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1
Nemutudi, Aluwani. "The prevention of mother to child transmission programme (PMTCT) experiences of HIV positive mothers at Tonga hospital in Nkomazi East." Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/41568.
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Mother To Child Transmission (MTCT) of HIV is a major challenge in Sub-Saharan Africa due to a variety of socio-economic and political factors. In South Africa, for example, there was element of denialism by government on the fact that treatment could assist in reducing the likelihood of transmitting the virus to the baby. It was only in 2001 after the Treatment Action Campaign took the South African government to court that they were ordered to develop a programme to prevent the transmission of HIV from mother to child. The South African government established a PMTCT programme that aligned itself with the United Nations’ Millennium Goal of ensuring that all HIV positive pregnant women receive treatment in an effort to eliminate babies born with HIV.
This study, therefore, explored the experiences of HIV positive mothers who enrolled on PMTCT programme at Tonga hospital. The researcher explored the participants’ understanding of the programme prior to enrolment, the extent to which they experienced the programme, the nature of support and services they received while on the programme as well as challenges they faced. All this was done with the intention and commitment to strengthening the intervention strategies for the HIV pregnant women, thereby ensuring that they receive top quality services from a group of multi skilled professionals.
To achieve this, the study applied a collective case study within a qualitative approach. The population for the study was HIV positive mothers who enrolled on the PMTCT programme between June 2011 and July 2012. The sample consisted of 12 HIV positive mothers who took part in the PMTCT programme at Tonga hospital. For data collection purposes, the researcher applied semi-structured interview.
Informed by the findings, the study concluded that there is lack of knowledge and understanding of the programme in the community. It further established that the clinic is situated under the ward where HIV positive patients are treated and that psycho social services are not offered to the HIV positive pregnant women. It also concluded that the women’s husbands or partners are not encouraged to be part of the programme.
Consistent with the above, the study recommended that the PMTCT programme should be provided in a holistic and well integrated manner, where all health care disciplines contribute as required to make the participants’ experiences on the programme more comfortable both socially and emotionally. There should be a way to get the male counterparts of the participants more involved in the programme so as to afford them the opportunity to get first-hand information about pregnancy and what is expected of them as partners. Each health worker’s role should be clearly defined and a referral system be developed so that all services are easily accessible.Dissertation (MSW)--University of Pretoria, 2013.
am2014
Social Work and Criminology
unrestricted
2
Jumare, Fadila. "Prevention of mother to child transmission (PMTCT) of HIV/AIDS: a review of using PMTCT services in South Africa." Thesis, Nelson Mandela Metropolitan University, 2012. http://hdl.handle.net/10948/d1011508.
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Despite good intentions and commitment from health providers, it is difficult for HIV positive pregnant women to access Prevention of Mother to Child Transmission of HIV (PMTCT) services (Skinner et al 2005:115). The aim of this research was to find out the extent to which socio-economic and cultural factors influence access to and utilization of PMTCT services. It appeared that despite having a legal plan and framework to ensure that PMTCT services are available and free, the realities confronting HIV positive women in South Africa as suggested by the literature contradicted this objective. Inevitably, these contradictions were identified as some of the main factors contributing to lack of access and inadequate utilization of PMTCT services. These factors were identified through a review of fifteen studies selected based on their relevance to the research aim. The findings were presented according to the following themes: Functioning of clinics, adherence to ART, uptake of VCT and infant feeding practices. According to research evidence, the major socio-cultural factors influencing access and utilization of PMTCT services include fear of stigma and discrimination which are related to cultural norms and practices. The socio-economic factors include transport costs, lack of food, medicines and formula milk which are all related to poverty and unemployment. The research also found that health system constraints such as long waiting times in clinics, stock-outs of formula milk, medicines and test kits influenced the utilization of PMTCT services by HIV positive women.
3
Cunnama, Lucy. "Economic evaluation of models of prevention of mother-to-child transmission of HIV intervention for large scale implementation." Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33604.
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Background: Huge successes have been seen in the prevention of mother-to-child transmission of HIV (PMTCT) towards its elimination. Now amidst a landscape of universal antiretroviral therapy (ART), focus has been placed on different models of care to support and retain mother-infant pairs in the vulnerable postpartum phase. Methods The aim was to establish economic evidence for scaling-up approaches and models of care for PMTCT particularly during the postpartum period in Southern Africa. The economic data were collected during three studies, Safe Generations (Eswatini), MCH-ART and PACER (South Africa), using mixed bottom-up and top-down methodology. Outcomes of these studies were used to estimate the cost-effectiveness using an incremental cost effectiveness ratio (ICER, calculated by the difference in cost divided by the difference in effects) of lifelong ART in comparison to Option A (the standard of care at the time) in Eswatini; and to estimate the annual costs, costeffectiveness and budget impact of three models of care (Model I: Routine Care - mothers in general ART and infants in well-baby clinics; Model II: Integrated Care - mothers-infant pairs in integrated care in midwife obstetric unit; and Model III: Community Care - mothers in community adherence clubs and infants in well-baby clinics) in South Africa, from the provider and patient's perspectives. Costs are presented in 2019 United States Dollars (US $). Results Lifelong ART can be considered cost-effective in Eswatini with an ICER of US $984 per mother retained in care to six months postpartum. In Cape Town, South Africa, Routine Care cost US $226 per mother-infant pair per annum; Integrated Care cost US $341; and Community Care cost US $254. Annual patient costs (direct and indirect costs) for Models I-III, were US $30-55, US $23-45 and US $76 per mother-infant pair respectively. Comparatively Community Care was the most cost-effective model with an ICER of US $97 per mother-infant pair retained and mother virally suppressed. Scaling-up Community Care nationally in South Africa would require US $5 720 096 more than Routine Care, 0.2% of the total health budget for 2020/21. Conclusions This work has generated novel empirical data in the form of new cost estimates and cost comparisons across different models of care. It has also provided a unique comparison of the different models of care using a cost-effectiveness analysis; and further a novel budget impact analysis of different approaches to rolling these strategies out. This data has helped to fill the gap in the evidence base for instance lifelong ART was implemented in Eswatini as a direct result of the Safe Generations study findings. Community Care was found to be cost-effective and if scaled up nationally in South Africa would only require a small increment of the total health budget. However, we recommend a mixture of models of care to cater for the needs and preferences of patients. Decision makers can use the empirical findings to help set realistic budgets in Southern Africa and explore ideal model implementation to support mother-infant pairs in the crucial postpartum phase.
4
Kasenga, Fyson. "Making it happen prevention of mother to child transmission of HIV in rural Malawi /." Doctoral thesis, Umeå : Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-26223.
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Velapi, Linda. "The experiences of mothers living with HIV of the PMTCT programme in Khayelitsha, Cape Town." University of the Western Cape, 2021. http://hdl.handle.net/11394/8100.
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Magister Curationis - MCurThe pandemic of HIV is the most severe health challenge affecting children across the world and it is estimated that more than 90% of all HIV infections in children result from Mother to Child Transmissions (MTCT). The global target of <2% MTCT risk of HIV has still not been achieved despite the duration of the implementation of the programme and its great progress. The prevention of mother to child transmission (PMTCT) programme is a programme developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of the virus to their infants.
6
Behumbiize, Prosper T. "Factors influencing male’s involvement in prevention of mother to child transmission (PMTCT) services in Kibaale District, Uganda." UWC, 2009. http://hdl.handle.net/11394/2683.
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Magister Public Health - MPHGlobally, approximately 600,000 infants each year are born with HIV infection in Sub-Saharan Africa as a result of mother to child transmission (MTCT) (UNAIDS, 2001). Whereas there is significant progress in reduction of mother to child transmission of HIV in Uganda, the Western Region of Uganda has low rates of PMTCT service utilization. The progress has been hampered by many factors including low male involvement (MOH, 2005). The main objective of this study was therefore to identify some of the factors that discourage men from participating in PMCT services in this region. The study was conducted in Kibaale District in the Western Region of Uganda for a period of one month in mid 2009. Data was collected using a qualitative methodology. The tools that were used for data collection were key informant in-depth interviews and focus group discussions (FGDs) guides. Data was collected from PMTCT service providers, women of reproductive age group and men whose partners had given birth during the last year (2008). For the focus groups, a purposive sample of men and women who had some children born in 2008, followed by random sampling from the list of potential subjects was used to select participants. The study sample comprised of three FGDs of women who had given birth in year 2008 and male partners of women who had also given birth in 2008. Each FGD consisted of eight participants. One FGD was with women only, the other with men only, while the third was with both men and women.
7
Mamudu, Rashidat Amanosi. "Knowledge, attitude and practices of prevention of mother to child transmission of HIV(PMTCT) among women of child bearing age, in Karu Village, Abuja, Nigeria." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86249.
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Thesis (MPhil)--Stellenbosch University, 2014.ENGLISH ABSTRACT: An estimated 34 million people worldwide are infected with HIV with 52% of them being women (UNAIDS, 2011), of this figure, an estimated 3.4 million are said to be children below the age of 15years. Sub Saharan Africa accounts for up to 90% of this burden in children. Nigeria, the most populous nation is Saharan African still contributes up to 30% of the global burden of mother to child transmission of HIV which is a major source of infection in children. According to the Federal ministry of health 2010 ANC survey report, the country has a prevalence of 4.1%. The Federal Capital Territory (FCT) where Karu village is located ranked 5th among the 36 states and Federal capital territory in Nigeria with a prevalence of 8.7%. Urban prevalence is 8.6% while the rural prevalence is 8.2%. An exploratory descriptive study was conducted among women of child bearing age (18 to 49years) living in Karu village, Abuja, FCT, North central Nigeria. A semi structured questionnaire designed to assess the knowledge, attitude and practices of prevention of mother to child transmission of HIV was administered by the researcher on 120 women of child bearing age living in Karu village after obtaining their consent. The study received an ethical review and approval from FCT human research ethics committee at the Health Department of the Federal capital development agency and Stellenbosch University, ethic committee. Findings from the 120 women who gave consent to participate showed that 28.33% had sufficient knowledge of how MTCT can occur with 77% having insufficient knowledge of how MTCT occur, 51.67% of them have sufficient knowledge of how PMTCT can be achieved while 48.33% do not. Of the participant surveyed, 89.17% of them have ever been pregnant while 24.17% were pregnant at the time of the survey, the bulk of the participants were between the ages of 18 to 34 with only 22.5% of them within the age of 35 – 49 years. From this study, women in Karu village were identified to have high level of general knowledge regarding MTCT and PMTCT of HIV but in-depth knowledge of both is still insufficient among a large group of women. Health workers and mass media were identified as key sources of information regarding MTCT and PMTCT of HIV and majority of women have favourable attitude towards PMTCT interventions but practices of these interventions is still relatively low.
AFRIKAANSE OPSOMMING: Ongeveer 34 miljoen mense is wêreldwyd aangetas deur MIV, waarvan 52% vroue is (UNAIDS, 2011). Hiervan is ongeveer 3.4 miljoen na bewering kinders onder die ouderdom van 15 jaar. Tot 90% van hierdie infeksie by kinders kom in sub-Sahara-Afrika voor. Nigerië, die digsbevolkte staat in sub-Sahara-Afrika, dra tot 30% van die globale las van moeder-tot-kind-oordrag van MIV, wat ’n groot bron van infeksie onder kinders is. Volgens die Federale Ministerie van Gesondheid 2010 ANC-opnameverslag het die land ’n voorkomssyfer van 4.1%. Die Federal Capital Territory (FCT), waar die dorp Karu geleë is, is as 5de van die 36 state in Nigerië geklassifiseer met ’n voorkomssyfer van 8.7%. Die stedelike voorkomssyfer is 8.6% teenoor die landelike voorkomssyfer van 8.2%. ’n Ondersoekende, beskrywende studie is uitgevoer onder vroue van vrugbare leeftyd (18 tot 49 jaar) wat in die dorp Karu, Abuja, FCT, Noord-sentrale Nigerië, woon. ’n Halfgestruktureerde vraelys is ontwerp om die kennis, houdings en voorkomingspraktyke van moeder-tot-kind-oordrag (MTCT) van MIV te beoordeel. Dit is deur die navorser toegepas op 120 vroue van vrugbare leeftyd wat in die dorp Karu woon nadat hul toestemming daartoe verkry is. Die studie het ’n etiese oorsig en goedkeuring van die FCT mensenavorsing-etiekkomitee by die Departement van Gesondheid van die federale hoofstad se ontwikkelingsagentskap en die Universiteit Stellenbosch se etiekkomitee ontvang. Bevindings van die 120 vroue wat ingestem het om deel te neem het getoon dat 28.33% toereikende kennis gehad het van hoe MTCT kan voorkom, met 77% wat onvoldoende kennis gehad het van hoe MTCT voorkom. Van hulle het 51.67% genoegsame kennis gehad van hoe PMTCT verkry kan word, terwyl 48.33% nie oor hierdie kennis beskik het nie. Van die deelnemers wat waargeneem is, was 89.17% al swanger, terwyl 24.17% tydens die opname swanger was. Die meerderheid van die deelnemers was tussen 18 en 34 jaar oud, met slegs 22.5% wat in die ouderdomsgroep 35 – 49 jaar geval het. Uit hierdie studie het geblyk dat vroue van die dorp Karu geïdentifiseer is as mense wat ’n hoë vlak van algemene kennis omtrent MTCT en PMTCT van MIV gehad het, maar dieptekennis van albei sake is steeds ontoereikend by ’n groot groep vroue. Gesondheidswerkers en die massamedia is geïdentifiseer as sleutelbronne van kennis oor MTCT en PMTCT van MIV en die meeste vroue het ’n gunstige houding teenoor PMTCT-intervensies, maar die toepassing van hierdie intervensies is nog betreklik laag.
