Utilization of PMTCT services in Awassa Ethiopia

Abstract

Background- Mother to child transmission of HIV (MTCT) is the major source of HIV infection among children under the age of 15 years. For the prevention of MTCT (PMTCT) a package of services including HIV counselling and testing, provision of prophylactic antiretroviral (ARV) drugs for mothers and babies, safe delivery practices and infant feeding counselling is made available. The effectiveness of PMTCT program largely depends on utilization of prophylactic ARV drugs by the women and their babies. In resource poor settings Nevirapine (NVP) single dose given to women during labour and to babies within 72 hours of birth prove to reduce the MTCT by 41%. In Ethiopia the PMTCT program was first launched in 2003 and is being scaled up across the country. According to the 2006 WHO report only 3% of the women in need of prophylactic NVP received the drug and only 28.1% of women attending antenatal care where PMTCT services were offered enrolled into the PMTCT programs. The PMTCT program was launched in Awassa Health Centre in 2005 with an opt-in approach then shifted in to an opt-out approach since August 2006.Objective -To assess utilization of PMTCT services and to identify determinants of the PMTCT service utilization in Awassa town, EthiopiaMethod -A cross sectional triangulation study using both quantitative and qualitative methods was conducted from January to July 2006 and in September 2007. In the quantitative part 377 women who had been visited two antenatal clinics in the town participated in the survey when HIV testing was offered in an opt-in approach. A trained data collector did the survey using a pretested structured questionnaire. PMTCT registers found in Awassa Health Centre were reviewed to assess the changes in PMTCT service utilization before and after the introduction of an opt-out approach. Nineteen in-depth interviews with nurse/midwife counsellors working in eight VCT/PMTCT clinics were conducted in their respective work places. Twenty one exit interviews were conducted with women after posttest counselling in Awassa Health Centre. Participant observation was also conducted in Awassa Health Centre PMTCT site. The qualitative interviews were conducted by the principal investigator using prepared interview guides.Results- The PMTCT services utilization was 9.8% (37/377) among the survey participants'. PMTCT service utilization was independently associated with being attending antenatal care in Awassa Health Centre (OR 4.6, 95% CI 1.7-12.5), being aware of the availability of NVP for PMTCT (OR 4.3, 95% CI 1.4-12.8) and having more than one antenatal visits (OR 2.1, 95% CI 0.9-5.1). The VCT service utilization in non antenatal setting was 49.4% (163/340) and in 83.2 of the cases the women were tested together with their husband. VCT service utilization in non antenatal setting was independently associated with having discussion with husband about HIV testing before hand (OR 8.5, 95% CI 3.3-21.9) and husband ever tested for HIV (OR 28.1, 95% CI 13.8-57.4).The PMTCT registers revealed that among women who attended antenatal care in Awassa Health Centre only 9.7% got pretest counselling on PMTCT when the service was offered in an opt-in approach while 38.9% when the services was offered in an opt-out approach. Among the women who got pretest counselling 82.6% were actually tested during the opt-in approach and 98.8% during the opt-out approach. However,...