Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India

Nishi Suryavanshi, Vidya Mave, Abhay Kadam, Savita Kanade, Srilatha Sivalenka, V. Sampath Kumar, Pauline Harvey, Radhayshyam Gupta, Asha Hegde, Nikhil Gupte, Amita Gupta, Robert C Bollinger, Anita V Shankar

Research output: Contribution to journalArticle

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Article numbere0203425
JournalPLoS One
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2018

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outreach
India
Mothers
HIV
Nevirapine
Health care
infant feeding
Wages
Motivation
health services
disease control
Social Stigma
Costs
Delivery of Health Care
Patient Participation
Costs and Cost Analysis
Infant Formula
House Calls
Telemedicine
Salaries and Fringe Benefits

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Challenges and opportunities for outreach workers in the Prevention of Mother to Child Transmission of HIV (PMTCT) program in India. / Suryavanshi, Nishi; Mave, Vidya; Kadam, Abhay; Kanade, Savita; Sivalenka, Srilatha; Sampath Kumar, V.; Harvey, Pauline; Gupta, Radhayshyam; Hegde, Asha; Gupte, Nikhil; Gupta, Amita; Bollinger, Robert C; Shankar, Anita V.

In: PLoS One, Vol. 13, No. 9, e0203425, 01.09.2018.

Research output: Contribution to journalArticle

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AU - Mave, Vidya

AU - Kadam, Abhay

AU - Kanade, Savita

AU - Sivalenka, Srilatha

AU - Sampath Kumar, V.

AU - Harvey, Pauline

AU - Gupta, Radhayshyam

AU - Hegde, Asha

AU - Gupte, Nikhil

AU - Gupta, Amita

AU - Bollinger, Robert C

AU - Shankar, Anita V

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