Dr Agyarko- Poku Thomas Dr Yeboah- Awudzi Kwasi PMTCT OPTION B+ IMPLEMENTATION AT THE PRIMARY LEVEL OF CARE IN THE ASHANTI REGION OF GHANA; CHALLENGES. Bandoh Dennis Dr Agyarko- Poku Thomas Dr Yeboah- Awudzi Kwasi

OUTLINE BACKGROUND OBJECTIVES METHOD RESULTS/KEY FINDINGS RECOMMENDATIONS CONCLUSION ACKNOLEDGEMENT

BACKGROUND The more efficacious Option B+ strategy for the prevention of mother- to-child transmission (PMTCT) of HIV has been implemented in Ghana over the past four years including the provision of ART services at the primary level of care. OBJECTIVE : This baseline study assesses challenges facing service delivery of Option B+ at the primary care levels in the Ashanti Region of Ghana. Primary level of care is defined by Ministry of Health, Ghana as CHPS compounds, clinics, maternity homes and health centres.(MOH)

Evolution of PMTCT ARV Recommendations(WHO,NACP) 2001 2004 2006 2010 Launch 2013 PMTCT 4 weeks AZT; AZT+ 3TC, or SD NVP AZT from 28 wks + SD NVP AZT from 28wks + sdNVP +AZT/3TC 7days Option A (AZT +infant NVP) Option B (triple ARVs) Option B or B+ Moving to ART for all PW/BF Move towards: more effective ARV drugs, extending coverage throughout MTCT risk period, and ART for the mother’s health

BACKGROUND (3) -About PMTCT Option B+(WHO) Option B+ is lifelong ART for HIV positive pregnant and lactating women irrespective of clinical stage or CD4 count Benefits of B+ No need for CD4 count before starting B+ No interruption of triple ART ‘’avoid a start-stop-start-stop approach’’ One regimen for all-non-pregnant populations and pregnant women Easier to harmonize with the treatment program Covers future pregnancies esp with high fertility Provided at the primary levels of health care

BACKGROUND - PMTCT KEY INDICATORS (ASH HIV ANNUAL REPORT,2017) PMTCT SITES 453 PMTCT SITES OFFERING ARV’S(OPTION B+) 297 PMTCT COVERAGE 87.7%(141,280) NUMBER ,%POSITIVE PMTCT 1.6%(2279) PMTCT ART COVERAGE 90.6% OPTION B +

METHOD Four hundred and fifty health(450) care providers made up of health care assistants, community nurses, enrolled nurses, midwives, physician assistants were selected from 75 health facilities. Facility geographical location (Urban and Rural) and ownership (Public, Private and Mission) were conferred. Sampling Methods – Purposive Sampling (PMTCT Sites Implementing Option B+) and Simple Random Sampling(75 Facilities) Data including socio-demographic information was collected using structured questionnaire. Data was analysed using SPSS 16.

RESULTS

Geographical Location/Facility Ownership/Facility Type NUMBER CHPS 24 CLINIC 3 MATERNITY HOMES 8 HEALTH CENTRES 40

SOCIO DEMOGRAPHIC INFORMATION(1)- CADRE

RESULTS Majority (68.1%; 307/450) of respondents were aged 45 years and below. More than half (56.9%; 256/450) of the respondents had worked just under 2 years, with 32.1%; (144/450) and 11.0% (49/450) over 2 years and 4 years respectively. 90.1%(405/450) mentioned stigmatization as explained by closeness of the health facility to their communities, preventing the women to access care. 65.1%(293/450) reported uncooperative attitude of pharmacist in terms of releasing of ARVs. Lack of confidence to administer ARV’s among the respondents was a major issue from inadequate training (70.2%; 316/450). Erratic supplies of logistics including medicines and Ora-Quick to confirm reactive cases were a major concern for over three-quarters of the respondents (72.9%; 328/450). 43.1% (194/450) Reported that Mothers are discouraged because Positive male partners are not allowed to take ARV’s from the PMTCT Sites but rather referred to ART sites Lack of Lab investigation at the lower levels due to unavailability of labs, trained personnel or equipment were reported by some respondents as a hindrance to initiating clients on ARV(25.2%:113/450 ) Continuum of Care after Delivery ? There were no significant differences for the respondents’ responses and geographical location (p-value 0.789) and facility ownership (p-value -0.699).

SUMMARY OF KEY FINDINGS

RECOMENDATIONS Training at lower level staff to build the trust of pharmacists to hand over ARVs to lower levels and also boost their confidence in administering ARV’s Regular Supervision, optimized mentoring from higher levels to provide on the spot trainings and corrective measures to improve capacity of HCW. Eg .Pharm should be supported to undertake supervision of ARV’s. Improved logistic management including quantification and forecasting to ensure uninterrupted supply of drugs and commodities Barriers caused by closeness of facility can be addressed through continuous Community sensitization and opinion leaders engagements to build trust of clients to attend the nearest facilities Capacity building of lab staff ,Logistical and infrastructure support to enable laboratory testing at the primary levels. Strategize to address the issue of ARV’s not given to male partners at PMTCT sites (Eg. Scaling up of PMTCT sites to provide ART, Task Sharing)

CONCLUSION The study found the fear of stigmatization due to closeness of facility as the main challenge for the implementation of Option B+ at the primary level of care ,other factors like erratic supply of commodities, inadequate training and lack of support from pharmacist are the main challenges facing health care providers at the primary levels of care. There is the need to urgently attend to these challenges to ensure the success of the PMTCT option B+.

ACKNOLEDGEMENT RDHS ,RHD Health Facilities DHA’s Pharm Kwaku Koduah

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