Journal of Public Health Advance Access originally published online on May 30, 2007
Journal of Public Health 2007 29(3):269-274; doi:10.1093/pubmed/fdm025
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Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda
H. Nuwagaba-Biribonwoha, Senior Monitoring and Evaluation Advisor1,
R. T. Mayon-White, Consultant Epidemiologist2
P. Okong, Senior Consultant Obstetrician and Gynecologist3
L. M. Carpenter, Reader in Statistical Epidemiology2
1 International Center for AIDS Care and Treatment Programs (ICAP), Columbia University, Dar es Salaam, United Republic of Tanzania
2 Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK
3 Department of Obstetrics and Gynecologist, St. Francis Hospital Nsambya, Kampala, Uganda
Address correspondence to H. Nuwagaba-Biribonwoha, E-mail: hn2158{at}columbia.edu/ nuwiehb{at}yahoo.com
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Abstract |
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Background To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda.
Methods Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach.
Results The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families.
Conclusion Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the ‘opt-out’ approach to HIV testing required further evaluation.
Keywords: health impact assessment, health services