8
Abraham, Susanna Aba. ""Why I stayed when others left": an appreciative inquiry of retention in the prevention of mother to child transmission of HIV in Takoradi Government Hospital, Ghana." Doctoral thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30025.
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Globally, great strides have been made in developing essential strategies and knowledge necessary to prevent vertical transmission of HIV. Retention in the Prevention of Mother to Child Transmission (PMTCT) programme is essential for the achievement of this aspiration. The study applied Mixed Method Sequential Explanatory Design to explore the factors that underscored the retention decisions of newly diagnosed HIV positive pregnant women. The study was set in the PMTCT programme in the Takoradi Government Hospital, Ghana, a lower middle income country. PMTCT records were retrospectively reviewed. Subsequently, the Appreciative Inquiry process using the 4Is terminology was applied to unearth the experiences and aspirations of mothers (n=12), midwives and Community health nurses (CHNs) (n=12) engaged in the programme. Ethical approval was granted by University of Cape Town Faculty of Health Sciences Human Ethics Research Committee and Ghana Health Service Ethics Review Committee. Retention rate at six weeks postpartum was 67.4%. Retention stories of women enrolled in the PMTCT programme reflected a life-enhancing experience in the face of a life-threatening diagnosis. Four themes were generated: Transitioning to the ‘new’ woman, Journeying with committed companions, Glimpses of triumph and Tying up the loose ends: A daring new path. The study highlighted development of hope in a seemingly hopeless situation, supportive network of family, healthcare professionals and religious leaders, and the commitment and companionship of the midwives and CHNs that culminated in the successes of the programme. ‘Healthy’ HIV-infected mothers and ‘exposed’ infants who tested negative to HIV at the end of the mother-infant pair’s journey in the PMTCT programme was evidence of the diligence of mothers, midwives and CHNs. A collaborative discussion resulted in the development of action plans to improve service delivery, enhance clients’ experiences and improve retention. The study recommends that PMTCT services should be structured to promote hope and empowerment for the clients through shared clients and healthcare professionals’ designed improvement programmes, instituting programmes that promote the emotional health of the health practitioners to sustain the programme, and promptly addressing health system challenges that contribute to disengagement.
9
Giddy, Janet. "The implementation of an integrated prevention of mother-to-child transmission of HIV (PMTCT) programme at McCord Hospital, South Africa, 2003-2013." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16567.
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Includes bibliographical referencesIntegration is an important emerging health systems issue, which has relevance to different health programmes. Improving prevention of mother-to-child transmission of HIV (PMTCT) programs in South Africa would reduce preventable maternal and infant morbidity and mortality, assist with achieving Millennium Development Goals 4 and 5, and help in the response to the WHO call for the elimination of MTCT, the new international PMTCT goal. Integrating PMTCT care into routine maternal and child health programmes has been recommended as a way to optimize PMTCT care. The Part B literature review in this dissertation examines the reasons why PMTCT programmes need to engage with integration as an issue, challenges to implementing integrated programmes, followed by a discussion of the benefits and lessons to consider in planning integrated PMTCT programmes. Theoretical concepts and frameworks such as Atun's framework, complexity, Theory of Change and innovation in health systems are discussed, as they have key relevance to the research findings. Lessons about implementing health system changes can be learned from programmes which have done so successfully. Using Case Study methodology, the process of developing the fully integrated longitudinal clinic at McCord Hospital is described in Part C, and reflections on the experience of providing integrated care are captured through qualitative interviews with the staff. Recommendations regarding innovation and change within complex systems are made, emphasizing the need to understand contexts which are receptive to change and the importance of leadership in managing change.
10
Paul, Unathi Mecia. "Challenges faced by midwives in implementing the prevention of mother to child transmission programme during the post-natal period at Khayelitsha Community Health Clinic, Western Cape Province." University of the Western Cape, 2016. http://hdl.handle.net/11394/4903.
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Magister Curationis - MCurBackground: In the South Africa, the number of HIV- positive pregnant women is rising and has resulted in more than 70,000 babies being born with HIV infection annually since the year 2000. In response to the escalating number of HIV-positive pregnant women, the Department of Health of South Africa, decided, in 2002, to implement the Prevention of Mother to Child Transmission (PMTCT) programme at 18 pilot sites in the country. An effective PMTCT programme could reduce the incidences of maternal and child mortalities in the country. An evaluation of the effectiveness of the PMTCT programme that was done in 2010 showed that, although the programme was rendered effectively during pregnancy and labour, there were still irregularities that appeared, especially during the postnatal period. Khayelitsha was the first pilot site in South Africa to provide Antiretroviral Therapy and initiate the Nurse Initiated Management of Antiretroviral Therapy (NIMART) at primary care level in the public sector. Midwives are the health professionals who render the PMTCT services to HIV-positive mothers and their babies until six weeks post-delivery. They have managed to test almost 100% of pregnant women during the antenatal period and the HIV-positive women were started on the PMTCT programme during their first visit. Aim: The aim of this study was to explore the challenges that midwives faced in rendering care to postnatal HIV-positive mothers enrolled in the PMTCT programme at the Khayelitsha Community Health Clinic in the Western Province of South Africa. Method: An exploratory design and qualitative approach was followed. The study population consisted of midwives who were rendering PMTCT services to HIV-positive mothers and their infants during the postnatal period. Purposive sampling was conducted until data saturation was reached. Six participants were included in the sample. The participants were informed about the study by means of an Information Sheet, advised that the study was voluntary and reminded that they could withdraw from the study at any time, without prejudice. In-depth, unstructured individual interviews were conducted with each of the participants. With the permission of participants, an audio tape recorder was used during the interviews to collect data, while the researcher took field notes to supplement and verify the voice recordings, after the interviews. The seven steps of Colaizzi were used to analyse the data. Six themes and sixteen sub-themes emerged during the data analysis. Trustworthinesswas maintained by using the criteria of Guba’s model, i.e. credibility, transferability, conformability and dependability. Permission to conduct the study was obtained from the appropriate ethical committees; the Department of Health, the Khayelitsha Community Health Clinic, as well as, the Senate Research Committee of the University of the Western Cape. Participants were asked to sign Informed Consent forms before participating in the study. The ethical principles of privacy, anonymity, withdrawal, confidentiality and consent were strictly adhered to. Findings: The study found several challenges faced by midwives while implementing the PMTCT programme during the postnatal period. These challenges included: the shortage of NIMART-trained staff attending to the high number of clients per day; the lack of manpower with data base systems to trace mothers who did not come back after delivery; and mothers who did not come back for postnatal appointments because of denial, non-disclosed HIV status and socioeconomic reasons. Furthermore, the participants also reported on midwives experiencing ‘burnout’ as a result of the hectic working environment at the Khayelitsha Community Health Clinic. Recommendations: There is an urgent need for all midwives in the MOU’s to be NIMART-trained. NIMART should be standardize and be the part of the curriculum that taught in all the tertiary institutions and be updated in a yearly basis as part of the in-service training or education for all practising midwives. The South African Government should introduce home visits in the PMTCT programme. Data-bases of all MOU’s and facilities that offer PMTCT services need to be synchronized and these MOU’s and facilities should all follow the same PMTCT guidelines. Further research should be done on the same topic at other clinics and MOU’s that render the PMTCT programme in the Western Cape.
11
Ngcongwane, Phindile G. "Missed Opportunities of Preventing Mother to Child Transmission Programme at Germiston District Hospital in 2004." Diss., University of Pretoria, 2006. http://hdl.handle.net/2263/61725.
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Background: The vertical transmission of HIV from mother to child ranges from 15 to
40%. The preventing mothers to child transmission programme (PMTCT) services have
been introduced during the past five years in South Africa; however vertical transmission
of HIV remains high.
Objectives: The objectives of the study were:
1. To describe the clinical and demographic characteristics of women attending the
ANC clinic and delivering at the Germiston Hospital;
2. To determine the proportion of women who were offered voluntary counselling
and testing (VCT) in 2004;
3. To determine the proportion of women who subsequently received PMTCT.
Methods: This is a cross-sectional study I which a sample of 776 patient files were
retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the
period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist
was used to extract specific information. Data was entered into EpiData and analysed
using STATA version 8. Pearson's chi-square test was used to obtain measures of
association for all categorical variables. The multiple logistic regression method was
used to investigate predictors for missed PMTCT opportunities.
Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)};
prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe
sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with
syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16-
4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to
have a missed PMTCT/VCT opportunity than women having made more than two visits
{OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}.
Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the
prevalence of syphilis is seven times greater than the national prevalence. Every antenatal
care visit is an opportunity for the healthcare worker to offer voluntary counselling and
testing. All women identified as having syphilis infection are at high risk of acquiring
HIV. Therefore every woman identified and treated for syphilis should be counselled and
tested for HIV. Women must be offered HIV and AIDS education at every ANC visit.
Routine opt-out counselling should be offered at every ANC visit for those who have not
been previously tested.
Recommendation: In order to increase the uptake of the PMTCT programme healthcare
workers should have training and re-orientation on:
1. The need to use every opportunity in antenatal care and maternity wards
to offer HIV counselling and testing to mothers;
2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care
of pregnant women.Dissertation (MPH)--University of Pretoria, 2006.
School of Health Systems and Public Health (SHSPH)
MPH
Unrestricted
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Murithi, Lydia. "A Positive Dimension: Exploring Factors that Enhance Utilization of and Adherence to Prevention of Mother-to-Child Transmission (PMTCT) of HIV Services in an Urban Setting in Kenya." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3005.
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Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing high numbers of children living with HIV globally and among the 22 PMTCT global plan priority countries. Using a mixed methods approach this study examined enabling factors –individual, social and structural – that enhance utilization of and adherence to PMTCT services in a plural urban setting in Kenya. The study was conducted from October-December of 2012 at St. Mary’s Mission Hospital, Lang’ata. HIV-positive birthmothers whose infants were HIV-negative at the time of the study were purposively selected to participate. All informants completed an interviewer-administered questionnaire (n = 55) and a subset (n = 15) participated in in-depth interviews. Contrary to the assertions of multiple studies that failures of PMTCT programs are a result of inadequate knowledge of mother-to-child transmission and PMTCT interventions, lack of support and acceptance by family and community, as well as poor quality of services, this study found these factors to be statistically insignificant in explaining PMTCT achievements. The study further found that HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to apply acquired knowledge on mother-to-child transmission and PMTCT interventions, mobilize support from family and community, and access more affordable care. Factors found to influence women’s decisions to utilize and adhere to PMTCT services include supportive counseling, striving for motherhood, maternal attachment and concern for the child’s wellbeing, assurance of confidentiality and testimonials of other successful mothers. Based on the study findings, policy recommendations have been proposed along with suggestions for future research.
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Uwimana, Jeannine. "Community participation in collaborative tuberculosis and HIV activities including prevention of mother- to- child- transmission (PMTCT): development and evaluation of an intervention to enhance integration of TB/HIV/PMTCT services in a rural area of South Africa." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/5139.
