Increasing uptake for PMTCT-EID services in a rural setting. A case of Kamuli district, Uganda
Access to PMTCT services in Kamuli district has been a challenge despite the high HIV prevalence of 12.3% among pregnant women. For the past 12 years only the two Hospitals (of the 15 health facilities) offered PMTCT services with very limited counseling services, health workers barely knew what was involved in delivery of a complete package of PMTCT services, and the single dose Niverapine recommended at the time was not readily available.
In order to bridge the gaps and in line with WHO guidance for elimination of mother to child transmission of HIV, the district quality improvement team with support from the ‘Strengthening TB, and HIV Responses in East-Central Uganda’ program embarked on strengthening PMTCT services within Kamuli district beginning April 2010. Operationally, this involved; (i) engaging expert HIV positive mothers who work closely with health workers to counsel, and physically escort mothers to various care points, (ii) establishing coaching and mentorships for health workers in implementation of PMTCT services and appropriate management of PMTCT logistics, (iii) use of PMTCT quality improvement indicators to measure performance of various facilities, (iv) establishment of PMTCT family support groups and finally (v) training health workers in PMTCT guidelines.
Comparison of data before and during this PMTCT strengthening process shows a remarkable improvement. 90% of the health workers at the various levels of health care in the district have trained in PMTCT-EID guidelines. A total of 15 health facilities (up from 2 of 2000) including hospitals, health centre IVs, IIIs and one HC II offer PMTCT services. Enrolment of HIV positive pregnant women onto prophylactic ARVs significantly increased to 90%. Similarly ART eligibility assessment of these mothers, and infant ARV prophylaxis significantly increased from 15% to 74% and 64% to 90%, respectively and all PMTCT facilities experienced zero stock outs of PMTCT drugs for the past one year.
Prevention of mother to child transmission of HIV is a dynamic and complex intervention, but can easily be improved if there are combined efforts from the various stakeholders.