Enhanced health systems to improve uptake of early infant diagnosis among post-partum women in primary health care in Malawi (EEHS study)

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Date
2022-06-06
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Kamuzu University of Health Sciences
Abstract
Type of the study: This is an embedded mixed-method, with a before and after design. Consultative workshop with stakeholders will inform an intervention, that will be evaluated for its effectiveness and acceptability, combining quantitative and qualitative data collection and analysis.Problem statement: In many African countries, low utilisation of health services after birth contributes to significant gaps in HIV testing for HIV-exposed infants (HEIs). Several integrated initiatives to improve early infant diagnosis (EID) have emerged. However, implementation of evidence-based practices may not always be achieved. In our formative assessment of implementation of EID services in Blantyre in 2019, various factors contributed to low uptake of EID services, including inability to identify HEIs and limited testing capacity of the point-of-care machine. Strengthening the health system, is likey to address factors that influence retention in health care and improve uptake of EID services. Overall objective: This study aims to evaluate the effectiveness and acceptability of an enhanced health system strategy (EEHS) among post-partum women and health care workers in primary health care in Blantyre, Malawi.Specific objectives: The study will have the following specific objectives: 1) To refine EEHS intervention with stakeholders in Blantyre District. 2) To assess the change in proportion of HEIs enrolled in HIV care clinics at birth, and tested at 6 weeks before and after introducing EEHs strategy. 3) To evaluate how well the EEHS package intervention will be delivered as intended. 4) To evaluate the acceptability of the EEHs strategy among health care workers (HCWs) and women with HEIs. Methodology: We will conduct the study in two primary health facilities in Blantyre District, Zingwangwa and Madziabango argeting women with HEIs and (HCWs) who provide EID services. Sampling will be done purposively for the interviews with HCWs, conveniently for women with HEIs and HCWs' observations. The eligibility criteria for HCWs will include: training or orientation in EEHs intervention and involvement in its implementation. For women with HEIs at birth and at 6 weeks of age, they can not have maternal complications, or sick children, and must be at least 18 years old All HEIs will have their data extracted by taking photographs without identifiers that will be backed up by entering data into tablets to validate routinely collected data because we anticipate data quality issues that was also observed during the formative study. Structured observations will be conducted to assess if HCWs are implementing the EEHs intervention as intended. Semistructured interviews will be conducted with HCWs and women with HEIs to assess the acceptability of the intervention. Quantitative data will be analysed and managed using the Pearson chisquare test and we will use R software to compare the proportions of enrolment and HIV testing before and after the EEHs intervention. N-Vivo will be used to manage qualitative data. A locked cabinet at the Malawi Liverpool Welcome programme(MLW) offices, will store the hard copies of study data, and electronic data will be stored on password-protected computers. Participants will be asked to give written informed consent by signing or using a thumbprint if illiterate. Ethics approval will be obtained from the College of Medicine(CoM) Research and Ethics Committee (COMREC) and Liverpool School of Tropical Medicine (LSTM). The study will not assess the cost-effectiveness of the intervention. However, this study will provide practical guidance on stakeholders engagement to guide the understanding of the system and context to develop appropriate interventions,The results cannot be generalized to all EID facilities in Malawi, which calls for further research. Expected findings and dissemination: The study will co-design a context appropriate intervention that will be assessed for its effectiveness and acceptability. The study findings will be made available to the LSTMREC, COMREC and to both study sites The results will be presented at conferences and published through mamanuscripts.
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Type of the study: This is an embedded mixed-method, with a before and after design.
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