Academic journal article Central European Journal of Public Health

Improving Quality of Prevention of Mother-to-Child HIV Transmission Services in Ukraine: A Focus on Provider Communication Skills and Linkages to Community-Based Non-Governmental Organizations

Academic journal article Central European Journal of Public Health

Improving Quality of Prevention of Mother-to-Child HIV Transmission Services in Ukraine: A Focus on Provider Communication Skills and Linkages to Community-Based Non-Governmental Organizations

Article excerpt

SUMMARY

Background: Ukraine has the highest rate of HIV infection in Europe, with an estimated adult prevalence of 1.6 percent. The epidemic in Ukraine remains largely driven by injection drug use, and women of reproductive age are being increasingly affected. Prior research has highlighted the need to improve the quality of services for prevention of mother-to-child transmission (PMTCT) and to address other issues related to HIV counseling, testing, and care, especially in the context of antenatal and obstetric services.

Methods: From 2004 to 2007, PATH led a collaborative effort to improve the quality of PMTCT services in Ukraine. Initial assessments included focus groups with Ukrainian women and review of existing educational materials. Interventions focused on training providers to improve skills in communication and referral to community-based support; they also addressed the underlying issue of stigma.

Results: Observational data demonstrated that providers who participated in the training intervention delivered PMTCT counseling of a consistently higher quality than did providers who did not undergo training. Exit interviews with clients confirmed these findings.

Conclusions: An intervention focused on strengthening voluntary counseling and testing for HIV, forging partnerships with local organizations, and undoing HIV-related stigma can help to improve access to and quality of PMTCT services in antenatal care clinics.

Key words: HIV/AIDS stigma, prevention of mother-to-child HIV transmission, voluntary counseling and testing, provider training, Ukraine

INTRODUCTION

Ukraine has the highest rate of HIV infection in Europe, an estimated adult prevalence of 1.6 percent (1). HIV sion in Ukraine is largely driven by injection drug use (2, 3), women are increasingly affected (3, 4). The percentage of HIV diagnoses among women rose from 24 percent in 1996 to estimated 44 percent in 2007 (5, 6). The estimated HIV among pregnant women is 0.5 percent nationwide and man 1 percent in some regions (7, 8). High-quality for HIV-positive pregnant women as part of Ukraine's national HIV strategy are clearly needed.

Background

In 2001 , the Ukrainian Ministry of Health introduced a strategy to integrate prevention of mother-to-child transmission (PMTCT) activities into maternal and child health services. The Programme provides free antenatal testing, rapid testing at livery, and management of HIV-positive women before, and after delivery (8). Voluntary counseling and testing (VCT) for pregnant women and their partners is an essential entry point for PMTCT and HIV-related services and theoretically is central to Ukraine's PMTCT Programme. Lack of provider training and stigma, however, have impeded VCT integration. A 2006 Human Rights Watch report found that health care providers in Ukraine widely discriminated against HIV-positive people by turning them away from hospitals, discharging them when their HIV status became known, and providing poor quality of care (9). Research also has highlighted the need for improved scale-up PMTCT interventions (8).

METHODS FOR PROJECT DEVELOPMENT AND EVALUATION

Project Overview

PATH, an international non-profit health organization, partnered with Ukrainian nongovernmental organizations (NGOs) and government health facilities to increase access to and quality of PMTCT interventions from October 2004 to September 2007. The effort focused on strengthening the quality of information, counseling, and referrals that pregnant women receive and on addressing factors contributing to HIV-related stigma (provider knowledge, skills, and attitudes). The rationale was that improved information dissemination, counseling, and support in clinical facilities and in communities could help pregnant women better understand HlV and risk behaviors, make it more likely that they would access available antenatal care and PMTCT services, and help reduce stigma within health facilities (10-13). …

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