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Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi
Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE’s) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retentio...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357126/ https://www.ncbi.nlm.nih.gov/pubmed/34379657 http://dx.doi.org/10.1371/journal.pone.0255788 |
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author | Kays, Megan Woelk, Godfrey Callahan, Tegan Katirayi, Leila Montandon, Michele Chauwa, Felluna Laterra, Anne Sampathkumar, Veena Kayira, Dumbani Kalua, Thokozani Kazemi, Erin Hoffman, Heather Modi, Surbhi |
author_facet | Kays, Megan Woelk, Godfrey Callahan, Tegan Katirayi, Leila Montandon, Michele Chauwa, Felluna Laterra, Anne Sampathkumar, Veena Kayira, Dumbani Kalua, Thokozani Kazemi, Erin Hoffman, Heather Modi, Surbhi |
author_sort | Kays, Megan |
collection | PubMed |
description | Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE’s) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes. |
format | Online Article Text |
id | pubmed-8357126 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-83571262021-08-12 Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi Kays, Megan Woelk, Godfrey Callahan, Tegan Katirayi, Leila Montandon, Michele Chauwa, Felluna Laterra, Anne Sampathkumar, Veena Kayira, Dumbani Kalua, Thokozani Kazemi, Erin Hoffman, Heather Modi, Surbhi PLoS One Research Article Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE’s) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes. Public Library of Science 2021-08-11 /pmc/articles/PMC8357126/ /pubmed/34379657 http://dx.doi.org/10.1371/journal.pone.0255788 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Kays, Megan Woelk, Godfrey Callahan, Tegan Katirayi, Leila Montandon, Michele Chauwa, Felluna Laterra, Anne Sampathkumar, Veena Kayira, Dumbani Kalua, Thokozani Kazemi, Erin Hoffman, Heather Modi, Surbhi Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title | Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title_full | Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title_fullStr | Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title_full_unstemmed | Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title_short | Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi |
title_sort | evaluating the effect of a community score card among pregnant and breastfeeding women living with hiv in two districts in malawi |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357126/ https://www.ncbi.nlm.nih.gov/pubmed/34379657 http://dx.doi.org/10.1371/journal.pone.0255788 |
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