High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.
Trop Med Int Health
; 10(12): 1242-50, 2005 Dec.
Article
en En
| MEDLINE
| ID: mdl-16359404
ABSTRACT
SETTING:
Thyolo District Hospital, rural Malawi.OBJECTIVES:
In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district.DESIGN:
Cohort study.METHODS:
Review of routine antenatal, VCT and PMTCT registers.RESULTS:
Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI) 95-97] were pre-test counselled, 2965 (95%, CI 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI 51-59) by the 36-week antenatal visit, 440 (68%, CI 64-71) by delivery, 450 (70%, CI 66-73) by the first postnatal visit and 524 (81%, CI 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.CONCLUSIONS:
In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Complicaciones Infecciosas del Embarazo
/
Aceptación de la Atención de Salud
/
Infecciones por VIH
/
Transmisión Vertical de Enfermedad Infecciosa
/
Consejo
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
Aspecto:
Implementation_research
Límite:
Adult
/
Female
/
Humans
/
Pregnancy
País/Región como asunto:
Africa
Idioma:
En
Revista:
Trop Med Int Health
Asunto de la revista:
MEDICINA TROPICAL
/
SAUDE PUBLICA
Año:
2005
Tipo del documento:
Article
País de afiliación:
Malawi