Needs assessment of MSH PMTCT
program in Haiti: stakeholder perceptions
C. Trout1,2, F. Guillaume1, P. Brunache1, J. Pollock1
1Management Sciences for Health, Center for Health Services, Cambridge, United States, 2Boston University School of Public Health, Boston, United States
Over 150,000 pregnant women were tested for HIV between October 2008 and
September 2009 in Haiti:
(MESI database) approximately 50%. Eighty-five percent (85%) of Haitian women
have at least one (1) prenatal visit. (EMMUS - IV) UNAIDS estimates that 43% of
HIV-positive pregnant women in Haiti
receive prophylaxis for Prevention of Mother to Child Transmission (PMTCT). (UNAIDS/WHO,
Methods: In 2009, Management Sciences for
Health (MSH) conducted a needs-assessment to identify challenges to PMTCT in
its sites, where only 45% of pregnant women who tested HIV+ completed
prophylaxis (542/1,372). This included formal qualitative measures of perceptions
of PMTCT staff.
held guided focus groups with 33 PMTCT staff in five sites. The interview questionnaire was based on the
international literature on PMTCT. One
month later, 26 PMTCT staff from 24 MSH sites completed a written questionnaire
which was developed using the focus group results.
data was analyzed based on the frequency of recurrent themes and their relative
importance elicited from the informants.
Results: Almost all pregnant women attending Antenatal Care (ANC)
are counseled and accept HIV testing. (Program data showed that 49,196 of
52,865 ANC attendees < 93%> received HIV testing.) In some sites, long
waiting times are a barrier to women's receiving their test results. Stock-outs of PMTCT drugs were not a problem in any MSH sites. Costs of transportation were sited as a major
barrier to PMTCT uptake. Most births
occur at home and women rarely bring the newborn to receive prophylaxis. Few cueing and education materials exist to
ensure quality of “post-test” counseling. Lastly, many newly identified HIV+
pregnant women refuse to accept their status.
Conclusions: Support services (including transportation and psychosocial services)
are essential to support adherence to PMTCT among low-income HIV-positive
pregnant women. Improved support
services are being implemented in 2010.
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