to control and eradicate HIV, such as Ministries responsible for health, district-level health managers, and implementing partners;…”

Section: Discussionmentioning

confidence: 96%

Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: A household longitudinal survey

Juma

Adamou

Amour

et al. 2019

Preprint

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Background Substantial number of women who deliver at home (WDH) are not captured in prevention of mother-to-child transmission (PMTCT) services. This delays HIV infection detection that negatively impacts endeavours to fight the HIV pandemic and the health of mothers and children. The study objective was to determine the feasibility of home-based HIV testing and linking to care for HIV services among WDH in Geita District Council, Tanzania.Methods A longitudinal household survey was conducted. The study involved all mentally-able women who delivered within two years (WDTY) preceding the survey and their children under the age of two. The study was conducted in Geita District Council in Geita Region, Tanzania from June to July 2017. Geita is among the region with high HIV prevalence and proportion of women delivering at home.Results Of the 993 women who participated in the study, 981 (98.8%) accepted household-based HIV counselling and testing (HBHCT) from the research team. HIV prevalence was 5.3% (52 women). HBHCT identified 26 (2.7%) new HIV infections; 23 (23.4%) were those tested negative at ANC and the remaining three (0.3%) were those who had no HIV test during the ANC visit. Among the 51 HIV+ women, 21 (40.4%) were enrolled in PMTCT services. Of the 32 HIV+ participants who delivered at home, eight (25.8%) were enrolled in the PMTCT compared to 100 percent (13/13) of the women who delivered at a health facility.Conclusion HBHCT uptake was high. HBHCT detected new HIV infection among WDH as well as seroconversion among women with previously negative HIV tests. The study findings emphasize the importance of extending re-testing to women who breastfeed. HBHCT is feasible and can be used to improve PMTCT services among WDH. BackgroundDespite major progress in implementing interventions for PMTCT in Sub-Saharan Africa, rates of new paediatric HIV infections remain unacceptably high, contributing to over 10% of new HIV infections globally and 15% of all HIV related mortality[1] .The PMTCT program effectively reduces mother-to-child transmission of HIV. Women are enrolled in the program at the health facility, either at an antenatal care (ANC) visit, or when they come for delivery. In Tanzania, only around 60-70% of pregnant women receive HIV counselling and testing

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“…Rendahnya pengetahuan ibu akan mempengaruhi terhadap pengambilan keputusan penolong persalinan, temuan ini sejalan dengan yang dikemukakan oleh Karjono et al (2013) bahwa pengetahuan ibu merupakan faktor dominan dalam pengambilan keputusan pertolongan persalinan ibu hamil. Hasil penelitian ini sesuai dengan penelitian relevan oleh Pranata et al (2011) (Lema et al, 2014). Hal ini tidak sejalan dengan fakta di lapangan bahwa tidak semua kader asuh melakukan kunjungan rumah terhadap setiap anak asuh untuk memonitoring ibu hamil dan memastikan ibu hamil memeriksakan kehamilannya di tenaga kesehatan.…”

Section: Peran Kader Asuh Dalam Penurun-unclassified

The Role of Community Health Workers in Maternal and Child Health Surveillance to Optimize Maternal and Child Health in Pasuruan District, East Java

Pangestu

Joebagio

Rahardjo

2017

J HEALTH POLICY MANAGE

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Background: Maternal mortality ratio, infant mortality rate, and underfive mortality rate are still high in Indonesia. Pasuruan is one of the districts in East Java with the highest infant mortality rate. One of the public health interventions that has been undertaken to address this issue is maternal and child health surveillance program with community health workers being the leading implementers. This study aimed to describe the role of community health workers in maternal and child health surveillance to optimize maternal and child health care services in Pasuruan District, East Java. Subjects and Method: This was a qualitative study using case study approach. It was conducted in Pasuruan, East Java. Key informants were selected by criterion sampling. The data were collected by in-depth interview, focus group discussion, observation, and document review. Data validity was checked by triangulation. Results: Community based maternal and child health surveillance program has been implemented for 4 years. However, only some of all community health workes have been trained in this program. The tasks of these community health workers included advocacy and monitoring of maternal and child health in the areas of posyandu. The implementation of these surveillance program had some obstacles, including low insentive of community health worker, inactive community health worker, lack of awareness among community members on maternal and child health issues, and medical factors of pregnant mothers that caused mortality. Conclusion: Community health workers help improve the quality of maternal and child health care by surveillance program, although their performances have yet to be enhanced.

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Community Health Workers to Improve Antenatal Care and PMTCT Uptake in Dar es Salaam, Tanzania

Cited by 31 publications

References 13 publications

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

Feasibility of home-based HIV counselling and testing and linking to HIV services among women delivering at home in Geita, Tanzania: A household longitudinal survey

The Role of Community Health Workers in Maternal and Child Health Surveillance to Optimize Maternal and Child Health in Pasuruan District, East Java

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