Background The human immunodeficiency virus (HIV) is a leading cause of death among women during pregnancy and the postpartum period, especially in areas of high prevalence. In 2018 there were approximately 1.3 million pregnant women living with HIV globally.Infants born to women living with HIV are at increased risk of contracting HIV as the virus can be transmitted to the foetus/ infant during pregnancy, labour, delivery and breastfeeding, posing a serious risk to their survival and well-being. Viral load (VL) testing of pregnant women living with HIV could contribute to improved care, thereby reducing the risk of vertical transmission of HIV from the mother to her infant. Aim The objective of this study was to describe HIV VL testing amongst pregnant women living with HIV at entry into the prevention-of-mother-to-child-transmission (PMTCT) services at selected health facilities in Mutare district of Manicaland Province, Zimbabwe from January to December 2018. Methods This descriptive cross-sectional mixed methods study evaluated the uptake of HIV VL testing amongst pregnant women living with HIV at entry into the prevention-of-mother-to-child transmission (PMTCT) services at 15 health facilities and explored factors that influence the provision of HIV VL testing services. Results Among 383 pregnant women living with HIV enrolled in antenatal care (ANC) and known to be on antiretroviral therapy (ART), only 121 (32%) had a VL sample collected and 106 (88%) received their results. Among these 106 women, 93 (88%) had a VL< 1, 000 copies/mL and 77 (73%) had a VL< 50 copies/mL. The overall median duration from ANC booking to VL sample collection was 87 (IQR, 7-215) days. The duration was significantly longer among pregnant women newly started on ART [207 (IQR, 99-299) days] compared to those already on ART [50 (IQR, 0-162) days], p< 0.001. The median time interval for the return of VL results from date of sample collection was 14 (IQR, 7-30) days. There was no significant difference when this variable was stratified by time of ART initiation. Viral load samples were significantly less likely to be collected at local authority facilities compared to government facilities [aOR=0.28; 95% CI: 0.16- 0.48]. Barriers for VL testing identified by health care providers included staff shortages, nonavailability of consumables and laboratory forms and weaknesses in sample transportation. Additionally, the turnaround time (TAT) was long as VL testing was centralised at the provincial hospital, and results feedback was not done electronically. High levels of knowledge among health care providers (75%) did not translate into high HIV VL testing coverage amongst pregnant women living with HIV. Conclusions and recommendations The low rate of HIV VL testing among pregnant women living with HIV in Mutare district is a cause of concern and needs to be addressed urgently in the interest of contributing to the eliminating mother to child transmission of HIV. The Ministry of Health should consider disseminating ARV and PMTCT guidelines and other policy documents using electronic platforms as these are more accessible and result in quicker dissemination, which may translate into faster implementation of new policies and policy updates. There is need to conduct regular mentorship and supervision processes and establish quality improvement initiatives for PMTCT services. Interventions like alert systems should be implemented for ease of identifying women who require HIV VL testing. Point of care technology and mHealth could reduce VL result turnaround time. All this should be aimed at ensuring that policies and guidelines are implemented, and targets are reached within agreed timeframes, to ensure that positive outcomes can be experienced by all pregnant women living with HIV.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/36036 |
| Date | 08 March 2022 |
| Creators | Musanhu, Christine Chiedza Chakanyuka |
| Contributors | Eley, Brian, Shea, Jawaya, Chitsike, Inam |
| Publisher | Faculty of Health Sciences, Department of Paediatrics and Child Health |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MPhil |
| Format | application/pdf |
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