Assessing prevalence and determinants of routine viral load  monitoring among pregnant and breastfeeding women on first line antiretroviral therapy at  Dedza District Hospital.

Chinthola, Wellings

Assessing prevalence and determinants of routine viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy at Dedza District Hospital.

Date

2021-07-15

Authors

Chinthola, Wellings

Publisher

Kamuzu University of Health Sciences

Abstract

Study type: This will be a descriptive quantitative cross-sectional study. Background Increased maternal viral load poses a serious health risk of mother to child transmission of HIV and increased morbidity and mortality to both pregnant and breastfeeding women. As part of prevention of mother to child transmission of HIV, both WHO and UNAIDS recommend vial load monitoring to all eligible client on ART at six months, 12 months and then every 12 months thereafter if the patient is stable on ART. Viral load monitoring plays a pivotal role in assessing treatment outcome, early detection of treatment failure and determining treatment failure. Currently, Malawi is using 4th edition of clinical management of HIV in adults and children of 2018. This is being used hand in hand with 2019 policy updates addendum to the 4th edition which came into force from April, 2019. The updated guidelines on routine monitoring of viral load recommends viral load testing at six months after starting ART, at 12 months and then every 12 months from the last test if the patient is stable on ART. This is different from the previous edition that was recommending routine monitoring of viral load at 6 months, 2years, 4yrs and then every 2years from the previous test. Problem Dedza District Hospital is one of the facilities that offers a wide range of ART and PMTCT services. It is estimated that more than 800 women are enrolled in PMTCT programme annually. Despite the reported positive progress on the increased number of pregnant and breastfeeding women enrolled in PMTCT programme at the facility, there is insufficient evidence suggesting the extent of routine viral load monitoring implementation and factors influencing it following introduction of 2019 new guidelines. This therefore calls for urgent need for a research to establish the magnitude of routine viral load monitoring among PMTCT women. Objectives The main objective of the study is to assess prevalence and determinants of Viral Load Monitoring among HIV Positive Pregnant Women on First Line Antiretroviral Therapy in Dedza District. The specific objectives include;  To establish social demographic characteristics of HIV positive pregnant and breastfeeding women receiving PMTCT services at Dedza district hospital  To ascertain the proportion of pregnant and breastfeeding women receiving routine viral load monitoring.  To determine factors associated with viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy Methodology A quantitative cross sectional design will be used on randomly selected master cards of clients enrolled in PMTCT from April 2019 to April 2020. Data will be collected using a structured data collection sheet and will be organized on a spread sheet for cleaning before actual analysis using Statistical Package for the Social Sciences (SPSS) version 20. Strength of association will be measured using odds ratio and 95% confidence intervals and the p-value <0.05 will be set for statistical significance. Expected findings This study is expected to reveal the prevalence of routine viral load monitoring among pregnant and breastfeeding women at Dedza district hospital and factors that determine it. Dissemination of results The results of this study will be disseminated at Kamuzu College of Nursing Research Conference. Copies will be sent to Dedza District Hospital where study will be conducted, Kamuzu College of Nursing Library where the researcher is pursuing his studies, College of Medicine Research Ethics Committee (COMREC) where ethical clearance will be obtained and all research supervisors who are providing academic support. Relevant findings of this study will also be sent for possible publication in peer-review journals through KCN.