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Association between service readiness and PMTCT cascade effectiveness : a 2018 cross-sectional analysis from Manica province, Mozambique

Association between service readiness and PMTCT cascade effectiveness : a 2018 cross-sectional analysis from Manica province, Mozambique


Title: Association between service readiness and PMTCT cascade effectiveness : a 2018 cross-sectional analysis from Manica province, Mozambique
Author: Dinis, Aneth
Augusto, Orvalho
Ásbjörnsdóttir, Kristjana H.
Crocker, Jonny
Gimbel, Sarah
Inguane, Celso
Ramiro, Isaías
Coutinho, Joana
Agostinho, Mery
Cruz, Emilia
... 9 more authors Show all authors
Date: 2022-11-28
Language: English
Scope: 1422
Department: Faculty of Medicine
Series: BMC Health Services Research; 22(1)
ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-022-08840-3
Subject: Early infant HIV diagnosis; HIV PCR testing; Mozambique; PMTCT; Service readiness; Vertical HIV transmission; Health Policy
URI: https://hdl.handle.net/20.500.11815/3893

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Citation:

Dinis , A , Augusto , O , Ásbjörnsdóttir , K H , Crocker , J , Gimbel , S , Inguane , C , Ramiro , I , Coutinho , J , Agostinho , M , Cruz , E , Amaral , F , Tavede , E , Isidoro , X , Sidat , Y , Nassiaca , R , Murgorgo , F , Cuembelo , F , Hazim , C E & Sherr , K 2022 , ' Association between service readiness and PMTCT cascade effectiveness : a 2018 cross-sectional analysis from Manica province, Mozambique ' , BMC Health Services Research , vol. 22 , no. 1 , 1422 , pp. 1422 . https://doi.org/10.1186/s12913-022-08840-3

Abstract:

Background: Despite high coverage of maternal and child health services in Mozambique, prevention of mother-to-child transmission of HIV (PMTCT) cascade outcomes remain sub-optimal. Delivery effectiveness is modified by health system preparedness. Identifying modifiable factors that impact quality of care and service uptake can inform strategies to improve the effectiveness of PMTCT programs. We estimated associations between facility-level modifiable health system readiness measures and three PMTCT outcomes: Early infant diagnosis (polymerase chain reaction (PCR) before 8 weeks of life), PCR ever (before or after 8 weeks), and positive PCR test result. Methods: A 2018 cross-sectional, facility-level survey was conducted in a sample of 36 health facilities covering all 12 districts in Manica province, central Mozambique, as part of a baseline assessment for the SAIA-SCALE trial (NCT03425136). Data on HIV testing outcomes among 3,427 exposed infants were abstracted from at-risk child service registries. Nine health system readiness measures were included in the analysis. Logistic regressions were used to estimate associations between readiness measures and pediatric HIV testing outcomes. Odds ratios (OR) and 95% confidence intervals (95%CI) are reported. Results: Forty-eight percent of HIV-exposed infants had a PCR test within 8 weeks of life, 69% had a PCR test ever, and 6% tested positive. Staffing levels, glove stockouts, and distance to the reference laboratory were positively associated with early PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.73 [95%CI: 1.24–2.40] and OR = 1.01 [95%CI: 1.00–1.01], respectively) and ever PCR (OR = 1.02 [95%CI: 1.01–1.02], OR = 1.80 [95%CI: 1.26–2.58] and OR = 1.01 [95%CI: 1.00–1.01], respectively). Catchment area size and multiple NGOs supporting PMTCT services were associated with early PCR testing OR = 1.02 [95%CI: 1.01–1.03] and OR = 0.54 [95%CI: 0.30–0.97], respectively). Facility type, stockout of prophylactic antiretrovirals, the presence of quality improvement programs and mothers’ support groups in the health facility were not associated with PCR testing. No significant associations with positive HIV diagnosis were found. Conclusion: Salient modifiable factors associated with HIV testing for exposed infants include staffing levels, NGO support, stockout of essential commodities and accessibility of reference laboratories. Our study provides insights into modifiable factors that could be targeted to improve PMTCT performance, particularly at small and rural facilities.

Description:

Funding Information: The research reported in this publication is supported by NICHD, NIAID, NCI, NIMH, NIDA, NHLBI, NIA of the National Institutes of Health under award numbers R01MH113435 and P30AI027757, and the Doris Duke Charitable Foundation’s African Health Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Doris Duke Charitable Foundation. Publisher Copyright: © 2022, The Author(s).

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