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Philosophiae Doctor - PhDThe epidemiological interconnectedness of tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics is well documented. Although international agencies such as the World Health Organisation (WHO) have been advocating for the implementation of collaborative TB/HIV activities at all levels in order to mitigate the impact of the dual epidemic on communities, health care delivery and programme management, its implementation has been very slow, particularly in countries highly burdened with TB/HIV infection, such as South Africa. Provision of integrated TB/HIV services has been partial and sub-optimal at community level. This requires innovative interventions that go beyond health facility boundaries such as engaging community care workers (CCWs). This thesis presents ways of engaging community members such as CCWs in collaborative TB/HIV activities including prevention of mother-to-child transmission of HIV (PMTCT). Methods: Both action research and health systems strengthening research were used as theoretical frameworks. The study was conducted in three phases which consisted of: a situational analysis; design and implementation of the intervention; and evaluation of the intervention. Mixed method research using both quantitative and qualitative research methods in one study was conducted, and various research designs were used depending on the research questions and the study phases. Results: The findings of Phase I of this study highlight partial integration of TB/HIV/PMTCT services at facility and community levels, and sub-optimal provision of integrated services, particularly at community level where only 10% of TB and HIV patients needing care at community level were supported by CCWs. Most TB-HIV co-infected patients were managed at the primary health care (PHC) clinic level of care, compared to other levels (p<0.05), and less than 50% of PHC clinic staff were trained in TB and HIV management. This phase also indicates poor linkage between facility and CCWs through the nongovernmental organizations (NGOs) managing CCWs. In addition, it identifies various health systems barriers that impede the implementation of collaborative TB/HIV/PMTCT activities and involvement of CCWs in the mainstream of the primary health care system. The findings of Phase II and III show that integrating different CCW cadres into one cadre and expanding their scope of practice to provide a comprehensive package of care for TB/HIV/PMTCT is a feasible and an effective intervention to accelerate the implementation of collaborative TB/HIV activities, including PMTCT, at community level. In addition, the findings suggest that up-skilled CCWs contribute significantly to bridging the current service delivery gaps in vertical TB, HIV and PMTCT services by increasing coverage for case finding of TB (38%) and sexually transmitted infections (STIs) (40%), PMTCT services (infant feeding, referral for PCR and AZT adherence support) (30%), and TB and antiretroviral treatment (ART) adherence (30%, 28%). The increase in uptake of TB/HIV/PMTCT services was statistically significant (p<0.05). Provision of home-based HIV counseling and testing by CCWs proved to be acceptable and feasible. Of 684 people offered home based HCT, 634 (82%) accepted to be tested and 45 (7%) tested HIV positive. However, other PHC care services such as integrated management of childhood illnesses (IMCI) and referrals to social welfare were poorly provided. Conclusion and Recommendations: The findings indicated that up-skilling CCWs resulted in improvement of CCW's performance in provision of integrated TB/HIV/PMTCT services, particularly for TB and STI symptom screening, HCT, infant feeding counselling and AZT treatment support for PMTCT, and treatment adherence support for TB and ART. However, this study emphasised the need for addressing contextual and health systems issues such as structural, organisational and managerial constraints. There is a need to reorganise the PHC system to ensure that CCWs are integrated as part of the PHC system. Systematic skills building and consistent CCW supervision, with reliable referral and monitoring and evaluation (M&E) systems are required for efficiency and sustainability of any community based intervention. It is also necessary to ensure that other PHC activities, such as referral for social welfare and IMCI, are not compromised when additional activities are added to the CCW care package.
This research was made financially possible by the, African Doctoral Dissertation Research Fellowship (ADDRF) of the African Population and Health Research Centre, in partnership with the International Development Research Centre and Ford Foundation. South African Tuberculosis AIDS Training (SATBAT): a South African/US research training collaboration funded by Fogarty International Center Grant 1U2RTW007370-01A1).
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Davis, Annemarie, D. Labadarios, D. Marais, and M. F. Cotton. "Prevention of mother-to-child transmission programme : how "informed" is the literate mother's decision regarding infant feeding options in the Gert Sibande district, Mpumalanga province, South Africa." Thesis, Stellenbosch : University of Stellenbosch, 2005. http://hdl.handle.net/10019.1/4957.
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225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices.Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner.
Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005.
ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers.
AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.
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Nguni, Catherine Musakanya. "Exploration and description of barriers to male participation in antenatal and prevention of mother-to-child transmission of HIV (pmtct) services in Mumbwa district, in Zambia." University of Western Cape, 2013. http://hdl.handle.net/11394/3918.
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Magister Public Health - MPHThe reproductive health of women is hugely dependent on the involvement of their male partners. Men also serve as gatekeepers to women’s access to reproductive health services. Male involvement is an important recommendation for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) program as their participation in antenatal care and HIV testing has been found to decrease infant HIV infection and increase HIV free survival. Male involvement is not just about promoting men to accompany their partners to antenatal clinic, but for men to provide supportive roles in their families, and also to bring men into HIV preventive and care services. Male involvement in PMTCT is defined as the fathers’ active involvement in attending antenatal care services and HIV testing during the antenatal period as well as the couple’s acceptance of PMTCT if the mother is found to be HIV positive. Men are traditionally not directly involved in their partner’s health in many sub-Saharan countries, although they most often make decisions about use of services. They may provide financial support but attending health services with their partner is not seen as part of the male’s role. There are therefore huge challenges in efforts to get men involved in reproductive health services and there is a need to better understand how to promote male involvement in different settings. Male involvement in PMTCT was adopted by the Zambian Government in 1999 but not much is known on how best to initiate and develop male involvement in their partner’s health.
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Londeree, Jessica K. "Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1546428369119761.
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Itiola, Ademola Joshua. "Evaluation of the effectiveness of prevention of mother to child transmission of HIV (PMTCT) Interventions in two selected health facilities in Adamawa State, Nigeria." University of the Western Cape, 2017. http://hdl.handle.net/11394/5966.
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Magister Public Health - MPH (Public Health)Most (90%) Human Immunodeficiency Virus (HIV) positive children are infected through mother to child transmission of HIV (MTCT). Without any interventions the risk of MTCT is between 20% and 45% at the final endpoint of 18 - 24 months. Efficacy studies have however proven that with antiretroviral interventions, MTCT risk can be reduced to less than 2% or 5% in non-breastfeeding and breastfeeding populations respectively. It is important to evaluate the effectiveness of Prevention of MTCT (PMTCT) interventions in routine health facility settings where service delivery may not be optimal. The current pool of evidence on PMTCT effectiveness in Sub-Saharan Africa is limited and no PMTCT effectiveness study has been conducted in Adamawa State, Nigeria since the programme started in 2007.
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Davidsson, Kajsa, and Elisa Torstensson. "Nurses' experiences of working with Prevention of Mother-to-Child transmission of HIV : A minor field study in the Rufiji district of Tanzania." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-14637.
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This study is a Minor Field Study and is funded by the Swedish International Development Cooperation Agency (SIDA). At the end of 2016 there were 1.4 million people living with HIV in Tanzania; That same year approximately 55.000 people were newly infected with the disease. The most frequent route of infection is through mother to child transmission (MTCT). The risk of transmission can be reduced with the help of medication and other strategies, called prevention of mother-to-child-transmission (PMTCT) of HIV. Tanzania is working actively with these prevention programs, however the rates of MTCT still remains high in the country. Due to their profession, nurses play a significant role in these prevention programs. They have an important role in educating the patients and encouraging a healthier lifestyle. Therefore, it is important to investigate nurses' experiences of working with PMTCT of HIV to gain knowledge and valuable information of their experiences. The aim of the study is to investigate local nurses' experiences of working with PMTCT of HIV in the Rufiji area in Tanzania. The data of the study have been collected through individual interviews with six nurses using a semi-structured guide with open questions. The nurses' experiences of working with PMTCT of HIV covers three key areas. First, they work actively with motivating the mothers in several significant areas, such as motivating the mothers to take a voluntary HIV-test and bringing their partners to undertake the HIV-test. Second, the nurses described the importance of counseling the mothers and their partners. One part in counseling is to get the mother's mind ready to receive the result of the HIV-test. Third, the nurses experienced stigma as something they all had to be aware of and meet in their everyday work life. Stigma from the community and relatives is one reason for poor adherence from the mothers to the PMTCT program.
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Chitambala, Cecilia. "Factors affecting HIV counselling and testing (HCT) in the provision of prevention of mother to child transmission (PMTCT) services among pregnant women in Kabwe, Central Province of Zambie." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79955.
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Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: This research study looked at the factors that affect HCT in provision of PMTCT services. It explored the socio cultural and personal factors that affect HCT. It also established the knowledge level about HIV/AIDS and PMTCT among pregnant women in Kabwe. The transmission of HIV from mother to child contributes largely to HIV prevalence among children. Efforts to reduce this mode of transmission include increasing number of women who know their HIV status and increasing the number of HIV positive women who when pregnant take instructions and act on them to protect their children from the possibility of infection (Bartlett et al. 2004). Individuals can only know their HIV status once they are tested for HIV. However, there are socio cultural and personal factors among other factors that affect the access of HCT. The aim of this study was to identify socio cultural and personal factors that affect HIV counseling and testing in provision of PMTCT services among pregnant women in Kabwe, in order to make recommendations for the development of an intervention program to help improve uptake of HIV counseling and testing for PMTCT services. Both quantitative and qualitative methodologies were used to conduct this study. Focus Group Discussions were conducted with groups of pregnant women that have never been tested for HIV before and Key Informant Interviews with health care workers (midwives or nurses) to ask them about factors affecting HCT in provision of PMTCT services among pregnant women were used. A retrospective statistical report review was also used to ascertain the accessibility rate for the HIV counseling and testing for PMTCT services. In this light, statistical report review was used to collect the number of pregnant women attending ANC and number of pregnant women receiving HIV testing. The findings of this study revealed that the pregnant women had excellent knowledge about HIV/AIDS and the update of HCT was as good as 91% among pregnant women. The research also revealed domestic violence, accusation of promiscuity by partner, abandonment by partner, and stigma & discrimination as socio factors that affect HCT in provision of PMTCT. Religion, fear disbelief of test results was revealed as personal factors affecting HCT in provision of PMTCT. The research revealed decision making, tradition medicines, and practices as cultural factors affecting HCT in provision of PMTCT. The conclusion was made that fear of abandonment by partner, fear of being accused of being promiscuous by partner, and fear of domestic violence were the main factors why some pregnant women did not accept to take an HIV test during their pregnancies. It is also concluded that most men make decisions for their families. Women in homes have no powers to make decisions, so if the husband refuses her to take a test, the wife just has to comply. It is also concluded that a person’s ability to access health related services is shaped by socio cultural and personal factors among others factors. These findings fit well with the Anderson behavioral model which describes the individual factors as having three elements that relate to the individual’s ability to access and utilize health care services.
AFRIKAANSE OPSOMMING: Hierdie navorsingstudie het gekyk na die faktore wat 'n invloed HCT in die voorsiening van VMTKO dienste. Dit ondersoek die sosio-kulturele en persoonlike faktore wat HCT. Dit het ook die kennis oor MIV / VIGS en VMNKO onder swanger vroue in Kabwe. Die oordrag van MIV van moeder na kind dra grootliks by tot die voorkoms van MIV onder kinders (Bartlett et al. 2004). Pogings om hierdie wyse van oordrag te verminder sluit in toenemende aantal vroue wat hul MIV-status ken en die verhoging van die aantal MIV-positiewe vroue wat toe swanger neem instruksies en reageer op hulle om hul kinders te beskerm teen die moontlikheid van infeksie. Individue kan slegs weet wat hul MIV-status wanneer hulle getoets word vir MIV. Egter, is daar sosiaal-kulturele en persoonlike faktore onder ander faktore wees wat die toegang van HCT. Die doel van hierdie studie was om sosiaal-kulturele en persoonlike faktore wat die MIV-berading en toetsing in die voorsiening van VMTKO dienste onder swanger vroue in Kabwe te identifiseer, ten einde aanbevelings te maak vir die ontwikkeling van 'n intervensie program te help opname van MIV-berading en toetsing vir VMNKO dienste te verbeter. Beide kwantitatiewe en kwalitatiewe metodes is gebruik om hierdie studie uit te voer. Fokusgroepbesprekings is gevoer met groepe van swanger vroue wat nog nooit vir MIV getoets is voor en onderhoude met sleutelinformante met gesondheidsorgwerkersVroedvroue of verpleegsters) is gebruik om hulle te vra oor die faktore wat HCT in voorsiening van PMTCT dienste onder swanger vroue. 'n Retrospektiewe statistiese verslag review is ook gebruik om die toeganklikheid koers vir die MIV-berading en om vas te stel toetsing vir VMNKO dienste. In hierdie lig, is statistiese verslag hersiening gebruik word om die aantal swanger vroue wat die ANC en die aantal swanger vroue MIV-toetsing in te samel. Die bevindinge van hierdie studie het aan die lig gebring dat die swanger vroue het uitstekende kennis oor MIV / VIGS en die update van HCT was so goed as 91% onder swanger vroue. Die navorsing het ook aan die lig gebring huishoudelike geweld, beskuldiging van losbandigheid deur vennoot, verlating deur vennoot, en stigma diskriminasie as sosio faktore wat 'n invloed HCT in die bepaling van die PMTCT. Godsdiens, vrees ongeloof van toetsresultate is geopenbaar as persoonlike faktore wat HCT in die voorsiening van PMTCT. Die navorsing het aan die lig gebring besluitneming, tradisie medisyne, en praktyke as kulturele faktore wat HCT in die voorsiening van PMTCT. Die gevolgtrekking is gemaak dat vrees vir verlating deur vennoot, vrees daarvan beskuldig dat hy van promisku deur vennoot, en die vrees van huishoudelike geweld was die belangrikste faktore waarom sommige swanger vroue nie aanvaar het nie 'n MIV-toets te neem tydens hul swangerskappe. Dit is ook die gevolgtrekking gekom dat die meeste mense besluite neem vir hul families. Vroue in huise het geen magte om besluite te neem, so as die man weier om vir haar 'n toets te neem, die vrou net om daaraan te voldoen. Dit is ook die gevolgtrekking gekom dat 'n persoon se vermoë om gesondheid verwante dienste om toegang te verkry tot gevorm word deur die sosiaal-kulturele en persoonlike faktore onder andere faktore. Hierdie bevindings pas goed met die Anderson gedrags-model wat die individuele faktore beskryf met drie elemente wat betrekking het op die individu se vermoë om toegang te verkry tot en gebruik van gesondheidsorgdienste.
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Ski, Samantha M. "Diffusion and Adoption of Policies for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) and their Effect on the Delivery of Key PMTCT Services in Eastern and Southern Africa." Thesis, The George Washington University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10145741.
