Listening to health workers: lessons from Eastern Uganda for strengthening the programme for the prevention of mother-to-child transmission of HIV

Abstract

BackgroundThe implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme.MethodsA qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings.ResultsThe key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers.ConclusionsThe voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers as urgent needs to strengthen the PMTCT programme.

Training of Traditional Birth Attendants on Prevention of Mother to Child Transmission of HIV: Effect on Their Knowledge and Delivery of Prevention of Mother to Child Transmission of HIV Services in Igbagu, Ebonyi State Nigeria

“…The TBAs' pre-training awareness of HIV was higher than their awareness of PMTCT of HIV of HIV, a finding that was in consonance with that from some other studies [8][9][10][11][12]14,26]. A study in India revealed even a poorer awareness [25].…”

“…This was similar to findings of a study of TBAs in Ebonyi State, Nigeria [21] and in some other developing countries [19,[22][23][24] but differs from studies in some sub-Saharan Africa and some other developing countries where there were more TBAs who had formal education than those without [8][9][10]14,25]. Except for one TBA, who acquired her skill following a one-year apprenticeship in a private hospital, others acquired theirs' from relations especially mother as a generational trade as reported in other literatures [26,19].…”

Infant feeding in the context of HIV: a qualitative study of health care workers’ knowledge of recommended infant feeding options in Papua New Guinea

“…Moreover, as a result of the power dynamics between patients and healthcare workers who are positioned as experts transferring knowledge about infant feeding is never an objective process, as implied by the informants. A similar concern regarding up-to-date health care worker knowledge of safe infant feeding practices is well documented in Southern Africa [23,24,26]. The risks associated with dissemination of out dated feeding advice in terms of infant health are not only in terms of HIV but also diarrhoeal diseases, malnutrition and mortality [13].…”

“…Additionally, at this time, breastfeeding should only be stopped if an alternative nutritionally adequate diet can be provided [1]. Review of the international literature highlights difficulties for health care workers conveying best practice recommendations for infant feeding, especially for HIV-positive mothers [22-24]. A health care workers’ lack of up-to-date evidence and informed knowledge subsequently impacts on a mothers’ ability to provide safe infant feeding to their children [25,26], with women often not adhering to best infant feeding practices to reduce HIV transmission [23,27].…”

Beyond early infant diagnosis

“…Further, unless provider-initiated counseling and testing (PITC) has been routinely implemented or providers have been sensitized to identifying signs and symptoms of HIV, they may treat children for opportunistic infections on multiple occasions without ever conducting an HIV test [34,35]. Finally, limited numbers of test kits and policies that do not allow rapid tests to be administered by certain cadres of staff may also contribute to reluctance of healthcare workers to test children without overt signs or symptoms of HIV disease [32,36]. …”