Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up Pre-meeting to the 20 th International AIDS Conference (AIDS 2014) Melbourne, Australia July 18-19, 2014 Challenges with retention of PMTCT clients in Uganda Dr Herbert Kadama Ministry of Health; Uganda
INTRODUCTION Uganda Located in East Africa, bordered by Kenya in the East, South Sudan in the North, DRC in East and Rwanda and Tanzania in the south Total area 236,040 sq km: land: 199,710 sq km, water: 36,330 sq km Approximately the size of Oregon state in USA Population: Approximately 35 million Population of reproductive age; 17.5 million Female 51%, Male 49% HIV prevalence 7.3% ; 8.2% in females and 6.4% males Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014
ESTIMATED BURDEN OF MTCT IN UGANDA (2013/14) Estimate of 1.75 M pregnancies Annually 8,2 % HIV + = 140,000 HIV infected pregnant women and same number of Exposed babies Without interventions, 30% of these mothers will infect their children with HIV 42,000 children infected with HIV, and up to 50% die before the first birthday and 75% by the third birthday Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014
CASCADE OF INTEGRATED PERINATAL PMTCT PROGRAM IN ANC Tudor Car L, Brusamento S, Elmoniry H, van Velthoven MHMMT, et al. (2013) The Uptake of Integrated Perinatal Prevention of Mother-to- Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review. PLoS ONE 8(3): e56550. doi:10.1371/journal.pone.0056550 Pre-meeting http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056550 to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014
CHALLENGES WITH RETENTION OF PMTCT CLIENTS (1) Patient related factors Patient related stigma associated with HIV infection Patient non disclosure to partner Side effects of the ARVs Pill burden Lack of transport to health facility Preference of Traditional Birth attendants Low knowledge among patients about importance of Post natal care Perceived low quality of health ser vices provided by some health facilities Long waiting time Lack of privacy and confidentiality Health system and facility related factors Lack of and poor dissemination of PMTCT guidelines, job aides and SOPs Stock out of HIV testing kits and ARV medicines No referral and linkage plan and tools for PMTCT mother baby pair Low numbers of health care workers especially in rural settings Heavy workload Limited space Poor organization of work place Long tur n-around time for DNA PCR and CD4 results Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014
TYPICAL ANC IN UGANDA
CHALLENGES WITH RETENTION OF PMTCT CLIENTS (2) Provider related factors Low knowledge and skills related HIV counseling and testing and adherence counseling Fear of teratogenic effects of ARV medicines especially efeverenz Heavy work load Poor attitude towards HIV positive mothers In-accurate and incomplete documentation of PMTCT indicators Untimely repor ting and poor forecasting of PMTCT medicines and commodities Community related factors Stigma and discrimination associated with HIV Weak and sometimes absent community support systems Cultural beliefs and practices that discourage mothers from delivering in health facilities Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014
ACKNOWLEDGEMENTS Finally my Acknowledgments to GOU, ICAP and all PMTCT stakeholders and you for listening to me Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up July 18-19, 2014