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With the goal of eliminating mother-to-child transmission by 2015, a wide range of governmental and other efforts within low- and middle-income countries have sought to provide services for the prevention of mother-to-child transmission of HIV (PMTCT) to the estimated 1.2 million pregnant women in need. In support of this goal, the World Health Organization (WHO), as the leading normative international body in the area of evidence-based clinical guidelines, issued policy recommendations on the use of antiretroviral drugs for PMTCT. Through various mechanisms, including guidance notes and dissemination workshops, WHO supports countries to adopt and adapt the guidelines within their national policy frameworks. Through three analyses, this dissertation examines the diffusion of WHO PMTCT guidelines in five Eastern and Southern African countries over a 16-year period (1998-2013) and estimates the effect of PMTCT policy adoption on delivery of key services.
The first analysis of the adoption of specific PMTCT guideline updates between 1998 and 2013 seeks to ascertain which internal factors may explain why and when countries decided to adopt new technical guidance. The policy analysis shows that the five countries adopted a majority of the key international PMTCT technical guidance updates. It can be concluded that international to national policy diffusion was taking place and that national policies converged to be more similar and more in line with international guidelines over the time period studied. Variation in adoption and in the internal determinants at play in each country was minimal, making it difficult to assess the influence of determinants qualitatively. The three internal determinants that appeared to most influence adoption of key PMTCT updates were: 1) the severity of the MTCT problem 2) governance effectiveness, and 3) prior PMTCT policy adoption. The lag between adoption and implementation in these countries is discussed. The findings indicate that in the countries studied, policies promoted by WHO and other international bodies can play a critical role in supporting national policy adoption for program advancement in the area of PMTCT.
The second and third analyses investigate whether the completeness of a country’s body of PMTCT-supporting policies was associated with the delivery of two key PMTCT services – the offer of an HIV test and the receipt of HIV counseling as a part of antenatal care (ANC) – in four of the five countries included in the first analysis. Two nationally representative surveys per country were used to conduct a quasi-experimental fixed-effects analysis of the role of policy in predicting a woman’s probability of being offered an HIV test or receiving HIV counseling in ANC, controlling for other key individual- and country-level covariates.
According to the ‘testing’ model, a one-unit increase in policy score was associated with a 0.042 (p<0.000) increase in the probability that a woman was offered an HIV test as a part of antenatal care. According to the ‘counseling’ model, a one-unit increase in policy score was associated with a 0.014 (p<0.001) increase in the probability that a woman received HIV counseling as a part of antenatal care. In both the testing and counseling models, the policy/education interaction was statistically significant in the final model, with a greater policy effect estimated at among those with higher education levels. Time statistically significantly influenced the probability of the outcome, as did government health spending, governance effectiveness, and donor health spending. Further study is needed to identify the policy elements that have the most impact on improving service delivery.
The three analyses presented here support the premise that international health policies influence national-level policy adoption, and that national-level policy adoption in turn influences national service outputs. As countries and their development partners mobilize for the Sustainable Development Goal era, policy adoption at the international level will continue to be an important influence in national policy adoption in the area of PMTCT. This research has described a number of potential internal and external determinants that will influence national adoption in this next round of global health policy advocacy. Looking forward, this study shows that countries and their development partners should continue to invest in the work of policy adoption to complement other efforts to reach health goals, including increased government health spending.
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Kumwenda, Andrew. "Evaluation of the quality of counselling for prevention of mother to child transmission of HIV offered to pregnant women in the copperbelt province of Zambia." University of the Western Cape, 2011. http://hdl.handle.net/11394/5095.
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Magister Public Health - MPHBackground: One study on estimating rates of mother to child transmission of HIV (MTCT) in program settings in Zambia showed significant reduction in the MTCT rate with some specific prevention of mother to child transmission of HIV (PMTCT) interventions. Prolonged breastfeeding and mixed feeding practices by HIV positive mothers increased the MTCT rate by more than double by the time the infant reached 6 to12 months of age. Although the study did not assess the quality of PMTCT counselling in antenatal care settings, literature shows that poor quality of counselling on PMTCT reduces the effectiveness of PMTCT interventions. Study aim: To evaluate the quality of PMTCT counselling offered to pregnant women attending antenatal care (ANC) services in four public health facilities in Kitwe, Copperbelt province of Zambia. Study design and data collection: This was a cross sectional descriptive study. Data was generated using qualitative research methods including document analysis and individual interviews with 22 participants using non-participant observations, client exit interviews and focus group discussions (FGDs) to collect data. The study participants were ANC attendees and PMTCT providers. Two FGDs were conducted with a total of 98 counselling observations done and 16 ANC client exit interviews. Client exit interviews were done immediately after the mothers had undergone PMTCT counselling. Results: Content for group health education (GHE) varied across the facilities. Individual pre-test, post-test and follow up counselling sessions were very short and lacked depth. A total of 41 (83.7%) pre-test observations took between 1 and 5 minutes to be conducted. In addition, several key topics including major modes of HIV transmission, MTCT and the "window period" were omitted. The counsellors' interpersonal skills were generally good but they did not consistently summarize the main issues. The 16 mothers interviewed had limited knowledge of PMTCT with only one client knowing all the MTCT modes correctly. Discussion: Quality of PMTCT counselling did not meet expectations. With a lot of key topics omitted, outcomes of PMTCT interventions may not be as good as expected. Facilities are faced with serious staff shortages and limitations with space. The few members of staff available are overworked and are not able to provide quality PMTCT counselling. Conclusion: While the PMTCT uptake was good and clients felt satisfied, the quality of PMTCT counselling is compromised. There is need to improve it and ensure optimal effectiveness of PMTCT services.
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Yako, Elizabeth Matseliso. "Adherence to pre-selected infant feeding practices among mothers on the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS programme in the Amathole region, Eastern Cape." Thesis, University of Fort Hare, 2011. http://hdl.handle.net/10353/d1001091.
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Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.
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Chandiwana, Precious. "Exploration of factors influencing contraceptive use among HIV-positive women participating in a Prevention of Mother-to-Child Transmission program in an urban setting in Harare, Zimbabwe." University of the Western Cape, 2016. http://hdl.handle.net/11394/5500.
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Magister Public Health - MPHDual protection is protection against unwanted pregnancy, HIV and other sexually transmitted infections and a means of achieving safer sex and birth control (WHO, 2012). It is one of the essential tools promoted by the WHO for preventing unintended pregnancies and sexual transmitted infections among HIV-positive women to reduce dual risk of unintended pregnancies, re-infections and transmission of HIV in the cases of sero-discordant couples. However, the use of dual method use among HIV-positive women in Zimbabwe is poorly described. Hence to fill in the existing research gap, this study aims to explore the factors influencing dual protection use by HIV- positive women participating in a prevention of mother-to-child transmission (PMTCT) program in an urban setting in Zimbabwe. Methodology: A qualitative exploratory study design with a combination of qualitative research methods including interviews and focus group discussions was conducted. A total of five focus group discussions (FGDs) each consisting of 8-12 participants was conducted with a total of 51 women. Five in-depth interviews were conducted with key informants. All interviews and FGDs were audio recorded using a digital voice recorder. The interviews were conducted in Shona and translated into English. Data analysis was done manually using thematic coding. Codes emerged from the data using an inductive approach. Ethical principles of research and rigour were observed throughout the study. Results: Dual protection use was low among the HIV-positive women. Absolutely non-use of contraceptive was reported by some women. The main methods of contraceptives were the pill, depo provera and condoms. Inconsistent condom use was mentioned among the few women who reported using condoms. Many barriers to contraceptives use among HIV-positive women in Zimbabwe were identified. However there were a few facilitating factors too. Health system factors associated with health care workers (HCWs) related factors and service delivery processes were reported as major barriers to contraceptive use. Women expressed negative attitude towards condom use associating them with unfaithfulness. Facilitators of contraceptive use identified were couples' HIV testing and counselling, women's increase in CD4 count result, fear of vertical transmission and HIV sero-discordance between couples. Conclusion and Recommendations: In conclusion, dual protection use among HIV-positive women in this community was low. Health system factors were the main barriers to contraceptives use whilst health related factors were the main facilitators. HIV-positive women still face challenges in accessing and utilisation of contraceptives. Hence the barriers to contraceptive use needs to be addressed at the same time promoting the facilitators.
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Mubangizi, Lilian. "Examining the association between future pregnancy intentions, contraceptive use and repeat pregnancies among women living with HIV in Cape Town, South Africa." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32825.
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Background: Given the rapid expansion of antiretroviral therapy (ART) services in South Africa, there is growing recognition of the importance of fertility intentions, contraceptive use and childbearing among women living with HIV (WLHIV). With the integration of family planning services in the prevention of mother-to-child transmission of HIV (PMTCT) services, understanding fertility intentions and contraceptive use is crucial in evaluating such programs. We investigated the relationship between future fertility intentions, contraceptive use and repeat pregnancies among WLHIV in Cape Town, South Africa. Methodology: We analyzed data from the MCH-ART study conducted at the Gugulethu Midwife Obstetric Unit (MOU) in Cape Town, South Africa, which followed women initiating ART during pregnancy through 36-60 months postpartum. Self-report data were collected using standardized questionnaires at repeated study visits. Data on repeat pregnancies were abstracted from the Western Cape Provincial Data Centre. Associations between maternal characteristics and repeat pregnancies were examined using Cox proportional hazards models. Results: Overall, 109 incident repeat pregnancies were recorded among the 471 women included in this analysis. The median time at risk per individual was 4.27 years. The rate of repeat pregnancies was 5.72 per 100 person-years (PY). This rate was significantly lower among women aged 35-45 years (2.11/100PY) compared to women aged 18-24 years [7.56/100 PY; adjusted hazard ratio (aHR), 0.26: 95% confidence interval [CI], 0.09, 0.81). A total of 333 women contributed data on future fertility intentions and contraceptive use at 12 months postpartum, with 9% reporting that they wanted another child in the future, and 82% reporting current contraceptive use; 16% (n=54) reported not wanting another child but no contraceptive use. The rate of repeat pregnancies was 3 folds higher among women who reported wanting a child in the future (12.59/100 PY) compared to women who did not want 5 a child in the future (4.31/100 PY; aHR, 3.46: 95% CI, 1.83, 6.50). Contraceptive use at 12 months postpartum was not associated with repeat pregnancies. Women who did not want a child and used contraceptives had a 45% decreased hazard of repeat pregnancies compared to women who did not want a child and did not use contraceptives (aHR 0.55: 95% CI [0.32, 0.94]. Conclusion: Among women initiating ART during pregnancy, a repeat pregnancy incidence rate of 5.72/100 PY was observed through 36-60 months postpartum, with the incidence lower among older women. At 12 months postpartum, a notable proportion of women reported not wanting another child but no contraceptive use. Wanting a child in the future was associated with a higher rate of repeat pregnancy, but contraceptive use at 12 months postpartum was not associated with repeat pregnancies. These results highlight the importance of understanding factors associated with the dissonance between fertility intentions and contraceptive use and childbearing to ensure delivery of quality integrated reproductive health services in the PMTCT framework.
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Matroshe, Florence Nozakhe Skoti. "Attitudes, knowledge and behaviour of HIV positive pregnant women attending antenatal care in Buffalo city metropolitan district East London towards prevention of mother to child transmission (PMTCT)." Thesis, University of Fort Hare, 2014. http://hdl.handle.net/10353/d1016150.
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The National HIV and AIDS and STI strategic plan for South Africa, 2007-2011 aims to reduce the rate of mother to child transmission to less than 5% by 2011. On the World Aids day in 2009, the Honorable President Jacob Zuma announced the intervention to improve antiretroviral therapy (ARV), access to priority group’s in order to decrease the disease burden, to address maternal and child mortality, and to improve life expectancy (PMTCT Guidelines: 2010). According to the literature reviewed, accepting attitudes may indicate better knowledge and understanding of HIV and AIDS. Marking a change in South Africa’s history of HIV the South African Government launched a major HIV Counseling and Testing program campaign (HCT) in 2010. For the PMTCT program to work and be acceptable, it needs to be known by its clients. It helps the individual to know about their status so that they make important choices for self and others. Amongst the important choices, medications for opportunistic medications, ARV’S, behavior change, etc, are included (Project Literacy 2006:40). Aim and Objectives: The study assessed the knowledge that the pregnant women have towards the prevention of mother to-child transmission which includes HIV testing, antiretroviral prophylaxis during pregnancy, labour, and post natal and feeding options. Methods: A quantitative descriptive method was used for this study. The questionnaires developed by the researcher were used for data collection. The items on the questionnaire were divided into four (4) subsections. The questionnaire was administered to all positive pregnant women coming for follow up visit and those available at the time of data collection. Conclusion: In this study evaluation of the level of knowledge and attitude of positive pregnant women with regard to PMTCT in 5 Buffalo City Municipality clinics was conducted. It was found that some of positive pregnant women have better knowledge about PMTC though there were still those that need further education. Recommendations: The service providers, who are the professional nurses, should be provided with proper training on PMTCT program to improve their standard of service delivery and to capacitate them with knowledge and skills. Integration of HIV related health aspects during assessment and treatment of pregnant women should be strengthened, as the purpose of implementation of PMTCT was to reduce mortality rate by 50%, and also to reach the 4th Millennium Development Goal of reducing these deaths by two-thirds by 2015.east london towards prevention of mother to child transmission (pmtct)
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Ijezie, Echey. "An exploration of male participation in a PMTCT programme in West Itam, Akwa Ibom State, Nigeria." University of the Western Cape, 2017. http://hdl.handle.net/11394/5590.
