The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.
Int Health
; 10(1): 54-62, 2018 01 01.
Article
em En
| MEDLINE
| ID: mdl-29329386
ABSTRACT
Background:
Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti.Methods:
This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition.Results:
Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors.Conclusion:
Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Infecciosas na Gravidez
/
Cuidado Pré-Natal
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Infecções por HIV
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Transmissão Vertical de Doenças Infecciosas
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Antirretrovirais
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Instalações de Saúde
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Infant
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Newborn
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Pregnancy
País/Região como assunto:
Caribe
/
Haiti
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article