Implementation of Pmtct Option B+ In the Techiman Municipality: Client Satisfaction and Service Provider Challenges

Abstract

Background: Ghana including 20 other countries in 2009 were earmarked for rapid PMTCT interventions scale-up within their primary care system for maternal and child health. This intervention became operationalized in June 2015 with the introduction of the PMTCT option B+ where HIV-positive women are initiated on lifelong ARVs regardless of their CD4 count upon immediate diagnosis of HIV and infants born to HIV-positive women receive daily zidovudine (AZT) for the first 4–6 weeks of life. Objectives: To explore the socio-cultural, facility, and service related factors that influence implementation of PMTCT Option B+ in the Techiman Municipality. Methods: The study was a facility-based cross sectional study, which employed the mixed method approach. Qualitative and quantitative methods were used to interact with HIV positive women to find the socio-cultural, facility and service receipt factors that influenced client satisfaction whereas solely qualitative method was used to identify challenges service providers encountered under PMTCT Option B+. Results: HIV positive pregnant and nursing mothers as well as their service providers were involved in this study with their ages ranging from 17 years to 53 years. A little over 85 percent of the HIV positive women were less than 24 years with only 14.4 percent over 24 years. More than half (69.9%) were married with the remaining either separated, never married, cohabiting, divorced or widowed. Service providers included Medical Officers, Nurse midwives among others. Of other socio-demographic characteristics of respondents assessed, respondents‟ type of residence was statistically a significant predictor of client satisfaction (AOR: 3.256 95% CI. 1.556-6.813). None of the socio-cultural factors assessed was statistically significantly associated with client satisfaction. Facility and service related factors including waiting time (AOR: 0.151 95% CI. 0.066-0.347) and experience of stigma from service providers (AOR 0.070 95% CI. 0.007-0.731) made statistically significant difference with client satisfaction. Other facility and service related factors like medical tests carried out at the facility (AOR: 0.405 95% CI. 0.079-2.021), experience of side effects of medications (AOR: 1.844 CI 95% 0.861-3.951) and information given on medications (p<0.001) had associations with client satisfaction however they made no statistically significant difference with client satisfaction. Service provider challenges included heavy workload, shortage of operational logistics and high defaulter rates. Conclusion: Implementation of PMTCT Option B+ in the Techiman Municipality has seen milestones in areas of regular supply of medications, regular follow-up counseling, among others however the aspects of long wait time at the facility, stigma from service providers, inadequate infrastructure and other challenges dawdles. For service providers, heavy workload, client defaulting rates, challenges with operational logistics, inadequate training and workshops on PMTCT are still some challenges faced in the delivery of services under PMTCT Option B+ in the Techiman Municipality.