In‐Home HIV Testing and Nevirapine Dosing by Traditional Birth Attendants in Rural Zambia: A Feasibility Study

Brennan, Alana T.; Thea, Donald M.; Semrau, Katherine; Goggin, Caitlin; Scott, Nancy A.; Pilingana, Portipher; Botha, Belinda; Mazimba, Arthur; Hamomba, Leoda; Seidenberg, Phil

doi:10.1111/jmwh.12038

Cited by 16 publications

(26 citation statements)

References 24 publications

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“…Our estimate was also lower compared to what has been previously reported in other sSA settings[21,23]. The Western Kenya studies were carried out between 2008 and 2011, and before the implementation of free maternity services in 2013[35], which may explain the high estimates in home delivery from Western Kenya.…”

Section: Discussioncontrasting

confidence: 74%

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Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

et al. 2018

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BackgroundHome delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya.MethodsA cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively.ResultsOverall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers.ConclusionA quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in this setting.

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Section: Discussioncontrasting

confidence: 74%

“…Previous studies across the sSA region report variable prevalence of home deliveries ranging from 9% to 94% amongst women in the general population[8–20], and10% to 53% amongst HIV-infected women[21–26]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

et al. 2018

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“…TBAs can be an important resource to address the high number of children infected with HIV in Nigeria as well as other Global Plan priority countries (Brennan et al, 2014; Hamela et al, 2014). Researchers have found that after PMTCT training, TBAs were able to test and identify HIV positive pregnant women in rural Zambia and Malawi (Brennan et al, 2014; Hamela et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Researchers have found that after PMTCT training, TBAs were able to test and identify HIV positive pregnant women in rural Zambia and Malawi (Brennan et al, 2014; Hamela et al, 2014). Based on these findings, it was concluded that TBAs can play an important role in PMTCT by conducting initial HCT, especially in rural environments.…”

Section: Discussionmentioning

confidence: 99%

Increasing HIV testing among pregnant women in Nigeria: evaluating the traditional birth attendant and primary health center integration (TAP-In) model

et al. 2017

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Engaging Traditional Birth Attendants (TBAs) may be critical to preventing mother-to-child transmission of HIV (PMTCT) in Nigeria. We integrated TBAs into Primary Health Centers (PHCs) and provided the TBAs with HIV counselling and testing (HCT) training for PMTCT (TAP-In). The purpose of this study was to evaluate the impact of TAP-In on HCT uptake among pregnant women. A quasi-experimental design was used for this study. Twenty PHCs were assigned to the intervention group that integrated TAP-In and 20 were assigned to the control group. Data were collected six months prior to the initiation of TAP-In and six months post, using antenatal clinic registries. Intervention PHCs more than doubled the number of pregnant women who received HCT in their catchment area post TAP-In while control PHCs had no significant change. After initiating TAP-In, intervention PHCs provided almost three times more HCT than the control PHCs (p<0.01) with TBA provided over half of the HCT post TAP-In. The TAP-In model was effective for increasing HCT among pregnant women.

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“…39 Studies have found that with training, traditional birth attendants are able to administer ART peripartum, enhancing PMTCT. 40 Few intervention studies have targeted critical steps for PMTCT further down the continuum of care, and IS research is needed to improve EID uptake, ARV prophylaxis for exposed newborns, and linkage to care for HIV-infected infants. 41 …”

Section: Discussionmentioning

confidence: 99%

Linkage to Care, Early Infant Diagnosis, and Perinatal Transmission Among Infants Born to HIV-Infected Nigerian Mothers: Evidence From the Healthy Beginning Initiative

Pharr

Obiefune

Ezeanolue

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:In 2014, Nigeria accounted for 33% of all new childhood HIV infections that occurred among the 22 Global Plan priority countries where 80% of HIV-infected women reside. Even with a vertical HIV transmission rate of 27%, only 6% of infants born to HIV-infected women in Nigeria receive early infant diagnosis (EID). This article reports rates of antiretroviral prophylaxis, EID, and mother-to-child transmission in a congregation-based Healthy Beginning Initiative (HBI) designed to increase HIV testing among pregnant women in southeast Nigeria.Methods:This is a nested cohort study of HIV-exposed infants (HEI) within the HBI trial originally designed as a 2-arm cluster randomized trial. HIV-infected mothers and infants were followed between January 2013 and August 2014.Results:Across both arms of the study, 72 HIV-infected women delivered 69 live infants (1 set of twins) and 4 had miscarriages. Of the 69 live-born HEI, HIV status was known for 71% (49/69), 16% (11/69) died before sample collection, and 13% (9/69) were lost to follow-up. Complete information was available for 84% of HEI (58/69), of which 64% (37/58) received antiretroviral prophylaxis. Among the 49 infants tested for HIV, 88% (43/49) received EID within 2 months and 12% (6/49) received antibody testing after 18 months. The mother-to-child transmission rate was 8.2% (4/49).Conclusions:EID was higher and HIV transmission rate was lower among the HBI participants compared to reported rates in 2014. However, further progress is needed to achieve goals of elimination of infant HIV infection.

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In‐Home HIV Testing and Nevirapine Dosing by Traditional Birth Attendants in Rural Zambia: A Feasibility Study

Cited by 16 publications

References 24 publications

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

Increasing HIV testing among pregnant women in Nigeria: evaluating the traditional birth attendant and primary health center integration (TAP-In) model

Linkage to Care, Early Infant Diagnosis, and Perinatal Transmission Among Infants Born to HIV-Infected Nigerian Mothers: Evidence From the Healthy Beginning Initiative

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