Traditional Birth Attendants’ (TBAs) involvement in prevention of mother to child transmission (PMTCT) of HIV-1 service delivery in Lilongwe District, a semi-urban area

C. Kabondo1, C. Zimba1, E. Kamanga1, I. Mofolo1, B. Bulla1, G. Hamela1, I. Hoffman2, F. Martinson1,2, C. van der Horst2, Chris Sellers2, M. Hosseinipour1,2,

R.C. Nakanga3, Alice Maida3, Nina Pagadala4

1 UNC Project, Lilongwe, Malawi2 University of North Carolina at Chapel Hill, USA

3 Malawi Ministry of Health4 Elizabeth Glaser Paediatric AIDS Foundation

BACKGROUND

UNC Project implements PMTCT program at 4 sites in Lilongwe (Bwaila hospital, Kawale, A18, A25 health centres) since 2002 reaching 20,000 women annually.

Since 2005, we have achieved approximately 100% uptake of HIV testing using opt out approach1

HIV prevalence rate in Lilongwe is 11.5% among women2

BUT in 2006,

44% of women delivered at home with TBAs1

45% of infants did not receive NVP as they were delivered at home. 1,090 (35%) infants born to HIV positive women were tested. 16% of

them were HIV positive1

1 Moses et al AIDS, 2008 2 Malawi District Health Survey 2004

Objectives

Main ObjectiveImprove uptake of PMTCT services through involvement oftrained traditional birth attendants (TBAs) in PMTCT service delivery.

Specific Objectives Assess the benefits of incorporating TBAs in PMTCT process.Examine incentives and barriers for TBAs to participate in PMTCT process.

METHODOLOGY

The study started in January 2008 to date. The study is conducted in catchment areas of Bwaila hospital,

Kawale, A18 and A25 health centres 14 TBAs were identified using criteria. TBAs were trained on PMTCT issues and TBA new roles. TBAs were provided with TBA logs and birthing kits.

FIGURE 1: TBA LOG

Has started pushing at her home

The mother’s condition is good

The mother has taken NVP

The mother is on ARVs

The mother has died

The baby’s condition is good

The baby has taken NVP

The baby has died

Has been referred to hospital

Delivery during the day

Delivery at night

DATE

NAME OF CLIENT PMTCT#

NAME OF TBA

_______________

MONTH

METHODOLOGY CONTINUED

Health professionals were trained to document PMTCT number for an HIV result.

Monthly supervision was done. 2 focus group discussions were conducted to evaluate TBAs’

performance.

RESULTS

Benefits for involving TBAs:From March 2008 to January 2009, out of 1,707 pregnant women who delivered at the TBAs:

134 (7.9%) were HIV positive 65/134 (48.5%) women received Nevirapine. 28/134 (20.9%) HIV exposed infants took

Nevirapine. 1,574 women were referred to health facilities.

– 1,359 (86%) women were referred after delivery– 215 (13.6%) women were referred before delivery

BENEFITS (2)

TBAs are able to identify HIV positive women using antenatal card.

Communities are sensitised to utilize health facility for delivery. Decrease in number of TBA deliveries e.g. from 60 to 20 per

month.

RESULTS CONTINUED

Incentives for TBAs to participate in PMTCT: Trainings on HIV and AIDS and PMTCT. Monthly supervision to remind them on their new roles.

Barriers to participate in PMTCT

Lack of transport for referral. Women’s preference to deliver at TBAs. Lack of sustainable source of income influencing

TBAs to continue conducting deliveries; Non-disclosure of status by HIV positive women

since some could deliberately leave their health passports at home.

Inability to determine whether Nevirapine is taken or not.

Difficult to track referred women as to whether they reach health facilities or not.

CONCLUSION

TBAs can supplement efforts to provide PMTCT services in communities.

RECOMMENDATIONS

Train and supervise TBAs on HIV/AIDS, PMTCT and TBA new roles.

Intensify community sensitization on hospital delivery: (HSAs, TBAs, Community nurses).

Availability of reliable transport. Infrastructures to accommodate antenatal women who are

waiting for labour. Develop a proper mechanism to track referrals from TBAs to

health facilities.

Acknowledgements

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) for sponsoring the program.

MOH Lilongwe DHO for the collaboration and support.

The TBAs for their participation.

Call To Action/PMTCT study teams

THANK YOU!!