Abstract

Needs assessment of MSH PMTCT program in Haiti: stakeholder perceptions

C. Trout^1,2, F. Guillaume¹, P. Brunache¹, J. Pollock<sup>1

1</sup>Management Sciences for Health, Center for Health Services, Cambridge, United States, ²Boston University School of Public Health, Boston, United States

Background: 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, 2009).
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.
MSH 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.
The 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.