Delivery of integrated infectious disease control services under the new antenatal care guidelines: a service availability and readiness assessment of health facilities in Tanzania

Abstract

BackgroundTanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization’s (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO’s service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services.MethodsComposite indicators of the five components of integration were constructed from primary datasets of the Tanzanian Service Provision Assessments (SPA) under the Demographic and Health Survey (DHS) programs. Chi-squared analysis, T test and ANOVA were conducted to determine the associations of each of the defined components and background characteristics of facilities/health workers. A logistic regression model was further used to explore strength of relationships between availability of service readiness components and a pregnant women’s receipt of HIV, Malaria and TB services by reporting adjusted odds ratios.ResultsGenerally, capacity to integrate malaria services was significantly higher (72.3 95% CI 70.3–74.4 p = 0.02) compared to Tuberculosis (48.9 95% CI 48.4–50.7) and HIV (54.8 95% CI 53.1–56.9) services. Diagnostic capacity was generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds ratio of having all five components of integration and receiving integrated care was 1.9 (95% CI 0.8–2.7). Among these components, the strongest determinant (predictor) to pregnant women’s receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 0.6–4.5).ConclusionToward a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious disease care especially HIV and TB. Channelling investments into training of health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and unborn child.

Performance of the Roche cobas MTB Assay for the Molecular Diagnosis of Pulmonary Tuberculosis in a High HIV Burden Setting

“…9 For TB diagnostics, the Xpert XVI (64 tests/8 hours; Cepheid) and the Xpert Infinity-80 (320 tests/8 hours; Cepheid) systems are used. 10 In response to the need for HIV and TB integration of care 11 and to address gaps in access to pathology and laboratory health services in low-resource settings, 12 manufacturing companies are increasing the number and types of diagnostic tests available on molecular diagnostic platforms. 9,10,13,14 Following this approach, the cobas MTB assay was developed for integration on to the fully automated, high-throughput cobas 6800/8800 system, which was initially only used for HIV viral load monitoring.…”

“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

“…In addition to integrated care—which studies show is still a long way from being available to pregnant women with infectious diseases [ 40 ]—the results of this study show that besides additional psychosocial and socioeconomic support pregnant women with RR-TB would benefit from tailored counseling aimed at addressing their specific needs in both the ante- and post-partum periods. Such counseling, could include how health care providers best communicate with pregnant women, understanding their rights around delivery, and how to manage common adverse events.…”

Malaria, HIV and TB in Tanzania: Epidemiology, Disease Control Challenges and Interventions

“…However, 8,600 children still acquired HIV in 2018 (Ministry of Health, 2017a). Odjidja, et al (2019) conclude that the integration of health services can be an effective mechanism to increase coverage and to reduce the impact of infectious diseases during pregnancy. The authors found that the strongest determinant of receiving integrated care during antenatal session was having a trained staff in all disease areas on site.…”

“…To reach as many women as possible, the vast majority of PMTCT services are now integrated with reproductive and child health services (Ministry of Health, 2013a). Odjidja et al (2019) report that Tanzania has adopted WHO's latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal care. Such provision visits purportedly increase the HIV testing rate among mothers age and enrolment in paediatric ART (Bergmann et al, 2017).…”

“…Such provision visits purportedly increase the HIV testing rate among mothers age and enrolment in paediatric ART (Bergmann et al, 2017). Using the provision of ANC to improve HIV screening needs to be carefully planned, however, with a need to ensure acceptance by mothers and healthcare staff (Odjidja et al, 2019).…”