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    Apr 22, 2021
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    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.

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    Authors
    Manzi, M
    Zachariah, R
    Teck, R
    Buhendwa, L
    Kazima, J
    Bakali, E
    Firmenich, P
    Humblet, P
    Affiliation
    Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi. m.manzi@belgacom.net
    Issue Date
    2005-12
    
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    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.
    Publisher
    Wiley-Blackwell
    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
    ae974a485f413a2113503eed53cd6c53
    10.1111/j.1365-3156.2005.01526.x
    Scopus Count
    Collections
    HIV/AIDS

    entitlement

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