Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, Côte d'Ivoire.

BACKGROUND: Cervical cancer incidence is high among women living with HIV due to high-risk HPV persistence in the cervix. In low-income countries, cervical cancer screening is based on visual inspection with acetic acid. Implementing human papilloma virus (HPV) screening through self-sampling could increase women's participation and screening performance. Our study aims to assess the preintervention acceptability of HPV screening among HIV-infected women in Abidjan, Côte d'Ivoire. METHODS: Applying the Health Belief Model theoretical framework, we collected qualitative data through in-depth interviews with 21 HIV-infected women treated in an HIV-dedicated clinic. Maximum variation sampling was used to achieve a diverse sample of women in terms of level of health literacy. Interviews were recorded and transcribed with the participants' consent. Data analysis was performed using NVivo 12. RESULTS: Screening acceptability relies on cervical cancer representations among women. Barriers were the fear of diagnosis and the associated stigma disregard for HIV-associated health conditions, poor knowledge of screening and insufficient resources for treatment. Fees removal, higher levels of knowledge about cervical cancer and of the role of HIV status in cancer were found to facilitate screening. Healthcare providers are obstacle removers by their trusting relationship with women and help navigating through the healthcare system. Self-confidence in self-sampling is low. CONCLUSIONS: Free access to cervical screening, communication strategies increasing cervical cancer knowledge and healthcare provider involvement will foster HPV screening. Knowledge gathered through this research is crucial for designing adequate HPV-based screening interventions for women living with HIV in this setting.

Assessment of clinical decision-making among healthcare professionals performing caesarean deliveries in Burkina Faso.

OBJECTIVE: To identify the factors associated with quality decision-making of healthcare professionals in managing complicated labour and delivery in referral hospitals of Burkina Faso. METHODS: We carried out a six-month observational cross-sectional study among 123 healthcare professionals performing caesareans in 22 hospitals. Clinical decision-making was evaluated using hypothetical patient vignettes framed around four main complications during labour and delivery and developed using guidelines validated by an expert committee. The results were used to generate a quality decision-making score. A multivariate linear regression analysis was used to identify the factors independently associated with the score. RESULTS: Out of 100, the mean ±â€¯SD quality decision-making score was 63.84 ±â€¯7.21 for midwives, 65.58 ±â€¯6.90 for general practitioners (GPs), and 71.94 ±â€¯6.70 for gynaecologist-obstetricians (p < 0.001). Quality decision-making score was higher among professionals with more than seven years' work experience and those with the highest level of professional qualification. Working in a service where partograms are regularly reviewed by peers dramatically increased the skills of professionals. CONCLUSION: The simple dissemination of written clinical guidelines is not sufficient to maintain high-quality decision-making among healthcare professionals in Burkina Faso. Midwives may have some better scores than GPs if duly retrained and supervised. Increasing in-service training and supervision of both junior staff and lower-qualified healthcare professionals might help to improve obstetric practices in referral hospitals of Burkina Faso.

Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal.

BACKGROUND: Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions. Poor quality obstetrical care contributes to high maternal mortality; however, poor care is often linked to insufficient hospital resources. One promising method to improve obstetrical care is maternal death review. With a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care. METHODS: The trial began with a pre-intervention year (2007), followed by two years of intervention activities and a post-intervention year. We measured obstetrical quality of care in the post-intervention year using a criterion-based clinical audit (CBCA). We collected data from 32 of the 46 trial hospitals (16 in each trial arm) and included 658 patients admitted to the maternity unit with a trial of labour. The CBCA questionnaire measured 5 dimensions of care- patient history, clinical examination, laboratory examination, delivery care and postpartum monitoring. We used adjusted mixed models to evaluate differences in CBCA scores by trial arms and examined how levels of hospital human and material resources affect quality of care differences associated with the intervention. RESULTS: For all women, the mean percentage of care criteria met was 66.3 (SD 13.5). There were significantly greater mean CBCA scores in women treated at intervention hospitals (68.2) compared to control hospitals (64.5). After adjustment, women treated at intervention sites had 5 points' greater scores than those at control sites. This difference was mostly attributable to greater clinical examination and post-partum monitoring scores. The association between the intervention and quality of care was the same, irrespective of the level of resources available to a hospital; however, as resources increased, so did quality of care scores in both arms of the trial.