83 research outputs found
SUPPORTING THE IMPLEMENTATION OF GUIDELINES TO PREVENT MOTHER-TO-CHILD-TRANSMISSION OF HIV IN MALAWI: A QUALITATIVE DESCRIPTIVE CASE STUDY
No full textChifundo Colleta Zimba: Supporting the implementation of guidelines to prevent mother-to-child transmission of HIV in Malawi: A qualitative descriptive case study (Under the direction of Jennifer Leeman) The burden of human immunodeficiency virus (HIV) on women aged 15–49 years is high in Malawi (13%), resulting in HIV transmission to 12,000 children in 2011. Malawi has adopted the Option B+ guidelines which, if fully implemented, could prevent over 95% of HIV cases in children born to HIV-infected women. Because adoption of guidelines is not enough to move science into practice, the UNC Project—a partner organization to the Malawi government—provided prevention support (e.g., training and technical assistance [TA]), to 134 Malawian clinics between 2011 and 2014 to enhance implementation of the Option B+ guidelines. This qualitative, descriptive multiple-case study aimed to describe the types of prevention support the UNC Project provided to 4 clinics, how support varied across low- and high-performing clinics, and factors that may explain variations in Option B+ implementation across clinics (N=4). Data were gathered through 21 in-depth interviews with 18 key stakeholders (n=6 TA providers and n=12 care providers). Observation supplemented data from in-depth-interviews. Directed content, thematic, and cross-case analyses were used to analyze data. The study found that the UNC Project used the following prevention support strategies: off-site trainings of the service providers; ongoing, onsite TA that employed collaborative and audit and feedback approaches; tools such as standard operating procedures (SOPs); and resources such as HIV testing kits. Variations occurred in TA dose (i.e., time TA providers spent on guidelines activities in the clinic and community) and on TA focus (i.e., the unit where TA providers spent more hours). All four clinics reported full implementation of most of the Option B+ guideline core components. Implementation gaps were found on community mobilization, documentation, and components done during the post-delivery period. Staffing and transportation emerged as the most salient contextual factors influencing TA delivery while size of the clinic staff, service space/infrastructure, stocks of the HIV testing kits, and magnitude of the served population explained differences in guideline implementation between low- and high-performing clinics. Results of this study can help advance understanding of the way prevention support enhances implementation of new evidence-based interventions and contextual factors that may need to be addressed.Doctor of Philosoph
Chifundo chamanga (I long for my mother)
No full textSung by a lad of about 12 years old who sang this song in a quiet voice and was much applauded by everyone, whether for the singing or the sentiment, was not clear. Self delectative song with board zither
Perceived implementation of guidelines to prevent mother-to-child transmission of HIV in Malawi: A qualitative multiple case study
No full textSession presented on Thursday, July 21, 2016 and Friday, July 22, 2016:
Purpose: To describe the extent to which four rural Malawi clinics implemented the core components of the 2011 Malawian Option B+ guidelines following three years of an extensive implementation support program.
Methods: This study used a descriptive multiple case-study design. N=4 clinics were purposefully sampled from a total population of 134 health facilities. Of the 4, n=2 fell into the highest while n=2 into the lowest quartile of the proportion of eligible women who were tested for HIV in Fiscal Year 2012-2013. In-depth interviews were done with 18 informants who were actively involved in either implementing (n=12) or providing support for implementation (e.g., technical assistance, tools; n=6) of the guidelines at the study clinics. To assess perceived implementation of the guidelines at clinic level, all informants were asked to what extent the study clinics were carrying out each of the core components of the Option B+ guidelines. Responses were ranked from 0 to 3, with 0 assigned when the interviewee reported that the component was never implemented and 3 when always implemented as specified by the guidelines. Each clinic\u27s responses were then averaged for each item to create a final score. Clinics were coded as HP-1, HP-2, LP-1 and LP-2.
Results: All four clinics reported full implementation of most of the core components. Self-rating of implementation ranged from 2.3 to 2.8 on a scale of 3.0. An outstanding performance was reported to have occurred at HP-2 clinic with an overall score of 2.8 while both LP clinics reported scores of 2.3. A critical assessment of each of the core components across all the four study sites showed that all but HP-2 clinic minimally conducted community sensitization and mobilization activities; both LP clinics failed to fully identify and ascertain HIV status of the HIV exposed children at 6 weeks, 12, and 24 months; and all but the LP-1 clinic reported documentation problems.
