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Free Content High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting

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Abstract:

Summary Setting

Thyolo District Hospital, rural Malawi. Objectives

In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering ‘opt-out’ voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. Design

Cohort study. Methods

Review of routine antenatal, VCT and PMTCT registers. Results

Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95–97] were pre-test counselled, 2965 (95%, CI: 94–96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n = 646) was 358 (55%, CI: 51–59) by the 36-week antenatal visit, 440 (68%, CI: 64–71) by delivery, 450 (70%, CI: 66–73) by the first postnatal visit and 524 (81%, CI: 78–84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16–22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. Conclusions 

In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a ‘different way of acting’ if PMTCT is to be scaled up in our setting.

Keywords: Malawi; Voluntary counselling HIV-testing; nevirapine; prevention of mother-to-child HIV transmission; scaling-up

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2005.01526.x

Affiliations: 1: Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi 2: Médecins sans Frontières, Brussels Operational Center, Belgium 3: Thyolo District Health Services, Ministry of Health and Population, Thyolo, Malawi

Publication date: 2005-12-01

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