Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India
The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown....
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| Veröffentlicht in: | PloS one 2018-09, Vol.13 (9), p.e0203425-e0203425 |
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| creator | Suryavanshi, Nishi Mave, Vidya Kadam, Abhay Kanade, Savita Sivalenka, Srilatha Kumar, V Sampath Harvey, Pauline Gupta, Radhayshyam Hegde, Asha Gupte, Nikhil Gupta, Amita Bollinger, Robert C Shankar, Anita |
| description | The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown.
The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach.
Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback.
Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care. |
| doi_str_mv | 10.1371/journal.pone.0203425 |
| format | Article |
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The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach.
Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback.
Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0203425</identifier><identifier>PMID: 30180186</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject><![CDATA[Acquired immune deficiency syndrome ; Adult ; AIDS ; Anti-Retroviral Agents - administration & dosage ; Anti-Retroviral Agents - economics ; Antiretroviral agents ; Antiretroviral therapy ; Biology and Life Sciences ; Breastfeeding & lactation ; Costs and Cost Analysis ; Data processing ; Disease prevention ; Disease transmission ; Feeding ; Female ; Health care ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - economics ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; Human immunodeficiency virus ; Humans ; India - epidemiology ; Infectious Disease Transmission, Vertical - economics ; Infectious Disease Transmission, Vertical - prevention & control ; Medical diagnosis ; Medical personnel ; Medicine and Health Sciences ; Motivation ; National Health Programs - economics ; National Health Programs - organization & administration ; Nevirapine ; Norms ; Occupational health ; Patients ; People and Places ; Pregnancy ; Prevention ; Preventive Health Services - economics ; Preventive Health Services - organization & administration ; Prophylaxis ; Risk factors ; Shortages ; Social behavior ; Time dependence ; Training ; Womens health ; Workers]]></subject><ispartof>PloS one, 2018-09, Vol.13 (9), p.e0203425-e0203425</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c593t-c239a3cf66af53a6dc113bd75411a88fdad8239ac433945f22964cc50ed595f23</citedby><cites>FETCH-LOGICAL-c593t-c239a3cf66af53a6dc113bd75411a88fdad8239ac433945f22964cc50ed595f23</cites><orcidid>0000-0001-8917-0302</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122806/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122806/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23847,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30180186$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>van Wouwe, Jacobus P.</contributor><creatorcontrib>Suryavanshi, Nishi</creatorcontrib><creatorcontrib>Mave, Vidya</creatorcontrib><creatorcontrib>Kadam, Abhay</creatorcontrib><creatorcontrib>Kanade, Savita</creatorcontrib><creatorcontrib>Sivalenka, Srilatha</creatorcontrib><creatorcontrib>Kumar, V Sampath</creatorcontrib><creatorcontrib>Harvey, Pauline</creatorcontrib><creatorcontrib>Gupta, Radhayshyam</creatorcontrib><creatorcontrib>Hegde, Asha</creatorcontrib><creatorcontrib>Gupte, Nikhil</creatorcontrib><creatorcontrib>Gupta, Amita</creatorcontrib><creatorcontrib>Bollinger, Robert C</creatorcontrib><creatorcontrib>Shankar, Anita</creatorcontrib><title>Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown.
The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach.
Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback.
Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>AIDS</subject><subject>Anti-Retroviral Agents - administration & dosage</subject><subject>Anti-Retroviral Agents - economics</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Breastfeeding & lactation</subject><subject>Costs and Cost Analysis</subject><subject>Data processing</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Feeding</subject><subject>Female</subject><subject>Health care</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - 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Vidya</au><au>Kadam, Abhay</au><au>Kanade, Savita</au><au>Sivalenka, Srilatha</au><au>Kumar, V Sampath</au><au>Harvey, Pauline</au><au>Gupta, Radhayshyam</au><au>Hegde, Asha</au><au>Gupte, Nikhil</au><au>Gupta, Amita</au><au>Bollinger, Robert C</au><au>Shankar, Anita</au><au>van Wouwe, Jacobus P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-09-04</date><risdate>2018</risdate><volume>13</volume><issue>9</issue><spage>e0203425</spage><epage>e0203425</epage><pages>e0203425-e0203425</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown.
The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach.
Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback.
Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30180186</pmid><doi>10.1371/journal.pone.0203425</doi><orcidid>https://orcid.org/0000-0001-8917-0302</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-09, Vol.13 (9), p.e0203425-e0203425 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2099424192 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Acquired immune deficiency syndrome Adult AIDS Anti-Retroviral Agents - administration & dosage Anti-Retroviral Agents - economics Antiretroviral agents Antiretroviral therapy Biology and Life Sciences Breastfeeding & lactation Costs and Cost Analysis Data processing Disease prevention Disease transmission Feeding Female Health care Highly active antiretroviral therapy HIV HIV infections HIV Infections - economics HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Humans India - epidemiology Infectious Disease Transmission, Vertical - economics Infectious Disease Transmission, Vertical - prevention & control Medical diagnosis Medical personnel Medicine and Health Sciences Motivation National Health Programs - economics National Health Programs - organization & administration Nevirapine Norms Occupational health Patients People and Places Pregnancy Prevention Preventive Health Services - economics Preventive Health Services - organization & administration Prophylaxis Risk factors Shortages Social behavior Time dependence Training Womens health Workers |
| title | Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T15%3A55%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Challenges%20and%20opportunities%20for%20outreach%20workers%20in%20the%20Prevention%20of%20Mother%20to%20Child%20Transmission%20of%20HIV%20(PMTCT)%20program%20in%20India&rft.jtitle=PloS%20one&rft.au=Suryavanshi,%20Nishi&rft.date=2018-09-04&rft.volume=13&rft.issue=9&rft.spage=e0203425&rft.epage=e0203425&rft.pages=e0203425-e0203425&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0203425&rft_dat=%3Cgale_plos_%3EA557795685%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2099424192&rft_id=info:pmid/30180186&rft_galeid=A557795685&rft_doaj_id=oai_doaj_org_article_7d6a307410364411b70a6b156f9826f1&rfr_iscdi=true |