Conclusion: After three years of implementation of the Option B+ guidelines with an aid of extensive supporting strategies, all four Malawian rural clinics reported full implementation of most of the core components of the implemented guidelines. On a scale of 0 to 3, self-rating of implementation ranged from 2.3 to 2.8. Documentation of rendered activities; failure to fully sensitize and mobilize the served communities; and failure to identify and ascertain HIV status of the HIV exposed children are gaps that exist in implementation of the Option B+ guidelines. If communities are not well informed, fewer women in need of ART will benefit from the implemented guidelines which could lead to many babies contacting HIV infection from their mothers. Failure to properly document the rendered activities and identify and test the HIV-exposed children as per guidelines hindered clinics\u27 ability to assess the impact of the Option B+ guidelines on Maternal transmission of HIV. Further research is required to test implementation support strategies that may enhance community awareness, quality documentation and early identification of HIV exposed children in order to prevent mother-to-child transmission of HIV in Malawi
Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study
No full textBackgroundHigh HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. MethodsA qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.ResultsFour categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.ConclusionsUnderstanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings
Evaluating the benefits of incorporating traditional birth attendants in HIV Prevention of Mother to Child Transmission service delivery in Lilongwe, Malawi
No full textThe objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman’s arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities
Factors influencing utilization of postpartum CD4 count testing by HIV-positive women not yet eligible for antiretroviral treatment
No full textIs religion the forgotten variable in maternal and child health? Evidence from Zimbabwe
No full textThe Apostolic faith, a rapidly growing and increasingly influential force in Zimbabwe, has received attention in the literature due to its potential role in shaping its followers' attitudes and behaviours towards health. Existing literature, however, has only examined small cross-section samples from a few confined survey sites or has failed to adequately control for the many factors that may mediate the effects of religion. This paper examines the effects of the Apostolic faith on the usage of maternal health and child immunization services in Zimbabwe. It is based on a nationally representative sample from the 2009 Multi-Indicator Monitoring Survey and employs the established Andersen model on access to health services. Well controlled multivariate logit regression models derived from these data show that an affiliation with the Apostolic faith is a substantial and significant risk factor in reducing the utilization of both maternal and child health services. Moreover, even when the services were least costly and readily available and when gaps along other social and economic factors were limited, as in the case of Bacillus Calmette-Guerin vaccination and one visit to antenatal care, women and children from Apostolic faith families still fared significantly worse than others in accessing them. (C) 2014 Elsevier Ltd. All rights reserved.Public, Environmental & Occupational HealthSocial Sciences, BiomedicalSCI(E)[email protected]
Paediatr Perinat Epidemiol
No full textBackgroundThe relationship between mastitis and antiretroviral therapy among HIV-positive, breastfeeding women is unclear.MethodsIn the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-infant pairs were randomized to a nutritional supplement group and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care for 24 weeks of exclusive breastfeeding and 4 weeks of weaning. Among 1,472 HIV-infected women who delivered live infants between 2004 and 2007, we estimated cumulative incidence functions and sub-distribution hazard ratios (HR) of mastitis or breast inflammation comparing women in maternal ART (n=487) or infant nevirapine (n=492) groups to the standard of care (n=493). Nutritional supplement groups (743 took, 729 did not) were also compared.ResultsThrough 28-weeks post-partum, 88 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (RD 4.5, 95% confidence interval (CI): 0.9, 8.1) and infant NVP (RD: 3.6, 95%CI: 0.9-6.9) compared to standard of care. The hazard of late-appearing mastitis or breast inflammation (from week 5-28) was also higher for maternal ART (HR: 6.7, 95%CI: 2.0, 22.6) and infant NVP (HR: 5.1, 95%CI: 1.5, 17. 5) compared to the standard of care.ConclusionsMastitis or breast inflammation while breastfeeding is a possible side effect for women taking prophylactic ART and women whose infants take NVP, warranting additional research in the context of postnatal HIV transmission.D43 TW001039/TW/FIC NIH HHSUnited States/U48DP001944/ACL HHSUnited States/DP2 HD084070/HD/NICHD NIH HHSUnited States/R25 TW009340/TW/FIC NIH HHSUnited States/R24 TW007988/TW/FIC NIH HHSUnited States/U48DP001944/ACL HHS/U48 DP001944/DP/NCCDPHP CDC HHSUnited States/U48 DP000059/DP/NCCDPHP CDC HHSUnited States/P30 AI050410/AI/NIAID NIH HHSUnited States
