Increasing the uptake of prevention of mother to-child transmission of HIV services in a resource-limited setting
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Date
2010
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Publisher
BMC Health Services Research
Abstract
Background: As in other resource limited settings, the Ministry of Health in Zambia is challenged to make
affordable and acceptable PMTCT interventions accessible and available. With a 14.3% HIV prevalence, the MOH
estimates over one million people are HIV positive in Zambia. Approximately 500,000 children are born annually in
Zambia and 40,000 acquire the infection vertically each year if no intervention is offered. This study sought to
review uptake of prevention of mother-to-child (PMTCT) services in a resource-limited setting following the
introduction of context-specific interventions.
Methods: Interventions to improve PMTCT uptake were introduced into 38 sites providing PMTCT services in
Zambia in July 2005. Baseline and follow up service data were collected on a monthly basis through September
2008. Data was checked for internal and external consistency using logic built into databases used for data
management. Data audits were conducted to determine accuracy and reliability. Trends were analyzed pre- and
post- intervention.
Results: Uptake among pregnant women increased across the 13 quarters (39 months) of observation, particularly
in the case of acceptance of counseling and HIV testing from 45% to 90% (p value = 0.00) in the first year and
99% by year 3 (p value = 0.00). Receipt of complete course of antiretroviral (ARV) prophylaxis increased from 29%
to 66% (p = 0.00) in the first year and 97% by year 3 (p value = 0.00). There was also significant improvement in
the percentage of HIV positive pregnant women referred for clinical care.
Conclusions: Uptake of PMTCT services in resource-limited settings can be improved by utilizing innovative
alternatives to mitigate the effects of human resource shortage such as by providing technical assistance and
mentorship beyond regular training courses, integrating PMTCT services into existing maternal and child health
structures, addressing information gaps, mobilizing traditional and opinion leaders and building strong relationships
with the government. These health system based approaches provide a sustainable improvement in the capacity
and uptake of services.
Description
Research Article
Keywords
HIV services, Zambia, prevention of mother-to-child (PMTCT) services