Factors Affecting the Implementation of Prevention of Mother to Child Transmission (PMTCT) Of Hiv In Tema General Hospital (TGH)

Abstract

Introduction: Mother-to-Child Transmission (MTCT) is the main source of HIV in children. In an attempt to curb this, the UNAIDS in the year 2009 called for the elimination of MTCT of HIV by the year 2015. Ghana began the implementation of PMTCT in the year 2001, using an intervention package made up of four prongs. Study Objectives: This study investigated the factors that affected the implementation of PMTCT of HIV in Tema General Hospital from 2012 – 2016. It also assessed the knowledge of PMTCT Service Providers regarding PMTCT intervention, and further identified the socio-cultural and economic factors that influenced the implementation of PMTCT in TGH. Methods: The study used both quantitative and qualitative methods. A review of folders of HIV positive pregnant women who attended the ART Clinic from January, 2012 – December 2016, an in-depth interview for PMTCT Service Providers in TGH and a focus group discussion for some current HIV positive nursing mothers in TGH were also used to obtain data. A quantitative data analysis was done using SPSS, STATA and EPI-DATA computer packages for windows. A qualitative data analysis was also done through a thematic analysis using NVivo. Results: The results from the data reviewed indicated that 5 (2.24%) of the exposed children born to the 223 HIV positive women whose data were reviewed were infected with the virus. As high as 81.2% of the participants adhered to the PMTCT program by attending clinic regularly, taking their ARVs as prescribed, and giving ARV prophylaxis to their babies as prescribed. The mothers involved in the focus group discussions demonstrated adequate knowledge in PMTCT practices. They also mentioned stigmatization, beliefs (including superstition and religion) and partner attitude as some of the socio-cultural factors that may have either positive or negative impact on adherence to PMTCT. The PMTCT Service Providers that were included in the in-depth interviews demonstrated an adequate level of knowledge by explaining the importance of PMTCT, the eligibility for PMTCT services, the exact time for PMTCT service initiation and the timelines for re-testing for HIV in all pregnant women who tested negative to the initial HIV test. They also knew of when to link-up HIV positive women to ART care. Conclusion: Factors such as clients’ adherence to appointment dates, type of gestation (singleton or twins) and administration of ARV prophylaxis to exposed infants were identified to have significant effect on the PCR results of exposed babies. Both PMTCT clients and Service Providers expressed adequate knowledge in the PMTCT program. Some of the identified challenges that hindered the PMTCT program included long waiting time between the PCR tests and delivery of test results, lack of training for Service Providers, heavy workload on Service Providers and some amount of stigmatization meted out to clients by friends and relatives.