Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study

Dlama Nggida Rasmussen*, Holger Werner Unger, Morten Bjerregaard-Andersen, David Da Silva Té, Noel Vieira, Inés Oliveira, Bo Langhoff Hønge, Sanne Jespersen, Margarida Alfredo Gomes, Peter Aaby, Christian Wejse, Morten Sodemann

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Background The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. Objectives To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. Methods We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ2 test. Results Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). Conclusions Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.

OriginalsprogEngelsk
Artikelnummere0199819
TidsskriftPLOS ONE
Vol/bind13
Udgave nummer8
Antal sider15
ISSN1932-6203
DOI
StatusUdgivet - 2018

Fingeraftryk

Guinea-Bissau
cross-sectional studies
Cross-Sectional Studies
Mothers
HIV
Testing
testing
Health
low educational status
Educational Status
Maternal Mortality
World Health Organization
pregnant women
Screening
Pregnant Women
management systems
Personnel
morbidity
labor

Citer dette

Rasmussen, Dlama Nggida ; Unger, Holger Werner ; Bjerregaard-Andersen, Morten ; Da Silva Té, David ; Vieira, Noel ; Oliveira, Inés ; Hønge, Bo Langhoff ; Jespersen, Sanne ; Gomes, Margarida Alfredo ; Aaby, Peter ; Wejse, Christian ; Sodemann, Morten. / Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau : A retrospective cross-sectional study. I: PLOS ONE. 2018 ; Bind 13, Nr. 8.
@article{03caeb7396754d299afaa950ce558167,
title = "Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study",
abstract = "Background The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. Objectives To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Sim{\~a}o Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. Methods We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ2 test. Results Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6{\%} (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1{\%} (1,514/3973) in 2008 to 95.7{\%} (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50{\%} of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95{\%} CI 1.73–1.84), as was a lower educational status (APR 1.05; 95{\%} CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95{\%} CI 1.01–1.09) and on Sundays (APR 1.14; 95{\%} CI 1.07–1.22) and Mondays (APR 1.12; 95{\%} CI 1.05–1.19). Conclusions Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.",
keywords = "Adolescent, Adult, Counseling, Cross-Sectional Studies, Female, Guinea-Bissau/epidemiology, HIV Infections/diagnosis, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical/prevention & control, Pregnancy, Prenatal Care, Prevalence, Retrospective Studies, Young Adult",
author = "Rasmussen, {Dlama Nggida} and Unger, {Holger Werner} and Morten Bjerregaard-Andersen and {Da Silva T{\'e}}, David and Noel Vieira and In{\'e}s Oliveira and H{\o}nge, {Bo Langhoff} and Sanne Jespersen and Gomes, {Margarida Alfredo} and Peter Aaby and Christian Wejse and Morten Sodemann",
year = "2018",
doi = "10.1371/journal.pone.0199819",
language = "English",
volume = "13",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "8",

}

Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau : A retrospective cross-sectional study. / Rasmussen, Dlama Nggida; Unger, Holger Werner; Bjerregaard-Andersen, Morten; Da Silva Té, David; Vieira, Noel; Oliveira, Inés; Hønge, Bo Langhoff; Jespersen, Sanne; Gomes, Margarida Alfredo; Aaby, Peter; Wejse, Christian; Sodemann, Morten.

I: PLOS ONE, Bind 13, Nr. 8, e0199819, 2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau

T2 - A retrospective cross-sectional study

AU - Rasmussen, Dlama Nggida

AU - Unger, Holger Werner

AU - Bjerregaard-Andersen, Morten

AU - Da Silva Té, David

AU - Vieira, Noel

AU - Oliveira, Inés

AU - Hønge, Bo Langhoff

AU - Jespersen, Sanne

AU - Gomes, Margarida Alfredo

AU - Aaby, Peter

AU - Wejse, Christian

AU - Sodemann, Morten

PY - 2018

Y1 - 2018

N2 - Background The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. Objectives To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. Methods We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ2 test. Results Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). Conclusions Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.

AB - Background The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. Objectives To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. Methods We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson’s χ2 test. Results Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73–1.84), as was a lower educational status (APR 1.05; 95% CI 1.00–1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01–1.09) and on Sundays (APR 1.14; 95% CI 1.07–1.22) and Mondays (APR 1.12; 95% CI 1.05–1.19). Conclusions Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.

KW - Adolescent

KW - Adult

KW - Counseling

KW - Cross-Sectional Studies

KW - Female

KW - Guinea-Bissau/epidemiology

KW - HIV Infections/diagnosis

KW - Humans

KW - Infant, Newborn

KW - Infectious Disease Transmission, Vertical/prevention & control

KW - Pregnancy

KW - Prenatal Care

KW - Prevalence

KW - Retrospective Studies

KW - Young Adult

U2 - 10.1371/journal.pone.0199819

DO - 10.1371/journal.pone.0199819

M3 - Journal article

C2 - 30067793

AN - SCOPUS:85050967755

VL - 13

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 8

M1 - e0199819

ER -