Student Number : 0209337V - MPH research report - School of Public Health - Faculty of Health Sciences / In this chapter, an overview of the global HIV/AIDS epidemic is done with particular reference to the magnitude of the problem in sub-Saharan Africa. Emphasis is laid on the Mother to Child Transmission of the virus and its prevention within the context of the general HIV/AIDS reduction programmes internationally. The peculiarity of the epidemic in Swaziland, and the general response of the Swaziland government are discussed and a focus placed on the PMTCT programme in the Raleigh Fitkin Memorial Hospital, Manzini, Swaziland. The existing published literature on PMTCT programmes world wide is reviewed. This was done by reviewing scientific journals, Pub med and relevant literature from the library. The Google website was used as an additional search engine; with the key words PMTCT, Swaziland, South Africa, WHO/UNAIDS. Additional information was gathered from the booklets on PMTCT and RFM hospital produced by the Ministry of Health and Social Welfare (MOHSW), Swaziland. The chapter is concluded with the aim and objectives of the study described in this report.

Thesis (MPH)--University of Limpopo,2009. / Background: Women living with HIV frequently report in the clinic with pregnancy despite their health status and knowledge of mother-to-child transmission HIV. This study assessed the level of knowledge of Prevention of Mother-to-Child Transmission (PMTCT) and the reasons for pregnancy among women on PMTCT in Serowe, Botswana. Objectives: The objectives of this study were to assess the level of knowledge of the PMTCT program and vertical transmission among HIV-positive women in Serowe; evaluate the reasons for pregnancy among HIV-positive pregnant women enrolled in the PMTCT program as well as describe the practices of family planning among these women in Serowe. Methodology: The study was a cross-sectional descriptive survey using qualitative method. Twenty six (26) participants attending PMTCT clinics at Serowe clinic, Nutrition clinic, and Kadimo clinic participated in the study between October and December 2008 after consenting to participate. Research assistants conducted in-depth interviews to collect socio-demographic data of the participants. Qualitative methods were used to collect data about the women’s level of understanding of the PMTCT program, reasons for falling pregnant, types and duration of their relationships with their partners and family planning practices. The interviews were conducted in the local language (Setswana) and then translated into English by the research assistant for transcribing. Their responses were audio taped. Results: The results indicated that most of pregnancies were unplanned. However, 26.9 % of participants said that they became pregnant because they desire to have another child. A number of participants ( 15.4%) indicated that they became pregnant because their partners wanted a child. Although all 26 participants had good knowledge and understanding of the family planning practices, but only 18 (69.2 %) had used the family planning methods before falling pregnant. The findings in this study revealed good social suport from the family members and the disclosure of HIV status was not a big issue to the participants. Majority of respondents (66.6%)) had good knowledge and understanding of the PMTCT program. One-third of the participants were single, ninety- six percentages of participants were unemployed, and about one-third of them live on less than 50 U$ dollars per month. Conclusion: As the desire to have children is usually perceived as a normal part of life for all women, including women living with HIV. Most women chose not to become pregnant after knowing their HIV status (HIV-positive) but the found themselves with unplanned pregnacy. The women with a procreative inclination were found to be more likely to choose to become pregnant which outweighed social support and personal health concerns. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, unemploment and poverty. Participants had good knowledge of PMTCT program. The use of family planning by participants was poor despiste their good knowledge about it

In this thesis, I focus on the health-seeking experiences of women diagnosed with HIV in a prevention of mother-to-child transmission (PMTCT) program in Lilongwe, Malawi. Based on ethnographic research, which included participant observation, in-depth interviews, and focus groups with women participating in the program, I explore women's motivations for HIV testing, capacity to engage in health interventions, and the meaning they give to life with HIV. While the PMTCT program is delivered at a local site, it is produced at a local-global intersection where local actors and international processes converge. I utilize critical approaches to medical anthropology to examine the global political and economic context of local life and the PMTCT program. The program is one where lives are at stake; where women learn of their HIV status, available medical interventions, and work to prolong their lives. Women engage in this program because nurses communicate messages of hope in the face of HIV. These messages are the new benefits of HIV in countries with growing opportunities for therapeutic intervention. This thesis contributes to an emerging health/social science literature that seeks to develop successful HIV interventions by focusing on patients ' experiences of HIV and HIV therapies newly available in Africa. Yet, as reported in this study, women experience barriers to the purported benefits because of the dominant health-delivery paradigm. Specifically, its verticality; human resources, counseling, and education limitations; and structural constraints that prevent women's full participation in the program. Successful PMTCT programs will need a more comprehensive approach to health and disease treatment, to provide more than just techno-medical solutions. Successful therapeutic interventions need to not only provide drugs, but also address other barriers to health maintenance. / Thesis / Doctor of Philosophy (PhD)

