Premium
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
Author(s) -
Manzi M.,
Zachariah R.,
Teck R.,
Buhendwa L.,
Kazima J.,
Bakali E.,
Firmenich P.,
Humblet P.
Publication year - 2005
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2005.01526.x
Subject(s) - medicine , nevirapine , voluntary counseling and testing , pediatrics , cohort , population , pregnancy , confidence interval , obstetrics , human immunodeficiency virus (hiv) , family medicine , viral load , health facility , antiretroviral therapy , environmental health , health services , biology , genetics
Summary 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.