Details:

Alternative Title:
PLoS One
Personal Author:
Young, Nicole ; Taegtmeyer, Miriam ; Aol, George ; Bigogo, Godfrey M. ; Phillips-Howard, Penelope A. ; ... More +
Young, Nicole ; Taegtmeyer, Miriam ; Aol, George ; Bigogo, Godfrey M. ; Phillips-Howard, Penelope A. ; Hill, Jenny ; Laserson, Kayla F. ; Ter Kuile, Feiko ; Desai, Meghna Less -
Description:
Background

In sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women.

Methods

A longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence.

Findings

For first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin–piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses.

Conclusions

Integrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.


Subjects:
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Adult Anemia Anti-Bacterial Agents Anti-HIV Agents Antimalarials Artemether, Lumefantrine Drug Combination Artemisinins Dietary Supplements Erythromycin Female Folic AcidGuideline Adherence Health Personnel HIV Infections Humans Iron, Dietary Laboratory Proficiency Testing Longitudinal Studies Malaria Penicillins Point-of-Care Testing Pregnancy Pregnancy Complications, Hematologic Pregnancy Complications, Infectious Prenatal Care Quinine Quinolines Syphilis Trimethoprim, Sulfamethoxazole Drug Combination
Source:
PLoS One. 13(7).
Pubmed ID:
30028852
Pubmed Central ID:
PMC6054376
Document Type:
Journal Article
Place as Subject:
Kenya
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:bfd3a41f5c5c456ecc7f0f2b27095d9ab830e68a521f5cad02125644c19105ec
Download URL:
https://stacks.cdc.gov/view/cdc/59622/cdc_59622_DS1.pdf
File Type:

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