Health provider barriers in the implementation of prevention of mother-to-child transmission of HIV guidelines in Naivasha Distict

Abstract

Background The most common route of HIV infection in HIV positive children less than 5 years of age is through Mother- To-Child Transmission (MTCT). In light of this, the guidelines for Prevention of Mother to Child Transmission (PMTCT) of HI VIA IDS are recognized as one of the best ways to present recommended courses of action based on current best research evidence. In addition, the PMTCT services offered in Kenya are free and integrated into Maternal and Child Health (MCH) services. Even though guidelines have the potential to facilitate the implementation of evidence into practice these potential benefits have not been consistently achieved. The uptake of PMTCT still remains a challenge with only half of HIV -exposed infants having received ARV s for PMTCT in 2009. Objective The objective of this study is to identify health care provider barriers in the implementation of PMTCT of HI V guidelines at Naivasha district. Methodology The study was a cross-sectional qualitative survey involving in-depth interviews of key informant health care providers directly involved in the provision of PMTCT services. Naivasha District Hospital and 5 satellite health facility sites supplied with ARVs by Naivasha District Hospital and offering PMTCT services were purposefully sampled. The respondents were also identified by purposeful sampling. Sampling was stopped when saturation of the given concept was reached at 14 respondents. The interviews were transcribed and data analysis was done using content analysis. A narrative approach was used to describe the findings of the study. Results Two main health worker barriers in the implementation of PMTCT guidelines identified were intrinsic and extrinsic barriers. Intrinsic barriers included inadequate knowledge and skills, poor attitude and poor practices amongst the health workers. The extrinsic barriers included patient factors hindering the provision of PMTCT services, guideline content barriers and operational barriers. Conclusions In as much as the study primarily aimed at finding intrinsic barriers to PMTCT guideline implementation, extrinsic barriers were rampant and were reported to be a major hindrance to guideline implementation. Recommendations The implications of these findings are that in future, the PMTCT program should focus on interventions to increase targeted and intensive training of the PMTCT health workers and the hiring of more staff so as to reduce workload. The guideline makers should also consider involving health workers in the planning and design of guidelines so as to address the guideline content gaps. Old guidelines should also be moped up from the health facilities and incentives such as certificates of recognition for good PMTCT service provision should be given to the health workers.