Stakeholder perceptions: a needs assessment of the PMTCT program in Guyana
S. Sayana1, C. Trout2, J. Chang3, O. Alleyne4, H. Bailey3, H. Khanlou3
1Aids Healthcare Foundation, Internal Medicine, Los Angeles, United States, 2Boston University School of Public Health, Boston, United States, 3Aids Healthcare Foundation, Los Angeles, United States, 4Management Sciences for Health, Georgetown, Guyana
Issues: Guyana has an HIV prevalence rate of 1.8%. The country's national goals in the prevention-of-mother-to-child-transmission (PMTCT) program are to offer HIV testing and counseling to 90% of pregnancies and deliveries and reduce the number of children born HIV positive to < 10% per year. This assessment was conducted to identify the key barriers to achieving these goals from the perspective of program implementers and to propose strategies to address them.
Description: 25 key informants were interviewed between June 17-July 1, 2009 in coastal and interior regions of Guyana. The assessment was conducted using a semi-structured interview-format and included 9 individual in-depth-interviews and 6 focus-group sessions. The key informants consisted of service-providers, regional and national policymakers including the Minister of Health of Guyana. The data was analyzed based on both the frequency of recurrent themes and their relative importance elicited from the informants.
Lessons learned: According to the stakeholders, almost all pregnant women attending Antenatal Care (ANC) [which is over 80% in Guyana] are counseled and accept HIV-testing. The level of success of the PMTCT-program is due to high political support and well-trained staff. Challenges include getting men tested and involved in ANC-PMTCT, access to family-planning for HIV-infected-mothers, stigma and discrimination, missed PMTCT opportunities when some women arrive late in labor, the inconvenience and cost of going to two sites for ANC and treatment. Lastly, PMTCT outreach services are lacking in rural areas when 24-hour counseling and testing is unavailable, creating missed opportunities for treatment.
Next steps: These findings support the need for integrated PMTCT-services and continued scale-up, especially in rural areas. Many of the challenges presented are not unique to Guyana and lessons learned from other settings can be adapted to this setting.
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