Background
Methods
Study setting
HIV testing of study participants
Study design and data collection procedures
Quantitative data
Inclusion criteria
Qualitative data
Quality control
Measures
Data analysis
Results
Quantitative findings
Variables | Frequency (N=647) | % |
---|---|---|
Mother | ||
Age in yearsa | ||
≤15 years | 3 | 0.6 |
16 – 24 | 194 | 36.6 |
25 -34 | 294 | 55.5 |
35 – 44 | 37 | 7.0 |
≥45 | 2 | 0.4 |
Marital status | ||
Married | 456 | 70.5 |
Separated/Divorced | 57 | 8.8 |
Single | 60 | 9.3 |
Widowed | 12 | 1.9 |
Not documented | 62 | 9.6 |
Facility level | ||
HC III | 334 | 51.6 |
HC IV | 64 | 9.9 |
Hospital | 249 | 38.5 |
Entry care point | ||
IPD | 19 | 2.9 |
MCH | 307 | 47.5 |
Maternity | 27 | 4.2 |
OPD | 167 | 25.8 |
Not documented | 62 | 9.6 |
Others | 65 | 10.1 |
Use of ART before pregnancy | ||
Yes | 67 | 10.4 |
No | 580 | 89.6 |
WHO Stage at enrollmenta | ||
I | 409 | 68.7 |
II | 121 | 20.3 |
III | 62 | 10.4 |
IV | 3 | 0.5 |
CD4 at enrolment | ||
Average CD4 (78 Observations ) | 473 | NA |
Pregnancy status at ART start | ||
Pregnant | 381 | 58.9 |
Lactating | 122 | 18.9 |
None | 28 | 4.3 |
Not documented | 116 | 17.9 |
Infant characteristics | ||
Age at registration (in months)a | ||
<1 month | 101 | 15.9 |
1 – 6 months | 460 | 72.6 |
7 – 12 months | 42 | 6.6 |
13 – 18 months | 22 | 3.5 |
≥19 months | 9 | 1.4 |
Sexa | ||
Female | 347 | 53.7 |
Male | 299 | 46.3 |
Place of delivery | ||
Health facility-Public & PNFP | 468 | 72.3 |
Outside health facility | 73 | 11.3 |
Private clinics | 49 | 7.6 |
Unknown | 57 | 8.8 |
Mode of delivery | ||
Cesarean section | 81 | 12.5 |
Normal vaginal delivery | 496 | 76.7 |
Vacuum delivery | 2 | 0.3 |
Not documented | 68 | 10.5 |
HIV Prevalence among exposed infants
Variables | N = 493 | HIV+ve (n) | Prevalence |
---|---|---|---|
Overall prevalence | 493 | 32 | 6.5 |
Name of health facility | |||
Bishop Masereka HC III | 30 | 1 | 3.3 |
Bwera Hospital | 111 | 4 | 3.6 |
Hima HC III | 43 | 5 | 11.6 |
Kagando Hospital | 22 | 3 | 13.6 |
Kasanga PHC | 54 | 5 | 9.3 |
Kasese Town Council | 72 | 2 | 2.8 |
Katwe HC III | 17 | 2 | 11.8 |
Kilembe Mines Hospital | 60 | 2 | 3.3 |
Rukoki HC III | 39 | 3 | 7.7 |
St.Paul HC IV | 45 | 5 | 11.1 |
Marital status | |||
Married | 347 | 17 | 4.9 |
Separated/Divorced | 45 | 4 | 8.9 |
Single | 47 | 7 | 14.9 |
Widowed | 9 | 0 | 0.0 |
Not documented | 45 | 4 | 8.9 |
Entry care point | |||
IPD | 16 | 1 | 6.3 |
MCH | 224 | 9 | 6.3 |
Maternity | 22 | 1 | 4.6 |
OPD | 136 | 9 | 6.6 |
Not documented | 50 | 8 | 16.0 |
Others | 45 | 4 | 8.9 |
Level of facility | |||
HC III | 254 | 18 | 7.1 |
HC IV | 47 | 5 | 10.6 |
Hospital | 192 | 9 | 4.7 |
Place of delivery | |||
Health facility-Public & PNFP | 368 | 11 | 3.0 |
Outside health facility | 54 | 5 | 9.3 |
Private clinics | 34 | 5 | 14.7 |
Caretaker did not know | 37 | 11 | 29.7 |
Mode of delivery | |||
Cesarean section | 67 | 0 | 0.0 |
Normal virginal delivery | 372 | 24 | 6.5 |
Vacuum delivery | 2 | 1 | 50.0 |
Not documented | 52 | 7 | 13.5 |
Factors associated with HIV positive sero-status
Maternal factors
Characteristics | Number | Positive | Un adjusted OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value AOR |
---|---|---|---|---|---|---|
Place of delivery | ||||||
Health facility-Public & PNFP | 368 | 11 | 1 | |||
Outside health facility | 91 | 16 | 6.9(3.089-15.517) | <0.001* | 5.1(1.038-24.742) | 0.045* |
Private clinics | 34 | 5 | 5.9(1.820-17.198) | 0.003 | ||
ART Adherencea | ||||||
Good | 367 | 18 | 1 | |||
Fair | 28 | 1 | 0.72(0.092 - 5.585) | 0.752 | ||
