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High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.

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dc.contributor Médecins sans Frontières-Luxembourg, Thyolo district, Luxembourg, Malawi. m.manzi@belgacom.net
dc.creator Manzi, M
dc.creator Zachariah, R
dc.creator Teck, R
dc.creator Buhendwa, L
dc.creator Kazima, J
dc.creator Bakali, E
dc.creator Firmenich, P
dc.creator Humblet, P
dc.date 2005-12
dc.date.accessioned 2017-01-31T07:09:28Z
dc.date.available 2017-01-31T07:09:28Z
dc.identifier High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. 2005, 10 (12):1242-50 Trop. Med. Int. Health
dc.identifier 1360-2276
dc.identifier 16359404
dc.identifier 10.1111/j.1365-3156.2005.01526.x
dc.identifier http://hdl.handle.net/10144/17663
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/17663
dc.identifier Tropical Medicine & International Health
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/17663
dc.description SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS: In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting.
dc.language en
dc.publisher Wiley-Blackwell
dc.relation http://www.blackwell-synergy.com/loi/tmi
dc.rights Archived on this site with the kind permission of Wiley-Blackwell
dc.title High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.


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