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Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study

BACKGROUND: The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES: To assess the proportion of women approached and tested for...

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Autores principales: Rasmussen, Dlama Nggida, Unger, Holger Werner, Bjerregaard-Andersen, Morten, da Silva Té, David, Vieira, Noel, Oliveira, Inés, Hønge, Bo Langhoff, Jespersen, Sanne, Gomes, Margarida Alfredo, Aaby, Peter, Wejse, Christian, Sodemann, Morten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070169/
https://www.ncbi.nlm.nih.gov/pubmed/30067793
http://dx.doi.org/10.1371/journal.pone.0199819
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author Rasmussen, Dlama Nggida
Unger, Holger Werner
Bjerregaard-Andersen, Morten
da Silva Té, David
Vieira, Noel
Oliveira, Inés
Hønge, Bo Langhoff
Jespersen, Sanne
Gomes, Margarida Alfredo
Aaby, Peter
Wejse, Christian
Sodemann, Morten
author_facet Rasmussen, Dlama Nggida
Unger, Holger Werner
Bjerregaard-Andersen, Morten
da Silva Té, David
Vieira, Noel
Oliveira, Inés
Hønge, Bo Langhoff
Jespersen, Sanne
Gomes, Margarida Alfredo
Aaby, Peter
Wejse, Christian
Sodemann, Morten
author_sort Rasmussen, Dlama Nggida
collection PubMed
description BACKGROUND: The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES: To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. METHODS: We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ(2) test. RESULTS: Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). CONCLUSIONS: Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.
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spelling pubmed-60701692018-08-09 Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study Rasmussen, Dlama Nggida Unger, Holger Werner Bjerregaard-Andersen, Morten da Silva Té, David Vieira, Noel Oliveira, Inés Hønge, Bo Langhoff Jespersen, Sanne Gomes, Margarida Alfredo Aaby, Peter Wejse, Christian Sodemann, Morten PLoS One Research Article BACKGROUND: The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES: To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. METHODS: We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ(2) test. RESULTS: Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). CONCLUSIONS: Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience. Public Library of Science 2018-08-01 /pmc/articles/PMC6070169/ /pubmed/30067793 http://dx.doi.org/10.1371/journal.pone.0199819 Text en © 2018 Rasmussen et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rasmussen, Dlama Nggida
Unger, Holger Werner
Bjerregaard-Andersen, Morten
da Silva Té, David
Vieira, Noel
Oliveira, Inés
Hønge, Bo Langhoff
Jespersen, Sanne
Gomes, Margarida Alfredo
Aaby, Peter
Wejse, Christian
Sodemann, Morten
Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title_full Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title_fullStr Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title_full_unstemmed Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title_short Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study
title_sort political instability and supply-side barriers undermine the potential for high participation in hiv testing for the prevention of mother-to-child transmission in guinea-bissau: a retrospective cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070169/
https://www.ncbi.nlm.nih.gov/pubmed/30067793
http://dx.doi.org/10.1371/journal.pone.0199819
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