Access and quality of services in the prevention of mothers to child transmission of HIV in public health institutions in Thika district, Kenya
PMTCT of HIV has become an important intervention for prevention and control of HIV and AIDS in developing countries. MTCT is the most significant source of HIV infection in children below the age of 15 years, with approximately 2.5 million living with HIV and AIDS worldwide. Sub-Sahara Africa contributes 2.2 million of those living with HIV and AIDS globally. The prevalence rate of HIV in adults aged 15-49 years was estimated at 5.1 % in Kenya in 2006 and in pregnant women attending ANC clinics in Thika district stood at 5%. Public health facilities are challenged to adequately offer PMTCT services due to various constraints leading to loss of intervention opportunities which contribute to the high prevalence of HIV and AIDS in children. The objectives of this study were to determine the level of access and quality of PMTCT services and factors that influenced both in Thika District. The study population comprised of women of child bearing age (15-49 years) attending MCH clinics who were interviewed at the exit. Quantitative data was collected using structured face to face interview schedule and questionnaire and qualitative data through observation checklist, FGDs and key informant interviews. SPSS and MS Excel computer softwares were used to manage data. Descriptive statistics was used and computation of derived values used in data analysis. PMTCT of HIV services are accessed through attending ANC clinics, visiting a VCT centre, at the maternity, and CCC. In the study, distance from home to health facilities was not associated with antenatal clinic attendance (x2 =.728; df =1; p>0.05). No relationship was established between clinic attendance and testing (x2 =1.370; df =1; p>0.05) and frequency of attendance and testing (x2=2.980; df =1; p>0.05). Uptake of testing was higher in urban than in rural health facilities (x2=14.436; df =3; p<0.05).Younger clients (1524) were more receptive to testing than older clients (x2=8.546; df =2; p<0.05). ARV prophylaxis is a core intervention in PMTCT of HIV. Nevirapine was the only ARV being offered to infected mothers and infants at health facilities in the district during the study period beside cotrimoxazole for prevention of OIs. Occasional shortages were reported. Breastfeeding is a proved mode of MTCT of HIV. Respondents who reported breast problems and were breastfeeding were (19) 54.3%. The HIV infected were less likely to breastfeed (x2=34.942; df =1; p<0.05) and were more likely to practice exclusive replacement feeding as compared to the uninfected women (x2=52.721; df =2; p<0.05). All study sites offered free FP services and resources were available. Any effective FP method together with the condom is recommended for the HIV infected. In this study, FP method use was found to be influenced by marital status and occupation. Those married adopted FP method use more than others (x2=39.059; df =4; p<0.05) and professionals used FP methods more than others. Knowledge of where to find PLWHA support groups was higher in those who were visited by a health worker or a PLWHA since delivery (x2=8.109; df =1; p<0.05). Women who had involved their spouses in VCT highly influenced them to seek for these services (x2 =67.156; df =2; p<0.05) and were more likely to know where to seek for emotional support (x2= 4.846; df =1; p<0.05). Overall access to services was 16.7% and quality 12.5%. Consistent, sustainable availability of basic resources and standardized and knowledge based provision of care and follow up services underlined the quality of PMTCT of HIV services. Conclusions point to the need for policy and practical interventions that focus on enhancing access and quality of these services. The results from this study will assist policy makers, service providers and the wider community in scaling up PMTCT of HIV services for greater access and better quality.