The reduction of disease burden in the context of mother-to-child HIV transmission in Nigeria invokes a multi-sectoral and multi-disciplinary approach, which incorporates using research evidence to promote relevant policies. Nurses as health workers play a central role in health sector responses to ameliorate disease burdens such as those affiliated with HIV. Situated within critical social theory and using theoretical perspectives on power, this qualitative study examines the extent of nurses' contributions to research production and policy development in mother-to-child HIV transmission in the Cross River State, Nigeria. The study was guided by four specific objectives: 1) to assess nurses’ knowledge of current global strategies; 2) to describe nurses’ contributions to research and policy development; 3) to identify issues that encourage or impede the involvement of nurses in research and policy development and ;4) to identify promising models to actively engage nurses in research and policy development. A case study approach and participatory action research methodologies facilitated a comprehensive examination of the extent of Nigerian nurses' research and policy involvement and provided collective action for change. Interviews, document reviews, and focus group discussions were methods utilized for data collection and validation of collected data. Four major themes emerged: intimate knowledge of healthcare, marginal involvement in knowledge creation, limited involvement in mother-to-child transmission (MCTC) policy decision making and going with the flow. The study findings revealed that the nurses had good knowledge of local/global HIV trends, MTCT ameliorating strategies, barriers to MTCT uptake, processes of mobilizing local strategies, and an in-depth understanding of the integral role of implementing partners and the nursing workforce in ameliorating the impact of HIV on mother and child. However, this intimate knowledge did not translate into knowledge creation through independent research productivity in this context. The study further revealed that nurses were mostly involved in data collection and validation of collected data, which was not leading to publications. Barriers to knowledge creation included individual or personal constraints, as well as institutional and systemic barriers. Solving this problem requires funding of research studies, building research capacity, mentoring, earmarking research grants for nurses, increasing budgetary allocations to research, creating research awareness, creating a stimulating research environment with computers and internet access, using research as a criterion for promotion, and providing incentives. The study also revealed the insignificant participation of nurses in policy decision making, with involvement limited to implementation of PMTCT policy. Barriers to nurses' involvement in decision-making emanated from individual and health care system constraints, and nurses' contributions to decision making can only be improved by educational upgrading, integrating policy courses into nursing curricula, mentoring, group advocacy, involvement in politics, and organizational restructuring. The study showed that nurses were generally complacent about their involvement in knowledge creation and policy development. They tended to move with the flow of events and were afraid to question the status quo. A tree animation nursing (TAN) model provided a promising model for change with four main components:1) university education, 2) strong nursing leadership, 3) the identification of barriers, 4) and envisioned solutions, all of which are necessary to enable nurses to actively engage in research productivity and policy formulation. University education is recommended as a prerequisite for all nurses, and policies that foster a culture of nursing research productivity and policy development should be promoted.

Background: Huge successes have been seen in the prevention of mother-to-child transmission of HIV (PMTCT) towards its elimination. Now amidst a landscape of universal antiretroviral therapy (ART), focus has been placed on different models of care to support and retain mother-infant pairs in the vulnerable postpartum phase. Methods The aim was to establish economic evidence for scaling-up approaches and models of care for PMTCT particularly during the postpartum period in Southern Africa. The economic data were collected during three studies, Safe Generations (Eswatini), MCH-ART and PACER (South Africa), using mixed bottom-up and top-down methodology. Outcomes of these studies were used to estimate the cost-effectiveness using an incremental cost effectiveness ratio (ICER, calculated by the difference in cost divided by the difference in effects) of lifelong ART in comparison to Option A (the standard of care at the time) in Eswatini; and to estimate the annual costs, costeffectiveness and budget impact of three models of care (Model I: Routine Care - mothers in general ART and infants in well-baby clinics; Model II: Integrated Care - mothers-infant pairs in integrated care in midwife obstetric unit; and Model III: Community Care - mothers in community adherence clubs and infants in well-baby clinics) in South Africa, from the provider and patient's perspectives. Costs are presented in 2019 United States Dollars (US $). Results Lifelong ART can be considered cost-effective in Eswatini with an ICER of US $984 per mother retained in care to six months postpartum. In Cape Town, South Africa, Routine Care cost US $226 per mother-infant pair per annum; Integrated Care cost US $341; and Community Care cost US $254. Annual patient costs (direct and indirect costs) for Models I-III, were US $30-55, US $23-45 and US $76 per mother-infant pair respectively. Comparatively Community Care was the most cost-effective model with an ICER of US $97 per mother-infant pair retained and mother virally suppressed. Scaling-up Community Care nationally in South Africa would require US $5 720 096 more than Routine Care, 0.2% of the total health budget for 2020/21. Conclusions This work has generated novel empirical data in the form of new cost estimates and cost comparisons across different models of care. It has also provided a unique comparison of the different models of care using a cost-effectiveness analysis; and further a novel budget impact analysis of different approaches to rolling these strategies out. This data has helped to fill the gap in the evidence base for instance lifelong ART was implemented in Eswatini as a direct result of the Safe Generations study findings. Community Care was found to be cost-effective and if scaled up nationally in South Africa would only require a small increment of the total health budget. However, we recommend a mixture of models of care to cater for the needs and preferences of patients. Decision makers can use the empirical findings to help set realistic budgets in Southern Africa and explore ideal model implementation to support mother-infant pairs in the crucial postpartum phase.

Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing high numbers of children living with HIV globally and among the 22 PMTCT global plan priority countries. Using a mixed methods approach this study examined enabling factors –individual, social and structural – that enhance utilization of and adherence to PMTCT services in a plural urban setting in Kenya. The study was conducted from October-December of 2012 at St. Mary’s Mission Hospital, Lang’ata. HIV-positive birthmothers whose infants were HIV-negative at the time of the study were purposively selected to participate. All informants completed an interviewer-administered questionnaire (n = 55) and a subset (n = 15) participated in in-depth interviews. Contrary to the assertions of multiple studies that failures of PMTCT programs are a result of inadequate knowledge of mother-to-child transmission and PMTCT interventions, lack of support and acceptance by family and community, as well as poor quality of services, this study found these factors to be statistically insignificant in explaining PMTCT achievements. The study further found that HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to apply acquired knowledge on mother-to-child transmission and PMTCT interventions, mobilize support from family and community, and access more affordable care. Factors found to influence women’s decisions to utilize and adhere to PMTCT services include supportive counseling, striving for motherhood, maternal attachment and concern for the child’s wellbeing, assurance of confidentiality and testimonials of other successful mothers. Based on the study findings, policy recommendations have been proposed along with suggestions for future research.

Since the implementation of the prevention of mother–to–child transmission of HIV program in South Africa in 2001, infant deaths due to HIV and AIDS have still remained high. HIV–exposed infants need to be taken for follow–up, schedule at six weeks, for PCR HIV testing. When the infant is found to be HIV–positive, the antiretroviral treatment is commenced for life (DOH, 2010). This benefits them in that the earlier they start treatment, the higher their quality of life and their life expectancy will be. Health workers face a problem in that there are still mothers of HIV–exposed infants who do not return their babies for the 6 weeks of age follow–up schedule and their babies therefore do not benefit from the treatment and care. The study looked at the reasons for the low follow–up of babies born to HIV–positive mothers according to HIV–positive mothers and nurses and counsellors and what strategies can be used by nurses and counsellors to encourage the mothers to bring their babies for follow–up. To answer these questions, qualitative, exploratory and contextual design was used. Purposive sampling was done with participants who had knowledge about the research problem. HIV–positive mothers were individually interviewed and nurses and counsellors were interviewed in a focus group. Five individual interviews and three focus group interviews were conducted. The focus groups were interviewed twice for each question mentioned. Responses were satisfactory with the following categories emerging from the findings: fear about disclosure, denial of status, insufficient knowledge about HIV, accusations about who is the actual “giver” of HIV and incongruent health education on HIV and AIDS and the management thereof in the case of babies with HIV, with specific reference to incorrect and/or insufficient information. Recommendations are made concerning these issues, so as to effect an increase in the follow–up of babies born to HIV–positive mothers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Since the implementation of the prevention of mother–to–child transmission of HIV program in South Africa in 2001, infant deaths due to HIV and AIDS have still remained high. HIV–exposed infants need to be taken for follow–up, schedule at six weeks, for PCR HIV testing. When the infant is found to be HIV–positive, the antiretroviral treatment is commenced for life (DOH, 2010). This benefits them in that the earlier they start treatment, the higher their quality of life and their life expectancy will be. Health workers face a problem in that there are still mothers of HIV–exposed infants who do not return their babies for the 6 weeks of age follow–up schedule and their babies therefore do not benefit from the treatment and care. The study looked at the reasons for the low follow–up of babies born to HIV–positive mothers according to HIV–positive mothers and nurses and counsellors and what strategies can be used by nurses and counsellors to encourage the mothers to bring their babies for follow–up. To answer these questions, qualitative, exploratory and contextual design was used. Purposive sampling was done with participants who had knowledge about the research problem. HIV–positive mothers were individually interviewed and nurses and counsellors were interviewed in a focus group. Five individual interviews and three focus group interviews were conducted. The focus groups were interviewed twice for each