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Magister Public Health - MPHSince the introduction in 2005 of prevention of mother-to-child transmission of HIV (PMTCT) services in Akwa Ibom State in Nigeria the PMTCT programme has faced several challenges including that of poor male participation in the PMTCT programme. To date no research has focused on the issue of male participation in PMTCT programmes in Akwa Ibom State, and there is thus a limited understanding of why so few male partners of HIVpositive pregnant women participate in the State's PMTCT programme. It is therefore important to explore the factors affecting male involvement in PMTCT programmes in Akwa Ibom State, so that strategies can be put in place to help improve the overall health of their families and themselves. The overall aim of the study was thus to explore the factors affecting male participation in the PMTCT programme at a primary health care center in West Itam, Akwa Ibom State, in Nigeria. This explorative study was conducted using a descriptive qualitative research approach. The research study approach helped to understand the perspectives of the male partners of HIV positive pregnant women who received the PMTCT intervention, as well as key informants in the Primary Health Care (PHC) facility where these PMTCT services are offered. The study population consisted of all males living within the catchment area of the West Itam PHC, Akwa Ibom State, Nigeria. In the research study, 11 men were purposively sampled: five of whom were the partners of HIV-positive women who had attended, or were currently attending the PMTCT services at the West Itam PHC with their partner. The other six interviewees were local male community members – who would be eligible to potentially accompany their partner to PMTCT services at the facility. The data was collected through individual, in-depth interviews with the male partners and community members using a semi-structured interview guide. One focus group discussion (FGD) was conducted with key personnel working in the West Itam PHC using a semistructured interview guide. All interviews and the FGD were tape-recorded and transcribed. Thematic analysis was used to analyse the data. Ethical approval was first obtained from the UWC Research Ethics Committee and the Ethics Committee of the Akwa Ibom State Ministry of Health before proceeding with the study. From this study, it is suggested that most of the respondents knew that PMTCT services are offered at the PHC West Itam. They knew their partner's next antenatal appointment, but only very few accompany their pregnant partners to the antenatal clinic. The striking reason being a lack of time/being busy. The key means of support of the partners' antenatal visits was giving their pregnant partners money for transport, and money for food/snacks (at the clinic). Inter-spousal communication was found to be good, and there appeared to be a perception by the men that antenatal clinic (ANC)/PMTCT is not only for women, with most of the men agreeing that it is useful for men to participate in PMTCT. The barriers to male participation in the PMTCT programme that were elicited in this study include lack of belief about HIV/AIDS and lack of awareness about PMTCT and the perception of PMTCT as a "women's affair". Another barrier to male participation in the PMTCT programme was the men being busy with their jobs/lack of time, and fear. Facility-based barriers include delays/time wasting at the clinic, and the nurses, who were identified as having an unaccommodating attitude towards the clients. Finally, the fact that the nurses and counsellors at the PHC West Itam were all female was a problem for men. It is recommended that there is need for advocacy and education to raise awareness about HIV/AIDS, and encourage male participation in PMTCT. It is also important to encourage the disclosure of HIV status by the women to their male partners. Furthermore, a separate male counselling unit needs to be created, as well as ensuring the employment of male nurses and counsellors. Additionally, the female nurses at the facility need to be trained/re-trained on proper attitude and confidentiality, and efforts must be made to avoid delays at the clinic.
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Mkuyamba, Veronica. "An investigation of the knowledge and skills of health care providers on early infant diagnosis of HIV in Mzuzu, Malawi." University of the Western Cape, 2016. http://hdl.handle.net/11394/5248.
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Magister Curationis - MCurEarly infant diagnosis (EID) programmes offer diagnosis of HIV, which facilitates provision of life-saving care to infants infected with HIV. Implementing programmes for EID and treatment has proved challenging in Malawi. Many infants access EID late or not at all. Previous studies have shown that lack of knowledge among health care providers (HCPs) is a challenge to effective EID. Little is known on the knowledge and skills of health care providers in Malawi. Aim: The aim of the study was to investigate the knowledge and skills of HCPs on EID of HIV in Mzuzu, Malawi. Objectives: (i) to examine the knowledge of HCPs on EID of HIV; and (ii) to determine the skills of HCPs on EID of HIV. Methods: A descriptive cross-sectional survey design with a quantitative approach was used. The study was conducted in three hospitals in Mzuzu, Malawi. The population was HCPs (doctors, nurses/midwives, clinical officers and medical assistants) working in maternity, paediatric wards and under-five clinics. A total of 68 HCPs participated in the study. A closed-ended self-administered questionnaire was used to collect data. Data were analysed using the Statistical Package for Social Science version 23. Descriptive statistics were used to present the frequency tables of observations. Ethical approval was sought from the University of the Western Cape Senate Research Committee and Malawi National Health Research Council. Results: The results on the knowledge of HCPs demonstrate that 38% of them had a score of <69% (poor), 25% scored within 70–79% (fair), and 37% scored >80% (good). Results on the skills showed that 69% of the HCPs scored <69% (poor), 15% scored within 70–79% (fair), and 16% scored >80% (good). The results also showed a correlation between the knowledge of HCPs and their level of education achievement (certificate, diploma and degree) as well as the skills of HCPs and their department of work. Conclusion: The study found that more than one-third of the HCPs lacked knowledge and skills on EID of HIV. These findings reflect the need to address the practical challenges of EID service delivery. Recommendations: There is a need to increase the efforts that are being put in place to train HCPs on EID of HIV in order to scale up EID. Training should assess the needs of HCPs regarding the knowledge and skills required in the delivery of EID services.
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Nicol, Edward Fredrick. "Evaluating the process and output indicators for maternal, newborn and child survival in South Africa : a comparative study of PMTCT information systems in KwaZulu-Natal and the Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97073.
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Thesis (PhD)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The prevention of mother-to-child transmission (PMTCT) of HIV is a key maternal and child health intervention in the context of the HIV/AIDS pandemic in South Africa. Accordingly, the PMTCT programme has been incorporated in the District Health Management Information System (DHMIS) that collects monthly facility-based data to support the management of public health services. To date, there has not been a comprehensive evaluation of the PMTCT information system. By comparing the experiences in two health districts, using the Performance of Routine Information System Management (PRISM) framework and tools, this study seeks to evaluate the availability, quality and use of process and output indicators for monitoring PMTCT interventions. A comparative analytical and observational study was undertaken using a multi-method approach which included: a self-administered survey of health information personnel to assess confidence and competence levels for routine health information system (RHIS) tasks, an assessment of the routine PMTCT data for quality, completeness, accuracy, and data use; and a facility survey of RHIS processes and resources. In addition, in-depth interviews with 22 key informants and observations in health facilities were conducted. Data were collected from 57 health facilities in a convenience sample of two health districts, and also from 182 health information personnel in the 57 health facilities, three sub-districts, and two district offices. Descriptive statistics, χ2-test, correlation and multiple regression analyses were conducted using STATA® Version 13. A general inductive approach was also used to analyse the qualitative data, which was used for triangulation. The study revealed considerable data quality concerns for the PMTCT information with an average accuracy between the register and routine monthly report of 51% and between the routine monthly reports and DHMIS database of 84% suggesting that the primary point of departure for accurate transfer of data is during the collation process. The importance of human factors was emphasised by the observation that the average confidence level for performing RHIS-related tasks (69%) was not commensurate with the average competence levels (30%). Education was found to be associated with competence, implying that levels of education may be associated with the level at which RHIS competencies are acquired; and that three years or more of post-matriculation education is necessary. Motivation, on the other hand was not associated Stellenbosch University https://scholar.sun.ac.za iv with competence. The study observed the absence of processes such as data-quality checks and data-analysis in place in facilities. There was a general absence of a culture of information use, as a result of lack of trust in the data, and the inability of programme and facility managers to analyse, interpret and use information. We observed differences in the data accuracy by organisational authority, and multivariate analysis and qualitative information suggested that feedback may be an essential process to ensure quality. Although the PRISM framework has been developed from a multi-disciplinary evidence base, this study has been able to validate some of the internal assumptions but has also found some aspects that were not supported such as motivation and data display. Data collected from a larger number of facilities will be required to investigate this further. Institutional capacity to improve RHIS processes, ensure core competencies for RHIS-related tasks are needed, and in the longer term, measures to tackle problems associated with low pass rates in numeracy subjects among high school learners are needed. Further exploration of the possible factors that may influence data accuracy, such as supervision, training and leadership are needed as well as investigating the relationships between human and institutional agency-related aspects, in particular, how individual actions can bring about changes in institutional routines. Further study is needed to determine how decision for planning and evaluating key programmes such as PMTCT are made, and what informs such decisions if not routine data.
AFRIKAANSE OPSOMMING: In die lig van Suid Afrika se MIV/VIGS-pandemie kan ’n ingryping op gesondheidsvlak ’n belangrike rol speel om moeder-na-kind-oordrag (beter bekend as PMTCT) van MIV te voorkom. ’n Inligtingstelsel vir distriksgesondheidsbestuur – die DHMIS – was ontwerp vir die invordering van maandelikse fasiliteitsdata, wat gebruik kan word om die bestuur van openbare gesondheidsdienste en -programme te ondersteun. Die inligtingstelsel self was nog nie omvattend evalueer nie. Hierdie studie het die ervarings van twee gesondheidsdistrikte vergelyk met behulp van die PRISM- (Performance of Routine Information System) raamwerk en -instrumente. Derhalwe het hierdie studie die beskikbaarheid, gehalte en gebruik van proses- en uitsetaanwysers probeer bepaal om die PMTCT-ingrypings te monitor. ’n Vergelykende analitiese en waarnemingstudie is onderneem met behulp van ’n veelvuldige benadering. Die verskillende metodes het ’n selfopname onder gesondheidsinligtingspersoneel ingesluit om hul selfvertroue en bevoegdheid in roetinegesondheidsinligtingstelsel (RHIS)-take te evalueer. Daar was ook ’n assessering van die PMTCT-roetinedata om datagehalte, -volledigheid, -akkuraatheid en -gebruik te beoordeel.’n Fasiliteitsopname oor RHIS-prosesse en –hulpbronne was ook gedoen. Ander navorsingsmetodes het diepte-onderhoude met 22 sleutelpersone ingesluit, sowel as waarnemings in gesondheidsfasiliteite. Data is van 182 gesondheidsinligtingpersoneel van die 57 gesondheidsfasiliteite in ’n geriefsteekproef van twee gesondheidsdistrikte ingesamel. Deskriptiewe statistiek, χ2-toetsing, korrelasie en veelvoudige regressie is met behulp van STATA® weergawe 13 ontleed. ʼn Algemene induktiewe benadering is ook gevolg om die kwalitatiewe data te ontleed. Die studie toon dat menslike faktore ’n impak op datagehalte en -inligting kan hê, met ’n gemiddelde akkuraatheidsyfer van 51% van beide die register en roetine maandelikse verslae. Die akkuraatheid van die maandelikse verslae en RHIS databasis is 84%, wat aandui dat akkuraatheid slegs toegepas word indien inligting uit die staanspoor korrek aangeteken word. Die impak van menslike hulpbronafaktore was beklemtoon toe daar bevind was dat hoewel 69% van RHIS-dataverwerkers vertroue getoon het in die gebruik van RHIS-verwante take, slegs 30% wel bevoeg was om die werk te doen. Opvoeding was grootliks geassosieer met bevoegdheid, wat moontlik voorstel dat sekere vlakke van opvoeding benodig word vir spesifieke RHIS-bevoegdhede. Minsten drie jaar tersiêre opleiding word aanbebeel. Motivering was nie met Stellenbosch University https://scholar.sun.ac.za vi bevoegdheid geklassifeer nie. Die studie het bevind dat daar te min aandag aan datagehalte en –analise gegee word in fasiliteite. Oor die algemeen was daar nie ’n ordentlike kultuur van inligtinggebruik nie, a.g.v. die feit dat daar nie vertroue in die data was nie. Terselftertyd was program- en fasiliteitbestuurders nie bevoeg om inligting te analiseer en ontleed nie. Ons het verskille in die akkuraatheid van data opgetel wat deur organisasie-hoofde gedoen was. Meervoudige analise en kwalitatiewe informasie stel voor dat terugvoering ’n belangrike deel van die proses moet wees om kwaliteit te verseker. Hoewel die PRISM-raamwerk saamgestel was uit ’n multi-dissiplinêre bewyslewering, kon hierdie studie sommige van die interne voorneme valideer, maar daar was aspekte wat nie gestaaf kon word nie. Inligting van ’n groter aantal fasiliteite sal benodig word om verder hierna ondersoek in te stel. Institusionele kapasiteit word benodig om RHIS-prosesses te verbeter en basiese vaardighede vir RHIS-verwante take te verseker. Op langtermynvlak moet daar ook gekyk word na probleme wat lei tot laë slaagsyfers in syfervaardighede in hoërskoolleerders. Verdere ondersoek moet ingestel word om vas te stel watter faktore moontlik akkurate data teweeg kan bring. Dit sluit toesig, opleiding en leierskap, asook die verhoudings tussen menslike en agentskap-verwante aspekte in. Die feit dat optrede op individuele vlak veranderings in institusionele roetines kan aanbring, moet spesifiek na gekyk word. Verdere studies kan help om vas te stel hoe besluite vir beplanning en evaluaring vir hoofprogramme soos PMTCT gemaak word – asook hoe die besluite gemaak word indien hulle nie roetine voorafgaan nie.
