A qualitative study to assess the determinants of and strategies for postpartum HIV-retesting among women who tested HIV negative antenatally in Thyolo district, Malawi, version 1.0
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Date
2022-07-05
Authors
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Publisher
Kamuzu University of Health Sciences
Abstract
Type of research study
This a qualitative study to assess the determinants of and strategies for postpartum HIV-retesting
among women who tested HIV negative antenatally in Thyolo district, Malawi.
The problem
In Malawi, Prevention of Mother to Child transmission of HIV (PMTCT) services focus on
an opt-out approach where a woman can opt out of a test rather than a mandatory approach. All
pregnant women are offered Human Immunodeficiency Virus (HIV) test at their first
antenatal care (ANC) visit then a repeat HIV testing at 3 months and during delivery if status is
unknown. However, detection of HIV infection in women in late pregnancy or the postpartum
period is uncommon as testing practices often focus on testing at the first antenatal visit and
postpartum mothers can “opt-out”. The National PMTCT program updates for 2020 reported that
36% of the new HIV infections among children during postpartum and breastfeeding were from
mothers who became HIV positive after testing HIV negative during antenatal period. There is
currently no Malawi Ministry of health (MOH) policy pertaining postpartum HIV retesting. This
study, therefore, aims to assess the factors that influence and strategies that would promote
postpartum HIV retesting in women who were HIV negative during the antenatal period.
Broad Objective: To assess the determinants of and strategies for HIV retesting among
postpartum mothers who had HIV negative status antenatally to reduce mother-to-child
transmission of HIV.
Specific Objectives
Identify the facilitators for HIV retesting among postpartum mothers with previous
negative HIV status.
Explore the barriers to HIV retesting among postpartum mothers with previous
negative HIV status.
Assess the health system strategies that can be put in place to scale up the uptake of
HIV retest among postpartum mothers.
Outline the strategies that postpartum mothers prefer to increase uptake of the HIV
retest.
Describe the strategies that service providers prefer to increase uptake of
postpartum HIV retest
Methodology
The study will use descriptive and ethnographic qualitative approaches. We intend to use
multiple data sources to ensure increased data collection hence we will use both Focus group
discussions and in depth interviews. Each focus group discussion will comprise 6-12 health
workers from various study facilities. About 30 participants will be interviewed among health
care workers and postnatal mothers in the selected health facilities in Thyolo. We plan to use 3
health facilities of Thyolo district hospital and two health centers, Bvumbwe and Thekerani,
these facilities were selected as they have a maternity wing. The decision to increase the sample
size will depend on data saturation as the study progresses. Ethnographically, we will employ
participant observations of health workers’ HIV testing service delivery in late pregnancy and
postpartum period; during discharge from the ward and at all the visits a woman makes during
the postnatal period.
Expected findings and their dissemination.
The findings will clarify the pathways for postpartum HIV services for the district to improve its
delivery and will determine a service delivery strategy that will be applied in another phase of
the study to improve testing in the postpartum period. The results will also inform policymakers
like the Malawi Ministry of Health and partners on evidence-based interventions to increase HIV
retesting in women thus contributing to the Sustainable development goals (SDG) 3 “ensuring
healthy lives and promoting well-being for all” by optimizing HIV retesting thereby reducing
HIV and AIDS-related morbidity and mortality in children. The research results will be
disseminated through conferences to stakeholders such as the Malawi Ministry of Health
Department of HIV and AIDS Unit, Thyolo District Health Office as well as College of
Medicine Research Ethics Committee (COMREC). The results will also summarized in policy
briefs and be presented at international research conferences and published in peer-reviewed
journals.
Description
Keywords
Retesting postpartum for HIV negative women