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International Journal for Equity in Health

, 15:5

Interventions in primary health care to improve outcome and equity in health

Abstract

BackgroundDespite global scale up of interventions for Preventing Mother to child HIV Transmissions PMTCT, there still remain high pediatric HIV infections, which result from unequal access in resource-constrained settings. Sub-Saharan Africa alone contributes more than 90 % of global Mother-to-Child Transmission MTCT burden. As part of efforts to address this, African countries including Ghana disproportionately contributing to MTCT burden were earmarked in 2009 for rapid PMTCT interventions scale-up within their primary care system for maternal and child health. In this study, we reviewed records in Ghana, on ANC registrants eligible for PMTCT services to describe regional disparities and national trends in key PMTCT indicators. We also assessed distribution of missed opportunities for testing pregnant women and treating those who are HIV positive across the country. Implications for scaling up HIV-related maternal and child health services to ensure equitable access and eliminate mother-to-child transmissions by 2015 are also discussed.

MethodsData for this review is National AIDS-STI Control Programme NACP regional disaggregated records on registered antenatal clinic ANC attendees across the country, who are also eligible to receive PMTCT services. These records cover a period of 3 years 2011–2013. Number of ANC registrants, utilization of HIV Testing and Counseling among ANC registrants, number of HIV positive pregnant women, and number of HIV positive pregnant women initiated on ARVs were extracted. Trends were examined by comparing these indicators over time 2011–2013 and across the ten administrative regions. Descriptive statistics were conducted on the dataset and presented in simple frequencies, proportions and percentages. These are used to determine gaps in utilization of PMTCT services. All analyses were conducted using Microsoft Excel 2010 version.

ResultsAlthough there was a decline in HIV prevalence among pregnant women, untested ANC registrants increased from 17 % in 2011 to 25 % in 2013. There were varying levels of missed opportunities for testing across the ten regions, which led to a total of 487,725 untested ANC clients during the period under review. In 2013, Greater Accra 31 %, Northern 27 % and Volta 48 % regions recorded high percentages of untested ANC clients. Overall, HIV positive pregnant women initiated onto ARVs remarkably increased from 57% 2011 to 82 % 2013, yet about a third 33 % of them in the Volta and Northern regions did not receive ARVs in 2013.

ConclusionsMissed opportunities to test pregnant women for HIV and also initiate those who are positive on ARVs across all the regions pose challenges to the quest to eliminate mother-to-child transmission of HIV in Ghana. For some regions these missed opportunities mimic previously observed gaps in continuous use of primary care for maternal and child health in those areas. Increased national and regional efforts aimed at improving maternal and child healthcare delivery, as well as HIV-related care, is paramount for ensuring equitable access across the country.

KeywordsHIV prevalence mother-to-child HIV transmission HIV testing Antiretroviral therapy Ghana AbbreviationsANCantenatal clinic

ARV-ARTanti-retroviral therapy

CHPScommunity based health planning services

GACGhana AIDS Commission

HTCHIV testing and counseling

MNCHmaternal, neonatal and child health

MTCTmother to child transmission

NACPNational AIDS-STI Control Programme

PMTCTpreventing mother to child hiv transmission

WHOWorld Health Organization

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Autor: P. Dako-Gyeke - B. Dornoo - S. Ayisi Addo - M. Atuahene - N. A. Addo - A. E. Yawson

Fuente: https://link.springer.com/







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