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Bweupe, Maximillian M. "An exploration of timing of disclosure to male partners by HIV positive women attending a health care centre in Lusaka, Zambia." Thesis, University of the Western Cape, 2011. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_2124_1366189136.
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Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centreâs PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,
individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workersâ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia
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Kufa, Erica. "The timing of first antenatal care visit and factors associated with access to care among antenatal care attendees at Chitungwiza municipal clinics, Zimbabwe." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4553.
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Magister Public Health - MPHBackground and Rationale: Antenatal care (ANC) is vital for accessing prevention of mother to child transmission (PMTCT) services. The timing of the first ANC visit is critical for HIV infected pregnant women to access antiretroviral (ARV) prophylaxis as recommended. In addition pregnant women access other interventions like syphilis screening and treatment, provision of ferrous iron supplements, malaria prevention and treatment, health education, identification and management of risk factors. There is however paucity of information on factors associated with the timing and adequate use of ANC services in Chitungwiza Township, Zimbabwe. Aim: This study aimed to determine the factors associated with early access to and adequate use of ANC services among women attending ANC in the four polyclinics in Chitungwiza Township.Method:The study included a retrospective record review of women who registered for ANC in 2010 and a cross sectional study of pregnant women attending ANC clinic for the first time during the current pregnancy during the survey period. Data on gestation age at first ANC visit, number of ANC visits, age, gravidity, parity, tetanus, iron sulphate, rhesus results, HIV test result, WHO clinical stage, CD4 count, cotrimoxazole, PMTCT option accepted, date of initiation of AZT or ART; partner HIV test results; and infant feeding adherence done was abstracted into an MS Excel spreadsheet from the 2010 ANC registers in the four primary health care clinics. Every fourth record was captured. Exit interviews were also conducted on all women attending ANC for the first time during the current pregnancy using a structured questionnaire. Questions on socio-economic status, pregnancy history, reasons for seeking ANC, knowledge and belief about ANC services and their perception of the service received were asked. The outcome variables were gestation age at first ANC visit and the number of ANC visits. The spreadsheet was imported into Epi Info 7.0.9.7 and STATA 11 for analysis. The questionnaires were captured into an Epi Info 7 database exported to STATA 11 for analysis. A sample of 1,236 of first ANC visit records were abstracted from the 2010 ANC registers in the four primary care clinics and 80 women coming for ANC were interviewed in three clinics. The prevalence of pregnant women attending ANC for the first time at gestation age less or equal to 14 weeks and the prevalence of women with less than 4 ANC visits were computed. Pearson Chi-square tests were used to determine the strength of the relationships between the dependent variable (gestation age at the time of the first visit) and independent variables of age, marital status, level of education, parity, gravidity. All statistical tests were performed at 5% significance level and estimates were calculated at 95% confidence interval. Multiple logistic regression analysis was used to investigate the association between the outcome and the independent variables. Model interpretation was done using odds ratios (OR). Levels of knowledge and perception about ANC services as well as service content during the visit were also summarized. Results: Less than 1% of the women who attended ANC in 2010 came for 1st visit at week 14 or less, while of the women interviewed, 2.5% came at similar gestation age. Thirty-nine percent of women attending ANC in 2010 had at least four visits. Lower parity and tetanus immunization were significantly associated with early ANC initiation, while tetanus immunization and syphilis screening were associated with the number of visits.Among the interviewed women (n=80), 72.1% believed that a pregnant women should start ANC at 14 weeks or earlier. Most women (61.7%) cited having no money for booking as the reason for not coming earlier. Need for husband or partners permission, procrastination and not having any health problems with previous pregnancies were also a barrier to access. Uptake of HIV testing was very high at 94.7% of the women. However partner testing was very low at 2.1%. Knowledge of the appropriate time of the first ANC visit was somewhat high but not universal. Conclusions and Recommendations: Timely and adequate uptake of ANC services is very low in Chitungwiza Township. The user-fees appeared to be a major barrier to accessing ANC timely. While correct knowledge about when to go for ANC and the health problems women face during pregnancy and childbirth is prevalent,other factors like the need for permission from spouse or partner and procrastination were barriers to seeking service. Abolishing maternity fees should be seriously considered in order to increase access to timely ANC services. Sustainable means of financing services without reducing quality should be sought. There was variable uptake of various interventions in the ANC package due in part to supplies stock outs. There is need for strengthening the procurement and distribution systems so as to ensure continuous supplies at service delivery level.
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Dube, Lorraine Tanyaradzwa. "Exploring pre-and post-partum barriers to anti-retroviral therapy adherence for HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe." University of the Western cape, 2016. http://hdl.handle.net/11394/5594.
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Master of Public Health - MPHBackground: Zimbabwe has one of the highest HIV prevalence rates in sub-Saharan Africa, with the adult prevalence rate at 15%. The HIV prevalence is highest among adult women, at 18%. Mother-to-child transmission is the second leading cause of HIV in Zimbabwe. Therefore, provision of anti-retroviral therapy to pregnant women is important in reducing mother-to-child transmission. In 2012, the World Health Organisation formally adopted ART guidelines known as "Option B Plus", where triple therapy is provided to pregnant women for life, regardless of CD4 count. Zimbabwe subsequently adopted Option B Plus in September 2013. However, the success of ART depends on adherence to treatment. Lack of adherence to treatment leads to an increased risk of opportunistic infections and drug resistance, which is costly to treat. The aim of the study was to explore pre-and post-partum barriers to anti-retroviral therapy for HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. Methodology: Descriptive qualitative methods were used to explore the barriers to ART adherence for pre-and post-partum HIV-positive women initiated onto Option B Plus in Harare, Zimbabwe. In-depth, semi-structured interviews were conducted in Shona with 20 non-adherent pre-and post-partum HIV-positive women and four key informants who are health workers from two identified health facilities (Edith Opperman Polyclinic and Kuwadzana Polyclinic). The interviews were recorded, transcribed and translated into English. The data was analysed using inductive thematic analysis. Results: Health facility and individual factors emerged as barriers to adherence. Heavy workload and staff shortages, negative health worker attitude, cost of accessing health facilities, medicine shortages and detrimental health facility policies were all health facility related barriers identified by both key informants and the women. Individual barriers were related to difficulty in navigating the early days after diagnosis and treatment, stigma, intimate partner dynamics and religion. Conclusion: Despite free, decentralised provision of ART, barriers to adherence still exist. Many of the barriers have been articulated in previous research that focused on prevention of- mother-to-child transmission regimens, as well as ART regimens for the general population. The fact that the barriers remain suggests that the barriers are complex and addressing them will require tackling social constraints such as stigma and gender roles that pose a significant barrier to adherence.
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Girma, Marshet [Verfasser], and Michael [Akademischer Betreuer] Hölscher. "Effectiveness of prevention of mother-to child transmission (PMTCT) procedures in pregnant HIV infected women and their exposed infants at seven health centers in Addis Ababa, Ethiopia / Marshet Girma ; Betreuer: Michael Hölscher." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2016. http://d-nb.info/1122019327/34.
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Sogaula, Nonzwakazi. "Challenges faced by nurse-counselors in the implementation of HIV and infant feeding policy in Amathole District, Eastern Cape." Thesis, University of the Western Cape, 2008. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_7154_1262645603.
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This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. Objectives: To describe the demographic characteristics of the study population
Toexplore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines
To establish the nurse counselors&rsquo
perspectives on the infant feeding policy and guidelines for HIV positive mothers
To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers.
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Nkwandla, Buyiswa. "Knowledge, attitude and practices of HIV positive pregnant women towards the prevention of mother-to-child transmission (pmtc) in Khayelitsha maternity obstetric unit in the Western Cape." University of the Western Cape, 2021. http://hdl.handle.net/11394/8092.
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Magister CurationisThe National Programme of Prevention of Mother to Child transmission (PMTCT) in relation to HIV/AIDS was introduced by the Department of Health in different sites per province in South Africa in 2001. The number of women has a chance to access antenatal clinic services during pregnancy but they start to attend usually in late gestation.
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Harmon, Amanda L. "Preventing Mother-to-Child Transmission of Human Immunodeficiency Virus-1 (HIV-1): Effects of Intrapartum and Neonatal Single-Dose Nevirapine Prophylaxis and Subsequent HIV-1 Drug Resistance at Antiretroviral Treatment Initiation." Scholarship @ Claremont, 2011. http://scholarship.claremont.edu/cmc_theses/305.
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The prevention of mother-to-child transmission is one of the most powerful tools in human immunodeficiency virus type 1 (HIV-1) prevention and has huge potential to improve both maternal and child health. In the absence of any preventative measures, infants born to and breastfed by their HIV-positive mothers have roughly a one-in-three chance of acquiring the infection themselves. HIV can be passed on from mother-to-child during pregnancy, during labor and delivery, and even after during breastfeeding.
Intrapartum and neonatal single-dose nevirapine (sd-NVP) is the foundation of preventing mother-to-child transmission in lower resource settings where it has been used alone or as part of combination regimens. Both its simplicity and its long plasma half-life contribute to the success of sd-NVP based therapy. However, sd-NVP frequently results in HIV-1 viral resistance in mothers and children who become HIV infected despite prophylaxis. Sd-NVP leads to the development of non-nucleoside reverse transcriptase inhibitors (NNRTI) drug resistance, compromising the success of treatment of mother and child with subsequent antiretroviral combinations. Resistance to NNRTIs is particularly worrisome in lower resource settings since many subsequent regimens for maternal and infant antiretroviral therapy include a NNRTI drug.
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Van, Wyk Elisna. "The effect of pasteurisation on the composition of expressed human milk from HIV positive mothers, and its adequacy in relation to the growth of their very low birth weight premature infants." Thesis, Link to the online version, 2008. http://hdl.handle.net/10019/1507.
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Kanyinda, Muya. "Reasons for pregnancy among women on prevention of mother-to-child transmission (PMTCT)program in Serowe-Botswana." Thesis, University of Limpopo (Medunsa Campus), 2009. http://hdl.handle.net/10386/245.
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Thesis (MPH)--University of Limpopo,2009.Background: Women living with HIV frequently report in the clinic with pregnancy despite their health status and knowledge of mother-to-child transmission HIV. This study assessed the level of knowledge of Prevention of Mother-to-Child Transmission (PMTCT) and the reasons for pregnancy among women on PMTCT in Serowe, Botswana. Objectives: The objectives of this study were to assess the level of knowledge of the PMTCT program and vertical transmission among HIV-positive women in Serowe; evaluate the reasons for pregnancy among HIV-positive pregnant women enrolled in the PMTCT program as well as describe the practices of family planning among these women in Serowe. Methodology: The study was a cross-sectional descriptive survey using qualitative method. Twenty six (26) participants attending PMTCT clinics at Serowe clinic, Nutrition clinic, and Kadimo clinic participated in the study between October and December 2008 after consenting to participate. Research assistants conducted in-depth interviews to collect socio-demographic data of the participants. Qualitative methods were used to collect data about the women’s level of understanding of the PMTCT program, reasons for falling pregnant, types and duration of their relationships with their partners and family planning practices. The interviews were conducted in the local language (Setswana) and then translated into English by the research assistant for transcribing. Their responses were audio taped. Results: The results indicated that most of pregnancies were unplanned. However, 26.9 % of participants said that they became pregnant because they desire to have another child. A number of participants ( 15.4%) indicated that they became pregnant because their partners wanted a child. Although all 26 participants had good knowledge and understanding of the family planning practices, but only 18 (69.2 %) had used the family planning methods before falling pregnant. The findings in this study revealed good social suport from the family members and the disclosure of HIV status was not a big issue to the participants. Majority of respondents (66.6%)) had good knowledge and understanding of the PMTCT program. One-third of the participants were single, ninety- six percentages of participants were unemployed, and about one-third of them live on less than 50 U$ dollars per month. Conclusion: As the desire to have children is usually perceived as a normal part of life for all women, including women living with HIV. Most women chose not to become pregnant after knowing their HIV status (HIV-positive) but the found themselves with unplanned pregnacy. The women with a procreative inclination were found to be more likely to choose to become pregnant which outweighed social support and personal health concerns. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, unemploment and poverty. Participants had good knowledge of PMTCT program. The use of family planning by participants was poor despiste their good knowledge about it
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Nuwagaba-Biribonwoha, Harriet. "Prevention of mother-to-child transmission of HIV in Uganda." Thesis, University of Oxford, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413514.
