Missed opportunities for implementation of national guidelines on HIV retesting in labour/delivery and postpartum at Pumwani maternity hospital.

Abstract

Introduction: Vertical transmission of HIV is still a major challenge in developing countries. Mother-to child- transmission (MTCT) makes up for 90% of HIV infections/disease in children(1). WHO and NASCOP/MOH Guidelines recommend HIV testing to be done at various time points (2). These guidelines are important because of the high rates of seroconversion at 6.8% noted during pregnancy which continues to pose a threat regardless of the progress of efficacious PMTCT regimes (3). Objective: This study aimed to determine proportion of cases of missed opportunities for HIV retesting guideline implementation in labour/delivery and post-partum and to evaluate Knowledge and attitudes among health care workers at Pumwani maternity hospital (PMH) of those guidelines. Methodology: This involved a mixed methods survey. Women with an initial HIV negative result in ANC were sampled at labour/postnatal ward and at six weeks postnatal review. They were interviewed on social demographic characteristics and whether they accessed a repeat HIV test. Purposive sampling was employed to identify HCWs. Quantitative data was analyzed using SPSS version 25.0. Rates of HIV retest uptake were computed as proportions. Descriptive statistics was utilized for the study population. Audio recordings were transcribed. The emergent themes were identified, noted and presented in tabular form using thematic analysis approach. Results: There were 242 women who participated in the interview.97 of whom were followed up at 6 weeks via a telephone interview. There were 170 women interviewed at labor ward. The retesting rate was 116(69.5%). Majority of the women 114(67.5%) lacked awareness of need for HIV retesting. Of the 97 women followed up at 6 weeks postpartum, 72(75%) were retested for HIV. Of the 15 HCWs who were interviewed, 14 (93.3%) had received HTS training. One theme arrived at was varied knowledge on repeat testing guidelines for HIV and the team relied on mentor mothers and PMTCT nurses for guideline implementation. Conclusion: According to our study, the HIV retesting rate at labour was fair at 69.5%, while the retesting rate at 6 weeks was slightly higher at 71.8%. Recommendations: HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for interventions aimed at HIV prevention. There is need to hold health care workers training and continuous education on HIV Testing Services