Health Facility Challenges to Nurse and Midwife-Led PMTCT and Pediatric HIV Services in Eastern and Southern Africa Public
MacKay, Rebecca (Spring 2018)
Published
Abstract
Background: In eastern and southern Africa, almost 20 million people are living with HIV/AIDS; of these, about 40% are not receiving antiretroviral therapy (ART).1 In response to challenges involving access to HIV services, one promising solution is to train and authorize nurses and midwives to routinely provide this care. Nurse-initiated and managed antiretroviral therapy (NIMART) is a form of task sharing in which nurses and midwives provide first-line ART and other HIV services. Little is known about the extent to which NIMART is being utilized, its effectiveness, and what challenges and opportunities it is presenting in health facilities. The purpose of this study was to identify perceived barriers to and facilitators of NIMART services in high volume, high-HIV burden health facilities – in relation to pregnant and breastfeeding women, HIV-exposed infants, and pediatric populations.
Methods: Questionnaires with health providers and in-depth interviews (IDIs) with clinical supervisors were conducted in select health facilities across 11 countries in eastern and southern Africa. Questionnaires were analyzed with descriptive statistics and qualitative methods were used to evaluate the IDIs. Results were then triangulated to elicit a more comprehensive understanding of perceptions about NIMART practice.
Results: In this study, 211 providers and 62 clinical supervisors participated across 30 health facilities. On average, providers had 10.33% higher positive responses for in-service training than pre-service training, supervisors in 9 countries identified strengthening in-service training as a desired facilitator. Supervisors in 6 countries identified supportive supervision and clinical mentorship as a challenge, supervisors in 8 countries wanted to improve it, and it received the highest percentage of negative responses by providers (PBFW=33.8%; HEI=35.8%; Peds= 41.7%). Pediatric HIV services consistently received more negative responses as compared to PBFW or HEI.
Discussion: Findings are consistent with other studies concluding that supportive supervision and clinical mentorship are barriers to NIMART services. Limited pre-service training and continuing professional development impact the effectiveness of care provision. The lack of competence in pediatric HIV care provision is likely due to lack of pre-service training or continuing professional development for midwives and nurse-midwives. A standardized NIMART training is recommended for PMTCT and pediatric HIV service providers.
Table of Contents
CHAPTER 1: Introduction 1
BACKGROUND OF THE PROBLEM 1
AFRICAN HEALTH PROFESSIONALS REGIONAL COLLABORATIVE 2
STATEMENT OF THE PROBLEM 3
PURPOSE OF THE STUDY 4
SIGNIFICANCE STATEMENT 5
DEFINITION OF TERMS 6
CHAPTER 2: Review of the Literature 7
INTRODUCTION 7
GLOBAL TARGETS FOR HIV REDUCTION 8
HIV IN EASTERN AND SOUTHERN AFRICA: PROGRESS, CHALLENGES, AND STRATEGIES FOR ACHIEVING HIV TARGETS 16
SUMMARY OF MAIN PROBLEM AND STUDY RELEVANCE 25
CHAPTER 3: Manuscript 28
ABSTRACT 29
INTRODUCTION 30
METHODS 35
RESULTS 39
DISCUSSION 44
REFERENCES 47
TABLES AND FIGURES 49
CHAPTER 4: Conclusion 54
DISCUSSION 54
RECOMMENDATIONS 57
THESIS REFERENCES 60
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