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Fleek, Kimberly Anne. "Perspectives of HIV + Women on the Mother to Child Transmission of HIV in Addis Ababa, Ethiopia." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5355.
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Purpose and rationale: In 2012, an estimated 9,500 infants in Ethiopia were born with HIV. Mortality for these infants is high, and preventing infection offers the best hope for reducing the childhood death rates. Effective measures exist which can reduce the likelihood of a child acquiring HIV from its mother to less than 2%, and the necessary anti-retroviral medications are free and accessible to Ethiopian women. However, Prevention of Mother to Child Transmission of HIV (PMTCT) efforts in the country have not kept pace with the global reduction in infant infections over the last decade, and the Ethiopian MTCT rate was still 20% in 2012. Although a large number of women are getting tested for HIV during pregnancy, only 41% of eligible women in the country complete PMTCT therapy. The purpose of this exploratory study was to elicit the perspectives of HIV+ mothers on the unique socio-contextual factors which affect them during pregnancy, both positively and negatively, including the beliefs, attitudes, cultural norms and individuals who have influence over their reproductive health decisions. Methods: The mixed-methods study was done at a community level in Addis Ababa, Ethiopia. With the assistance of several large networks of people living with HIV (PLHIV), PLHIV mothers who have a child at least one year of age were recruited by mixed purposeful sampling; various socio-economic demographics were represented. In-depth interviews, focus groups and surveys were then completed in Amharic with a research assistant translating to English. Results: 98 women in total took part in the study: 23 completed interviews, 28 participated in focus groups, and 49 completed additional surveys. The greatest barriers to PMTCT completion identified were: feelings of hopelessness and carelessness, a general lack of understanding of the efficacy of ARVs, negative religious influences, stigma and poverty. The strongest facilitators to PMTCT use expressed by the women were: PLHIV peer support, faith, and gaining hope. It was recommended that PLHIV mothers be utilized in all PMTCT planning and interventions in the future. Implications: Program managers and health officials can build on these findings to modify existing PMTCT programs and to develop innovative and effective new PMTCT interventions. This will ultimately result in increased PMTCT uptake and adherence amongst HIV + pregnant women and a reduction in infant HIV transmission.
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Magaso, Farai Beverley. "Assessing the barriers to accessing prevention of mother-to-child transmission (PMTCT) services in Marondera Zimbabwe." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11433.
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Although Zimbabwe has invested in nationwide scale-up of prevention of mother to child transmission (PMTCT) services, high HIV-specific under-five mortality rates continue to be observed. This study aimed to document the potential reasons for low PMTCT uptake by examining factors constraining access to PMTCT services.
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Asuquo, Ekaete Francis. "Nurses’ Involvement In Health Care Research and Policy Development in the Context of Mother-to-Child HIV/AIDS Transmission in Nigeria." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/34650.
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The reduction of disease burden in the context of mother-to-child HIV transmission in Nigeria invokes a multi-sectoral and multi-disciplinary approach, which incorporates using research evidence to promote relevant policies. Nurses as health workers play a central role in health sector responses to ameliorate disease burdens such as those affiliated with HIV. Situated within critical social theory and using theoretical perspectives on power, this qualitative study examines the extent of nurses' contributions to research production and policy development in mother-to-child HIV transmission in the Cross River State, Nigeria. The study was guided by four specific objectives: 1) to assess nurses’ knowledge of current global strategies; 2) to describe nurses’ contributions to research and policy development; 3) to identify issues that encourage or impede the involvement of nurses in research and policy development and ;4) to identify promising models to actively engage nurses in research and policy development. A case study approach and participatory action research methodologies facilitated a comprehensive examination of the extent of Nigerian nurses' research and policy involvement and provided collective action for change. Interviews, document reviews, and focus group discussions were methods utilized for data collection and validation of collected data. Four major themes emerged: intimate knowledge of healthcare, marginal involvement in knowledge creation, limited involvement in mother-to-child transmission (MCTC) policy decision making and going with the flow. The study findings revealed that the nurses had good knowledge of local/global HIV trends, MTCT ameliorating strategies, barriers to MTCT uptake, processes of mobilizing local strategies, and an in-depth understanding of the integral role of implementing partners and the nursing workforce in ameliorating the impact of HIV on mother and child. However, this intimate knowledge did not translate into knowledge creation through independent research productivity in this context. The study further revealed that nurses were mostly involved in data collection and validation of collected data, which was not leading to publications. Barriers to knowledge creation included individual or personal constraints, as well as institutional and systemic barriers. Solving this problem requires funding of research studies, building research capacity, mentoring, earmarking research grants for nurses, increasing budgetary allocations to research, creating research awareness, creating a stimulating research environment with computers and internet access, using research as a criterion for promotion, and providing incentives. The study also revealed the insignificant participation of nurses in policy decision making, with involvement limited to implementation of PMTCT policy. Barriers to nurses' involvement in decision-making emanated from individual and health care system constraints, and nurses' contributions to decision making can only be improved by educational upgrading, integrating policy courses into nursing curricula, mentoring, group advocacy, involvement in politics, and organizational restructuring. The study showed that nurses were generally complacent about their involvement in knowledge creation and policy development. They tended to move with the flow of events and were afraid to question the status quo. A tree animation nursing (TAN) model provided a promising model for change with four main components:1) university education, 2) strong nursing leadership, 3) the identification of barriers, 4) and envisioned solutions, all of which are necessary to enable nurses to actively engage in research productivity and policy formulation. University education is recommended as a prerequisite for all nurses, and policies that foster a culture of nursing research productivity and policy development should be promoted.
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Singh, Vikesh. "Implementation of the dual therapy prevention of mother-to-child transmission protocol." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1374.
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Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
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Links, Nomvuyiseko. "Postnatal women's experiences of the prevention of mother-to-child transmittion of HIV programme." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/545.
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This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.
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Phuti, Angel. "Exclusive breastfeeding in the prevention of HIV-1 transmission from mother to child : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20326.
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Thesis (MCurr)--Stellenbosch University, 2012.ENGLISH ABSTRACT: HIV infection poses a major obstacle in breastfeeding as it represents the most common way by which children acquire HIV. Exclusive breastfeeding has been discovered as the most effective intervention in preventing mother-to-child transmission of HIV, mortality and promotion of HIV free survival. The main objective was to evaluate the evidence on the effectiveness of exclusive breastfeeding versus formula feeding and/ or mixed feeding in the prevention of HIV-1 transmission from mother to child. To identify the studies, an electronic search was conducted using PUBMED/MEDLINE, CINAHL, CENTRAL and EMBASE databases. Electronic journals, which include the Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health, were also accessed. Manual searches were carried out. In addition, relevant experts were contacted in order to locate more data. There were no limitations with regards to date and language. The review considered studies on infants who were vertically HIV-1 exposed (mother HIV positive during pregnancy, birth and breastfeeding). These infants were exclusively breastfed for six months with administration of antiretroviral prophylaxis and were compared to infants exclusively formula fed. The outcomes measured were vertically acquired HIV infection; mortality and HIV free survival up to 24 months of age. Two reviewers independently selected articles which met the inclusion criteria. They independently extracted the data using a data extraction tool. Disagreements were solved by discussion. Data was then meta-analysed using Rev Man 5.1.0. Methodological quality of each trial was assessed by the reviewers using the Cochrane assessment tool for risk of bias. Two randomised clinical trials and one intervention cohort study (n=2112 infants) comparing exclusive breastfeeding with exclusive formula feeding were included. HIV infection was associated with exclusive breastfeeding as compared with exclusive formula feeding (Risk ratio 1.67, 95% CI 1.26 to 2.23, p=0.0005). Exclusive formula feeding was associated with high mortality from infections (Risk ratio of 0.67 95% CI 0.43 to 0.83, p=0.002 Chi²= 1.30, p=0.52, I²=0%). There were no statistically significant differences in HIV free survival between exclusive breastfeeding and exclusive formula feeding as measured by trialists at 9, 18 and 24 months (Risk ratio 1.19, 95% CI, 0.92 to 1.54, p=0.19, Chi²= 3.15, p=0.21, I²=36 % 3 studies, 1012 infants). None of the studies included reported on mixed feeding. Complete avoidance of breastfeeding is effective in preventing mother-to-child transmission of HIV. HIV infection during breastfeeding might be an indicator of mixed feeding and poor adherence. Formula feeding is only applicable in settings where formula milk is accessible, feasible, acceptable, safe and sustainable (AFASS) because formula feeding carries a high risk of mortality from causes other than HIV. If the AFASS criteria cannot be met, mothers should be encouraged to exclusively breastfeed and ensure that their infants completely adhere to the antiretroviral prophylaxis because they decrease the rate of vertical HIV-1 transmission.
AFRIKAANSE OPSOMMING: MIV besmetting veroorsaak ‘n groot struikelblok vir borsvoeding, omdat dit die mees algemene manier is waarop babas met MIV besmet word. Eklusiewe borsvoeding is as die mees effektiewe intervensie ontdek in die voorkoming van moeder na kind oordrag van MIV, morbiditeit en die bevordering van MIV vrye oorlewing. Die hoofdoelwit is om die effektiwiteit van eksklusiewe borsvoeding teenoor formule-voeding en of gemengde voeding in die voorkoming van MIV oordrag van moeder na kind te evalueer. Elektroniese navorsing is gedoen deur gebruik te maak van PUBMED/MEDLINE, CINAHL, CENTRAL en EMBASE databasisse. Elektroniese joernale wat die Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health insluit, is ook gebruik. Handnavorsing is ook gedoen, asook relevante data van kenners op die gebied, is verkry. Geen beperking is geplaas op taal of tyd nie. Studies op babas wat blootgestel is aan die MIV-1 (moeder MIV positief gedurende swangerskap en borsvoeding) is in die oorsig oorweeg. Hierdie babas is eksklusief vir 6 maande gerborsvoed, met of sonder anti-retrovirale behandeling, en is vergelyk met eksklusiewe formule-voeding. Die resultaat was dat almal tot op 24 maande gemeet is aan MIV besmetting, mortaliteit en MIV vrye oorlewing. Twee resensente het onafhanklik artikels geselekteer wat aan die ingeslote kriteria voldoen het. Hulle het onafhanklik data geselekteer deur van ’n selekteringsinstrument gebruik te maak. Misverstande is deur besprekings opgelos. Data was daarna gemeet en gemetaanaliseer deur Rev Man 5.1.0. Die metadologiese kwaliteit van elk proeflopie is geassesseer deur die resensente wat gebruik gemaak het van die Cochrane evalueringsinstrument om die risiko van onewewigtigheid uit te skakel. Twee ewekansige kliniese proewe en een intervensie kohort studie (n = 2112 babas) wat eksklusiewe borsvoeding vergelyk met 'n eksklusiewe formule-voeding is ingesluit. MIVinfeksie wat verband hou met 'n eksklusiewe borsvoeding is vergelyk met eksklusiewe formule-voeding (risiko verhouding van 1.67, 95% CI 1.26 tot 2,23, p=0.0005). Eksklusiewe formule-voeding hou verband met 'n hoë mortaliteit van infeksies met ’n risiko verhouding van 0.67, 95% CI 0.43 tot 0.83, p = 0.52, Chi ² = 1.30, p = 0.52, I ² = 0%. Daar is geen statisties beduidende verskille in MIV-vrye oorlewing tussen eksklusiewe borsvoeding en eksklusiewe formule-voeding nie wat deur die proefnemers gemeet is op 9, 18 en 24 maande (risiko verhouding 1.19, 95% CI, 0.92 tot 1.54, p = 0,19, Chi ² = 3,15, p = 0.21, I ² = 36% 3 studies, 1012 babas). Nie een van die ingeslote studies het verslag gedoen oor gemengde voeding nie. Algehele vermyding van borsvoeding is effektief in die voorkoming van Moeder na Kind oordrag van MIV. MIV-infeksie gedurende borsvoeding mag ’n aanduiding van gemengde voeding en swak nakoming wees. Formule voeding is alleenlik van toepassing in situasies waar formule-melk toeganklik, uitvoerbaar, veilig en volhoubaar is, want formule-voeding dra ’n hoë risiko van mortaliteit weens ander oorsake buiten MIV. Indien daar nie aan hierdie kriteria voldoen kan word nie, behoort moeders aangemoedig te word om eksklusief te borsvoed en seker te maak dat hulle babas die antiretrovirale profilaksie getrou neem, want dit verlaag die koers van vertikale MIV-1 oordrag.
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Ikeakanam, Ottilie Tangeni Omuwa. "Infant feeding practices in the prevention of mother to child transmission in Onandjokwe district hospital, Namibia." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17794.