Poor | 28 | 4 | 3.23(1.013-10.304) | 0.047 | 4.5(0.411-49.398) | 0.218 |
WHO staging at enrollmenta | ||||||
I | 311 | 19 | 1 | |||
II | 94 | 7 | 1.23(0.503-3.038) | 0.64 | ||
III | 44 | 3 | 1.12(0.319-3.97) | 0.85 | ||
IV | 2 | 0 | ||||
Gestation age at ART/prophylaxisa | ||||||
1st trimester:1 – 12weeks | 26 | 1 | 1 | |||
2nd trimester:13 – 28weeks | 78 | 1 | 0.3(0.019-5.383) | 0.432 | ||
3rd trimester: 29 -40weeks | 35 | 2 | 1.5(0.129-17.664) | 0.74 | ||
Duration on ART before delivery | ||||||
>6 months | 155 | 1 | 1 | |||
<6 months | 192 | 7 | 5.7 (0.688 - 46.423) | 0.107 | 4.1(0.471-35.775) | 0.201 |
Mother care status at child final testing | ||||||
Active on treatment /Referrals | 391 | 22 | 1 | 1 | ||
Dead/Lost | 28 | 5 | 3.6 (1.265 - 10.508) | 0.017* | ||
Missed appointment/Stopped treatment | 41 | 2 | 0.8 (0.194 - 3.796) | 0.842 | 2.4(0.401-14.448) | 0.336 |
Information not documented | 30 | 3 | 1.7 (0.474 - 5.927) | 0.422 | ||
Appointments kepta | ||||||
Yes | 347 | 17 | 1 | |||
No | 106 | 8 | 1.5 (0.663 - 3.782) | 0.300 | ||
CD4a | ||||||
<350 | 38 | 2 | 1 | |||
350 - 499 | 12 | 1 | 1.6 (0.135 - 19.808) | 0.699 | ||
>500 cells | 25 | 3 | 2.5 (0.379 - 15.864) | 0.346 | ||
Treatment supportera | ||||||
Yes | 360 | 24 | 1 | |||
No | 57 | 1 | 0.3 (0.033 - 1.885) | 0.179 | ||
Not documented | 48 | 2 | 0.6 (0.139 - 2.66.0) | 0.509 | ||
Linkage to home based care | ||||||
Yes | 179 | 12 | 1 | |||
No | 111 | 5 | 0.65 (0.224 - 1.916) | 0.441 | ||
Not documented | 179 | 11 | 0.9 (0.391 - 2.122) | 0.829 |
Infant factors
Characteristics | Number | Positive | Unadjusted OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value AOR |
---|---|---|---|---|---|---|
Age at registration (in months) | ||||||
<7months | 428 | 17 | 1 | 1 | ||
7- 12 months | 34 | 9 | 8.7 (3.527 - 21.476) | <0.001 | 2.5 (0.704 – 9.140) | 0.154 |
>13 months | 24 | 6 | 8.1(2.838 - 22.880) | <0.001* | 2.9 (0.772 – 11.153) | 0.114 |
Not documented | 7 | 0 | ||||
Infant ARVs for prophylaxis | ||||||
Received any form of ART at birth | 370 | 9 | 1 | 1 | ||
No ARVs at birth | 92 | 17 | 9.1(3.904 – 21.173) | <0.001* | 4.9 (1.901 – 13.051) | 0.001* |
Unknown | 24 | 4 | 8.0 (2.273 – 28.307) | 0.001* | 4.8 (1.264 – 18.580) | 0.021* |
Not documented | 7 | 2 | 16.0 (2.738 – 94.024) | 0.002* | 11.7 (1.753 –77.689 | 0.011* |
Feeding methods at registration | ||||||
Exclusive breast feeding | 425 | 16 | 1 | 1 | ||
Replacement feeding | 5 | 1 | 6.3 (0.675 - 60. 481) | 0.106 | 7.9 (0.733 – 87.0187) | 0.088 |
Mixed feeding | 11 | 3 | 9.5 (2.322 - 39.570) | 0.002* | 3.4 (0.639 – 18.170) | 0.151 |
Complimentary feeding | 41 | 10 | 8.2 (3.453 - 19.689) | 0.000* | 1.8 (0. 511- 6.329) | 0.36 |
No longer breast feeding (NLB) | 9 | 2 | 7.3 (1.404 - 37.989) | 0.018* | 2.6 (0.031 - 0.412) | 0.311 |
Not documented | 2 | 0 |
Qualitative findings on health system factors affecting implementation of eMTCT services
Qualitative findings were derived from 20 KI interviews and 27 in-depth interviews (Table 5)
Methods | Category of participants | Number of interviews | Total number of participants |
---|---|---|---|
Key informant Interviews | Health workers at mother baby care point | 2 health workers for each facility | 20 |
In-depth interviews | Mothers of exposed infants receiving care and treatment at 10 health facilities | 2 mothers per facility for those in care and 1 mother among those who missed clinic visits | 27 mothers (20 active in care and 7 missed clinic appoints for ≥ 3months) |
What is not working well is that we are understaffed. So there is work overload (KI_ Rukoki HC III).
