Improving Quality of Prevention of Mother-to-Child HIV Transmission Services in Ukraine: a Focus on Provider Communication Skills and Linkages to Community-Based Non-Governmental Organizations

Abstract

SUMMARYBackground: Ukraine has the highest rate of HIV infection in Europe, with an estimated adult prevalence of 1.6 percent. The epidemic in Ukraine remains largely driven by injection drug use, and women of reproductive age are being increasingly affected. Prior research has highlighted the need to improve the quality of services for prevention of mother-to-child transmission (PMTCT) and to address other issues related to HIV counseling, testing, and care, especially in the context of antenatal and obstetric services.Methods: From 2004 to 2007, PATH led a collaborative effort to improve the quality of PMTCT services in Ukraine. Initial assessments included focus groups with Ukrainian women and review of existing educational materials. Interventions focused on training providers to improve skills in communication and referral to community-based support; they also addressed the underlying issue of stigma.Results: Observational data demonstrated that providers who participated in the training intervention delivered PMTCT counseling of a consistently higher quality than did providers who did not undergo training. Exit interviews with clients confirmed these findings.Conclusions: An intervention focused on strengthening voluntary counseling and testing for HIV, forging partnerships with local organizations, and undoing HIV-related stigma can help to improve access to and quality of PMTCT services in antenatal care clinics.

The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

“…Now I feel normal, because there is no discrimination, we are normal like other people”) and “manageability” through the provision of ART and health services, and media education campaigns coupled with HBC team community awareness-raising work are all likely to have contributed to the low levels of reported stigmatization of PLHIV in OD1. Previous research in other regions has shown the positive impact which the support of community-based teams (or being a member of an association of people living with HIV and AIDS) might have on PLHIV and their children [19], including through the countering of stigmatization through community-based support teams [13, 20]. …”

Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

“…Adherence can be promoted through additional home visits by community health workers, who might both encourage delivery in health facilities and decrease the fear of stigma that may prevent women from delivering in designated sites. For instance, Partners in Health has demonstrated a successful model of promoting adherence to HIV-1 medications by using paid community health workers who visit each patient at home (or a location of her choice) ensuring treatment adherence through directly observed therapy, as well as including referral for HIV-1 testing with regular clinic visits, subsidizing the transportation costs, and providing medications free of charge [59]. …”

Peer Group Intervention for HIV Prevention Among Health Workers in Chile

“…Health workers' lack of knowledge has been documented in Latin America (Andrewin & Chien, 2008; Massiah et al, 2004) as well as in both industrialized and low-resource countries in other parts of the world (Gamazina et al, 2009; Rahlenbeck, 2004; Reis et al, 2005; Wu et al, 2002). These same studies also found that health workers express stigmatizing attitudes toward PLWH, including negative judgments about the moral worth of persons living with HIV, rejection, and unwarranted fear of contagion.…”

“…Health workers also reported that the stigmatizing attitudes of their coworkers made them reluctant to be tested personally or to disclose their serostatus (Dieleman et al, 2007; Kiragu et al, 2007; Mahendra et al, 2007; Tarwireyi & Majoko, 2003). Health workers' inadequate knowledge has been explicitly linked to more stigmatizing attitudes toward PLWH among health workers (Gamazina et al, 2009; Mahendra et al, 2007; Rahlenbeck, 2004; Wu et al, 2002). However, a large meta-analysis of general population studies in more than 20 countries found that stigmatizing attitudes persisted despite moderate to high knowledge levels, suggesting that increasing knowledge will only partially address the issue of stigma by health workers (Albarracin et al, 2005).…”

“…In many countries, studies evaluating training have consistently found that health workers benefited from training on HIV, counseling, and other topics (Burr, Storm, & Gross, 2006; Gamazina et al, 2009; Wu et al, 2002). Clients may also indirectly benefit when health workers' HIV prevention teaching abilities are strengthened and their stigmatizing attitudes are reduced.…”