High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.

Hdl Handle:
http://hdl.handle.net/10144/17663
Title:
High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.
Authors:
Manzi, M; Zachariah, R; Teck, R; Buhendwa, L; Kazima, J; Bakali, E; Firmenich, P; Humblet, P
Journal:
Tropical Medicine & International Health
Abstract:
SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS: In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.
Affiliation:
Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi. m.manzi@belgacom.net
Publisher:
Wiley-Blackwell
Issue Date:
Dec-2005
URI:
http://hdl.handle.net/10144/17663
DOI:
10.1111/j.1365-3156.2005.01526.x
PubMed ID:
16359404
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorManzi, M-
dc.contributor.authorZachariah, R-
dc.contributor.authorTeck, R-
dc.contributor.authorBuhendwa, L-
dc.contributor.authorKazima, J-
dc.contributor.authorBakali, E-
dc.contributor.authorFirmenich, P-
dc.contributor.authorHumblet, P-
dc.date.accessioned2008-02-07T11:34:51Z-
dc.date.available2008-02-07T11:34:51Z-
dc.date.issued2005-12-
dc.identifier.citationHigh acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. 2005, 10 (12):1242-50 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid16359404-
dc.identifier.doi10.1111/j.1365-3156.2005.01526.x-
dc.identifier.urihttp://hdl.handle.net/10144/17663-
dc.description.abstractSETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS: In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAdulten
dc.subject.meshCohort Studiesen
dc.subject.meshCounselingen
dc.subject.meshDelivery, Obstetricen
dc.subject.meshDisease Transmission, Verticalen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV Seropositivityen
dc.subject.meshHumansen
dc.subject.meshMalawien
dc.subject.meshPatient Acceptance of Health Careen
dc.subject.meshPostnatal Careen
dc.subject.meshPregnancyen
dc.subject.meshPregnancy Complications, Infectiousen
dc.subject.meshRural Healthen
dc.titleHigh acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.en
dc.contributor.departmentMédecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi. m.manzi@belgacom.neten
dc.identifier.journalTropical Medicine & International Healthen

Related articles on PubMed

All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.