If mothers come when they have already delivered and not in the programme, some children are turning HIV positive on 1 st PCR (KI_Bwera hospital).
Family support meetings; not going on well. Mothers do not come as scheduled in the morning; others come early, others late (KI_II, Rukoki HC III).
We have very limited staff working on exposed infants and yet we are required to provide other services. At times you are allocated on the medical ward and when a mother of an exposed infant comes, you are expected to attend to her (KI_St.Paul HC IV).
Not well staffed. I work at EID alone. Does bleeding for viral load, CD4 sample collection, DBS collection and yet the lab would have a role in sample collection (KI_Bishop Masereka Medical Centre).
LCs and VHTs should be sensitized and facilitated to support eMTCT services (KI_Rukoki HC III).
There is need for motorcycles for health workers to do follow up on missed appointments or transport for follow up (KI_Kilembe hospital).
The service is good and I like it because I was well counseled and the councilors especially Janet and she gave me guidelines to follow while taking drugs. The Challenge is that I don’t know my blood group (IDI_Bishop Masereka Medical).
The services at this health facility are good because drugs are always available and health workers care about the patients (IDI _Hima HC III).
The services at this health centre are fine however, the challenge is that sometimes we lack Septrin (IDI _Kasese Municipal HC III).
People who knew me who come to that health facility were too many and I felt they would discover my status (IDI _Bishop Masereka Medical).
I chose Hima Health facility because it’s where I tested positive and it’s near my home (IDI_Hima HC III).
Because it is a government health facility and we get free drugs supplied by the government (IDI_Kasese municipal council HC III).
I failed to pick medicines when I was very sick and later on I was admitted to Kagando hospital which is near my parents. I now get drugs from Kagando hospital but I may come to Kasese when I get better (IDI_Kasese Municipal HC III).
I am working as a domestic worker and it is hard to leave and come for treatment (IDI_Bishop Masereka Medical Centre).
Domestic violence made me divorce and I moved far away from the health facility (KI_MunicipalHC III).
I got a job in Kamwenge and relocated. I couldn’t manage monthly visits from Kamwenge to Kasese. I am however getting treatment from Padre pio HC III (IDI_ Bishop Masereka Medical Centre).
I had gone home to give birth and get care from my mother. I will be coming soon to the hospital (IDI_Bwera hospital).
The services are good but the problem is with me the client who had failed to come to the facility (IDI_ Bishop Masereka Medical Centre).
The services are fair because sometimes drugs for other diseases like malaria, cough do get out of stock then we buy from drug shops (IDI_RukokiHC III).
Services are fair but time management by health workers is poor. They attend to patients up to late in the evening (IDI_Bwera Hospital).
We spend long time at the health facility without getting treatment while feeling hungry (IDI_Kasese Municipal HC III).
They ask for money and yet I was never asked for money at Bwera hospital while I was attending there (IDI_St Paul HC IV).
Health workers should be trained on time management since some clients miss taking drugs on the ART clinic day (IDI_Bwera Hospital).
Government should recruit enough health workers to help those seeking care and treatment at all government facilities (IDI_Municipal HC III).