Perspectives on HIV partner notification, partner HIV self-testing and partner home-based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia
No full textINTRODUCTION: HIV testing male partners of pregnant and postpartum women can lead to improved health outcomes for women, partners and infants. However, in sub-Saharan Africa, few male partners get HIV tested during their partner's pregnancy in spite of several promising approaches to increase partner testing uptake. We assessed stakeholders' views and preferences of partner notification, home-based testing and secondary distribution of self-test kits to understand whether offering choices for partner HIV testing may increase acceptability. METHODS: Interviewers conducted semi-structured interviews with HIV-negative (N = 39) and HIV-positive (N = 41) pregnant/postpartum women, male partners of HIV-negative (N = 14) and HIV-positive (N = 14) pregnant/postpartum women, healthcare workers (N = 19) and policymakers (N = 16) in Malawi and Zambia. Interviews covered views of each partner testing approach and preferred approaches; healthcare workers were also asked about perceptions of a choice-based approach. Interviews were transcribed, translated and analysed to compare perspectives across country and participant types. RESULTS: Most participants within each stakeholder group considered all three partner testing strategies acceptable. Relationship conflict was discussed as a potential adverse consequence for each approach. For partner notification, additional barriers included women losing letters, being fearful to give partners letters, being unable to read and men refusing to come to the clinic. For home-based testing, additional barriers included lack of privacy or confidentiality and fear of experiencing community-level HIV stigma. For HIV self-test kits, additional barriers included lack of counselling, false results and poor linkage to care. Preferred male partner testing options varied. Participants preferred partner notification due to their respect for clinical authority, home-based testing due to their desire to prioritize convenience and clinical authority, and self-test kits due to their desire to prioritize confidentiality. Less than half of couples interviewed selected the same preferred male partner testing option as their partner. Most healthcare workers felt the choice-based approach would be acceptable and feasible, but noted implementation challenges in personnel, resources or space. CONCLUSIONS: Most stakeholders considered different approaches to partner HIV testing to be acceptable, but concerns were raised about each. A choice-based approach may allow women to select their preferred method of partner testing; however, implementation challenges need to be addressed
The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi
No full textDepressive disorders are leading contributors to morbidity in low- and middle-income countries and are particularly prevalent among people with non-communicable diseases (NCD). Stressful life events (SLEs) are risk factors for, and can help identify those at risk of, severe depressive illness requiring more aggressive treatment. Yet, research on the impact of SLEs on the trajectory of depressive symptoms among NCD patients indicated for depression treatment is lacking, especially in low resource settings. This study aims to estimate the longitudinal association of SLEs at baseline with depression remission achievement at three, six, and 12 months among adults with either hypertension or diabetes and comorbid depression identified as being eligible for depression treatment. Participants were recruited from 10 NCD clinics in Malawi from May 2019-December 2021. SLEs were measured by the Life Events Survey and depression remission was defined as achieving a Patient Health Questionaire-9 (PHQ-9) score <5 at follow-up. The study population (n = 737) consisted predominately of females aged 50 or higher with primary education and current employment. At baseline, participants reported a mean of 3.5 SLEs in the prior three months with 90% reporting ≥1 SLE. After adjustment, each additional SLE was associated with a lower probability of achieving depression remission at three months (cumulative incidence ratio (CIR) 0.94; 95% confidence interval: 0.90, 0.98, p = 0.002), six months (0.95; 0.92, 0.98, p = 0.002) and 12 months (0.96; 0.94, 0.99, p = 0.011). Re-expressed per 3-unit change, the probability of achieving depression remission at three, six, and 12 months was 0.82, 0.86, and 0.89 times lower per 3 SLEs (the median number of SLEs). Among NCD patients identified as eligible for depression treatment, recent SLEs at baseline were associated with lower probability of achieving depression remission at three, six, and 12 months. Findings suggest that interventions addressing SLEs during integrated NCD and depression care interventions (e.g., teaching and practicing SLE coping strategies) may improve success of depression treatment among adult patient populations in low-resource settings and may help identify those at risk of severe and treatment resistant depression
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