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Thesis (MCur)--Stellenbosch University, 2011.ENGLISH ABSTRACT: The impact of infant feeding practices in the prevention of mother-to-childtransmission of HIV raised concerns in the field of health services. Breast feeding adds an additional 15-30% risk of HIV transmission to the infant; therefore, mothers who are HIV-positive are in need of information regarding safe infant feeding. A descriptive design for this particular study was applied with a primary quantitative approach. A convenient sample of sixty (n=60) participants between the ages of 15 – 37 were taken from subjects that enrolled in the prevention of mother-to-child transmission (PMTCT) programme in Onandjokwe district. The sample formed 85% of the target population (N=71). A structured questionnaire with closed and openended questions was used and completed by the researcher. Ethical approval for the study was obtained from the Ethics Committee at the Faculty of Health Sciences, University of Stellenbosch. Permission to conduct the research was obtained from the Ministry of Health and Social Services, Namibia, and the Onandjokwe district Hospital. A pilot study was conducted that constituted 25% of the sample. Validity and reliability was insured by the pilot study and the consultation of an expert in HIV research and an expert in nursing research. The presentation of results was mostly descriptive in nature by using frequency tables and a pie chart. The results showed that all participants (n=60/100%) were offered HIV counselling and testing during antenatal care. Mothers who were HIV positive knew that there is a possibility that the baby might be infected through breast milk. Furthermore, the study found that 70% (n=42) of participants used breast feeding exclusively, 20% (n=12) used replacement feeding and 10% (n=6) used mixed feeding practices. It was concluded that pregnant women and mothers known to be HIV-infected should be informed of the infant feeding practice recommended by the national or subnational authority to improve HIV-free survival of HIV-exposed infants. This includes information about the risks and benefits of various infant feeding options based on local assessments and guidance in selecting the most suitable option for their own situation.
AFRIKAANSE OPSOMMING: Die invloed van voedingspraktyke vir babas by die voorkoming van moeder-na-kindoordrag van die menslike immuungebrekvirus (MIV) het kommer op die gebied van gesondheidsdienste laat ontstaan. Borsvoeding dra ’n addisionele 15–30% risiko van MIV-oordrag tot die baba by en daarom benodig moeders wat MIV-positief is inligting ten opsigte van veilige voeding van hulle babas. 'n Beskrywende ontwerp vir hierdie besondere studie is gebruik tesame met 'n primêr kwantitatiewe benadering. 'n Gerieflikheidsteekproef van sestig (n=60) deelnemers tussen die ouderdomme 15–37 jaar is gekies uit persone wat ingeskryf het vir die voorkoming van moeder-na-kind-oordrag (VMNKO) program in Onandjokwe-distrik. Die steekproef het 85% van die teikenpopulasie (N=71) uitgemaak. 'n Gestruktureerde vraelys met geslote en oop vrae is gebruik en deur die navorser voltooi. Etiese goedkeuring vir die studie is verkry van die Etiese Kommitee van die Fakulteit Gesondheidswetenskappe, Universiteit Stellenbosch. Toestemming om die navorsing te doen, is verkry van die Ministerie van Gesondheid en Maatskaplike Dienste, Namibië, en die Onandjokwe Distrikshospitaal. 'n Loodsstudie is onderneem wat 25% van die steekproef behels het. Geldigheid en betroubaarheid is verseker deur die loodsstudie en oorlegpleging met 'n kundige op die gebied van MIV-navorsing en 'n kundige in verpleegnavorsing. Die aanbieding van resultate was meestal deskriptief van aard deur van frekwensietabelle en 'n sektordiagram gebruik te maak. Die resultate het getoon dat MIV-berading en -toetsing gedurende voorgeboortesorg aan alle deelnemers (n=60/100%) aangebied is. Moeders wat MIV-positief is, het geweet dat daar 'n moontlikheid bestaan dat die baba moontlik deur moedersmelk geïnfekteer kan word. Verder het die studie bevind dat 70% (n=42) van deelnemers uitsluitlik borsvoeding gebruik, 20% (n=12) gebruik ’n vervanging vir moedersmelk en 10% (n=6) gebruik gemengde voedingspraktyke. Daar is tot die slotsom gekom dat swanger vroue en moeders van wie bekend is dat hulle MIV-geïnfekteer is, ingelig behoort te word oor die babavoedingspraktyk aanbeveel deur die nasionale of subnasionale owerheid vir die verbetering van MIVvrye oorlewing van babas wat aan die MIV blootgestel is. Dit sluit in inligting oor die risiko’s en voordele van verskeie babavoedingsopsies gebaseer op plaaslike assesserings en leiding ten opsigte van die kies van die geskikste opsie vir hulle eie situasie.
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Gourlay, A. "Improving the usage of prevention of mother-to-child transmission of HIV services in rural Tanzania." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2101870/.
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This thesis aims to investigate the use of prevention of mother-to-child transmission (PMTCT) of HIV services in rural Tanzania. Paper A, a systematic literature review of barriers and facilitating factors to the uptake of antiretroviral drugs for PMTCT in sub-Saharan Africa, identified many influencing factors at the level of individuals, their communities and health systems. Paper B discusses the challenges, including lack of unique identification numbers, associated with using routine clinic data for monitoring PMTCT programmes in Africa. Papers C and D use clinic data linked to community HIV cohort data to describe community-level access to PMTCT services among HIVpositive pregnant women. Paper C documented low, but increasing, coverage with PMTCT services in 2005-2012, with weaknesses throughout the PMTCT service continuum. Paper D identified women from remote areas, younger women, and unmarried women as less likely to access PMTCT services. Voluntary counselling and HIV testing before pregnancy, longer duration of HIV-infection, and more recent pregnancies were associated with improved PMTCT service use. Paper E critiques the use of a vignette within a qualitative investigation of barriers to PMTCT service uptake, suggesting that vignettes can be used successfully in rural Africa to draw out barriers to PMTCT service use. The qualitative analysis for paper F revealed a pivotal role for patient-provider interactions in PMTCT service use, through decision-making processes, trust, and features of care. The collective findings highlight the considerable barriers to uptake of PMTCT services that must be tackled in order to successfully eliminate new paediatric HIV infections. Potential positive impacts of ‘Option B+’ (initiating all HIV-positive pregnant women onto life-long antiretroviral therapy) may be limited by these barriers. Addressing health systems issues, particularly stock-outs of HIV test kits, drugs and delivery materials, and improving patient-provider relationships, may have the greatest immediate impact on PMTCT service use in this setting.
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Chopra, Mickey. "Prevention of Mother to Child Transmission of HIV in Africa : Operational Research to Reduce Post-natal Transmission and Infant Mortality." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-9331.
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This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda . Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites. The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5). With respect to HIV and infant feeding most health workers across the four countries (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made. This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.
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Jenkins, Lorna Elizabeth. "Mother- to - Child Transmission of HIV and congenital syphilis: A snapshot of an Epidemic in the Republic of Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4692.
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ABSTRACT
Background: Worldwide HIV is going through a feminization and rejuvenation as more women are living with HIV/AIDS, increasing the risk of vertical transmission. Despite the efforts in Latin America and the Caribbean (LAC) by 2010, Panama was the third most affected country in the region with HIV/AIDS, with females aged 15-24 twice as affected as men.
Methods: This descriptive epidemiological study of HIV vertical transmission in Panama reviewed clinical charts to identify health care personnel's practices during pregnancies in 2008. This study also examines the impact of interventions comparing the HIV outcome of the children at the end of the 18-month follow-up period (March 2011).
Results: This study found 290 clinical charts; 116 from women and girls living with HIV who were pregnant in 2008 and 174 clinical charts of prenatally exposed children to HIV in 2008. During pregnancy, 58.05% of the mothers received HAART, and 68.39% received intravenous zidovudine during labor. The 81.03% of the children received oral zidovudine six weeks after birth, and 54.02% were fed with infant-adapted formula. During the follow-up period 12.64% of children studied were diagnosed as HIV positive and 36.36% of those children had an older seropositive sibling.
Discussion: The Republic of Panama has made efforts to prevent vertical HIV transmission. The current study shows early interventions such as receiving HAART during pregnancy, intravenous zidovudine during labor, caesarean section birth, receiving oral zidovudine six weeks after birth, and feeding with infant-adapted formula that show statistical significance when compared to final diagnosis of the prenatally exposed children to HIV.
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Gazimbi, Marufu. "Integrated HIV and maternal/reproductive health service utilization : trajectory for prevention of mother to child transmission of HIV in Zimbabwe." Thesis, University of Hull, 2018. http://hydra.hull.ac.uk/resources/hull:16534.
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Background: The persistent high mortality related to HIV infection in sub-Saharan Africa has prompted calls for scaling-up access to sexual and reproductive health services including family planning as a trajectory to prevent HIV infection. Thus, HIV prevention programs have been integrated into family planning and reproductive health care services as a means to reach out to men and women who are HIV positive and those who are vulnerable to HIV infection. While the rationale for integration of HIV and reproductive health (RH) services is strong, there is paucity of information on which population groups most utilize these services. Due to the considerable stigma attached to HIV/AIDS, people living with HIV and those who perceive themselves to be at risk of HIV infection may be less likely to use integrated health care services. This thesis aims to inform policy and programs on better integration of HIV testing, maternal health care, and family planning services in order to optimize HIV prevention programs such as prevention of mother to child HIV transmission and condom use with the broader aim to reduce the HIV pandemic. Objectives: Focusing on individual and community-level predisposing, enabling and perceived need factors (PREP), the specific objectives of the study are to: (i) examine the effects of HIV on reproductive health care services; (ii) identify the determinants of HIV testing, antenatal and delivery care services; (iii) examine contraceptive methods choice among women who know their HIV-sero status; and (iv) establish community-level variation in service utilization. Data and Methods: The study applied multilevel binary and multinomial logistic regression models to nationally-representative samples of women and men who participated in the 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys. Results: Overall, those who were ever tested for HIV and with low HIV stigma were more likely to use maternal health services than their counterparts who had never been tested or with high HIV stigma. These groups were also more likely to use condoms and long-term contraceptive methods as a means to prevent both unwanted pregnancies and HIV infection. The results from the analysis of HIV testing showed an evidence of improvement in HIV testing uptake between 2005/6 and 2010/11, especially for women. Most individual level socio-economic and demographic factors associated with HIV testing are largely consistent with patterns in Southern Africa (e.g higher uptake by women and those who are wealthier), but important patterns have also emerged. In particular, results reveal notable gender differences in the determinants of HIV testing: rural residence is associated with lower uptake of HIV testing for women but higher for men; for women, average wealth in a community is a more important factor in enabling HIV testing than household wealth, but the converse is true for men; individual-level, rather than community-level stigma is important for women, while for men, it is community-level stigma that is important. The analysis of determinants of maternal health care shows that use of antenatal and delivery care services in Zimbabwe are improving and are determined by a wide range of individual-level factors relating to women’s economic and demographic status as well as HIV factors relating to stigma, HIV awareness, ever been tested for HIV during pregnancy, knowing someone who died due to HIV, and factors relating to availability and access to health care and media within the community. The individual-level enabling factors that were particularly strong for women included high socio-economic status and not having observed HIV stigmatisation and discrimination. These groups of individuals have an extremely high likelihood of having been ever tested for HIV during pregnancy, or having an early or more than four ANC visits; and have delivered their babies in a health institution with a professional delivery attendant, particularly if they live in richer communities or in communities with low stigma and HIV prevalence. The analysis of determinants of contraceptive methods choice among women who know their HIV status identified a number of potential pathways of the determinants of this outcome. The analysis revealed that women who know their HIV-positive status were more likely to use condoms and long-term methods than those who know their HIV-negative status. The study also revealed that even though wealth status has no direct effect on the choice of contraceptive methods, it has an indirect impact on the choice of condom versus hormonal methods through intermediate factors such as HIV sero-status. Conclusions: First, the observed gender disparities in determinants of HIV testing calls for a gender specific response. Couple-oriented HIV counselling and testing services where men accompany their spouses to HIV screening during pregnancy may help increase HIV testing uptake for males and reduce gender disparities. Second, the fact that enabling factors such as socioeconomic status, having been tested for HIV as part of ANC and stigmatization are predictors of maternal health care utilization suggests that being wealthier, having been HIV tested during pregnancy; and having low HIV stigma do translate into expected behavior for pregnant women. Third, knowing own HIV status emerges as a major predictor of condom use and long-term contraceptive methods for women who are HIV positive. These findings have important policy and integrated programme implications for addressing unmet need for HIV and RH services in Zimbabwe.
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Staflin, Emma, and Jennie Lundkvist. "Nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding : A qualitative study." Thesis, Linköpings universitet, Omvårdnad, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-76743.
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Introduction: HIV is a serious problem in Namibia, 13.1% of the adult population is HIV-positive or is a carrier of AIDS. This is one of the highest numbers in the world. HIV is passed from mother to child during pregnancy, during labour or through breast milk. 18.8 % of the pregnant mothers in Namibia who is in contact with the maternity welfare have HIV. Aim: The aim of the study was to describe nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding. Method: Eight nurses working with PMTCT of HIV were interviewed in Namibia. The interviews were transcribed and a content analysis was made. 18 sub-categories and seven categories were found. Findings: It is important that nurses provide individual counseling, are supportive and motivate the mothers. Poverty is an obstacle for the mothers, stigmatization occurs and cultural differences can have influence on the mothers. It is also important that nurses are updated in counseling and PMTCT. Conclusion: Nurses should provide mothers with the correct information in a pedagogical way. Nurses need to be aware of obstacles for the mothers and their families to be able to meet their different demands. Men are not involved in PMTCT-counseling and nurses think that partner involvement would benefit PMTCT of HIV.