Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.

Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE's) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) ret...

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Autores principales:	Megan Kays, Godfrey Woelk, Tegan Callahan, Leila Katirayi, Michele Montandon, Felluna Chauwa, Anne Laterra, Veena Sampathkumar, Dumbani Kayira, Thokozani Kalua, Erin Kazemi, Heather Hoffman, Surbhi Modi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6f8195bc63ff4496a652d8de18b1baf1
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spelling	oai:doaj.org-article:6f8195bc63ff4496a652d8de18b1baf12021-12-02T20:18:24ZEvaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.1932-620310.1371/journal.pone.0255788https://doaj.org/article/6f8195bc63ff4496a652d8de18b1baf12021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255788https://doaj.org/toc/1932-6203Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE's) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.Megan KaysGodfrey WoelkTegan CallahanLeila KatirayiMichele MontandonFelluna ChauwaAnne LaterraVeena SampathkumarDumbani KayiraThokozani KaluaErin KazemiHeather HoffmanSurbhi ModiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255788 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Megan Kays Godfrey Woelk Tegan Callahan Leila Katirayi Michele Montandon Felluna Chauwa Anne Laterra Veena Sampathkumar Dumbani Kayira Thokozani Kalua Erin Kazemi Heather Hoffman Surbhi Modi Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
description	Malawi faces challenges with retaining women in prevention of mother-to-child HIV transmission (PMTCT) services. We evaluated Cooperative for Assistance and Relief Everywhere, Inc. (CARE's) community score card (CSC) in 11 purposively selected health facilities, assessing the effect on: (1) retention in PMTCT services, (2) uptake of early infant diagnosis (EID), (3) collective efficacy among clients, and (4) self-efficacy among health care workers (HCWs) in delivering quality services. The CSC is a participatory community approach. In this study, HCWs and PMTCT clients identified issues impacting PMTCT service quality and uptake and implemented actions for improvement. A mixed-methods, pre- and post-intervention design was used to evaluate the intervention. We abstracted routine clinical data on retention in PMTCT services for HIV-positive clients attending their first antenatal care visit and EID uptake for their infants for 8-month periods before and after implementation. To assess collective efficacy and self-efficacy, we administered questionnaires and conducted focus group discussions (FGDs) pre- and post-intervention with PMTCT clients recruited from CSC participants, and HCWs providing HIV care from facilities. Retention of HIV-positive women in PMTCT services at three and six months and EID uptake was not significantly different pre- and post-implementation. For the clients, the collective efficacy scale average improved significantly post-intervention, (p = 0.003). HCW self-efficacy scale average did not improve. Results from the FGDs highlighted a strengthened relationship between HCWs and PMTCT clients, with clients reporting increased satisfaction with services. However, the data indicated continued challenges with stigma and fear of disclosure. While CSC may foster mutual trust and respect between HCWs and PMTCT clients, we did not find it improved PMTCT retention or EID uptake within the short duration of the study period. More research is needed on ways to improve service quality and decrease stigmatized behaviors, such as HIV testing and treatment services, as well as the longer-term impacts of interventions like the CSC on clinical outcomes.
format	article
author	Megan Kays Godfrey Woelk Tegan Callahan Leila Katirayi Michele Montandon Felluna Chauwa Anne Laterra Veena Sampathkumar Dumbani Kayira Thokozani Kalua Erin Kazemi Heather Hoffman Surbhi Modi
author_facet	Megan Kays Godfrey Woelk Tegan Callahan Leila Katirayi Michele Montandon Felluna Chauwa Anne Laterra Veena Sampathkumar Dumbani Kayira Thokozani Kalua Erin Kazemi Heather Hoffman Surbhi Modi
author_sort	Megan Kays
title	Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
title_short	Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
title_full	Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
title_fullStr	Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
title_full_unstemmed	Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.
title_sort	evaluating the effect of a community score card among pregnant and breastfeeding women living with hiv in two districts in malawi.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6f8195bc63ff4496a652d8de18b1baf1
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Evaluating the effect of a community score card among pregnant and breastfeeding women living with HIV in two districts in Malawi.

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