question mentioned. Responses were satisfactory with the following categories emerging from the findings: fear about disclosure, denial of status, insufficient knowledge about HIV, accusations about who is the actual “giver” of HIV and incongruent health education on HIV and AIDS and the management thereof in the case of babies with HIV, with specific reference to incorrect and/or insufficient information. Recommendations are made concerning these issues, so as to effect an increase in the follow–up of babies born to HIV–positive mothers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Background: The prevalence of cases of HIV among children below the ages of 15 years continues to increase and majority of these children acquired the infection through mother-to-child transmission. Methodology: The main objectives of the study were to explore the perceptions of local women regarding the PMTCT program, to evaluate the strength of these perceptions and to make recommendations. A qualitative method was used involving a number of focus group discussions among antenatal clinic attendees in the 27 primary health care clinics in Qwa-Qwa, Free State province of South Africa. Findings: The findings were organised under eight major themes: (1) Knowledge of the program -where the participants expressed high knowledge about the PMTCT program as they knew how MTCT of HIV occurs and how it can be prevented, (2) Perceived concerns about the program- which were mainly fear of resistance to ARVs, fear of stopping the treatment after delivery, potential for high numbers of orphans, depression and suicide when HIV result is positive, the fear of the family neglecting the baby if the mothers dies, the perception that the program cares for only the babies and not their mother, (3)Readiness to do HIV test- where majority of the participants said it was difficult doing the HIV test due to fear of positive result, (4) Ease of taking ARVs- Difficulty in taking the ARVs due to fear of resistance and harmful side effects, (5) Relationship with clinic staff- a majority of the participants were happy with their relationship with the clinic staff, (6) Reactions expected from family members when program advice is followed- more than half of the participants expected negative reactions from family members if the program advice is followed because of the negative attitudes of their male partners and the elders’ of the resistance to change from their cultural beliefs, (7) Advantages of the program- according to the focus group participants, the advantages of the program include the knowledge gained about HIV, modes of MTCT of HIV and how to prevent MTCT of HIV. Other advantages mentioned were prevention of MTCT of HIV, pre-test counselling reducing the fear of doing HIV test, knowing one’s HIV status as well as the potential of the program to have positive change on the cultural beliefs of the people, and lastly (8)How they felt being part of the program- where all the participants said they were excited . Conclusions: The findings were similar to those of other studies in many respects. Recommendations: The recommendations were community and family HIV/AIDS education and their involvement in the PMTCT program in other to reduce misconceptions about the disease, and stigmatization against the women in the program. Other recommendations include: the concept of PMTCT-plus which provides ongoing support and treatment for the mothers, babies and infected family members; integration of innovative health education and culturally appropriate interventions into the program; provision of adequate maternity leaves to women in the PMTCT program as well as full integration of the PMTCT program into the District Health System (DHS) as part of the “horizontal” delivered package.

Magister Public Health - MPH / Objective: The study aim was to measure the operational effectiveness of a single dose Nevirapine for PMTCT programme among infants aged six weeks in Khomas region of Namibia.Methods: This was a retrospective record review quantitative study based on a descriptive approach. The record review aimed at measuring operational effectiveness through the distribution of certain variables among HIV exposed infants including the socio economic variables such as age, sex and the breast feeding practices of their mothers. A total of 451 HIV positive mothers and their infant pairs` record registers were reviewed in two hospitals of Khomas region, Namibia.Results: A total of 451 PMTCT mothers’ records for the year 2007 (median age 29 years) were reviewed in the Katutura and Windhoek Central hospitals of Namibia.. The HIV prevalence among infants aged six weeks or more out of the total 167 tested was 5% (95%CI, 0.9 -3.7). Conclusion: The findings from this study shows that although the rate of PMTCT in tested infants was low, registers for maternity and infant follow up are extremely poorly completed with the vast amounts of missing information making it difficult to assess programme effectiveness and monitor programme outcomes. PMTCT programme registers and routine monitoring and evaluation data need to be strengthened.