Level and factors associated with adherence to recommended intrapartum guidelines for PMTCT among health care workers in Kawempe National Referral Hospital

Abstract

Introduction: Mother to child transmission is the most common form of HIV transmission among children, accounting for 90% of pediatric HIV cases. Without any intervention, the risk of an infant acquiring HIV from an HIV positive mother is 20-45%. As a result, Uganda developed Prevention of Mother to Child Transmission (PMTCT) guidelines basing on the best available evidence to provide clinicians with recommendations for delivering high-quality care, evidence-based interventions, optimize patient outcomes, reduce the risk of complications, and enhance overall quality of care. However, the mother to child HIV transmission rate in Kawempe National Referral Hospital stands at 7.4%, which is higher than the country’s current transmission rate and the WHO PMTCT target. This study sought to assess the level and factors associated with adherence to intrapartum PMTCT of HIV guidelines among health care workers. Methods: A cross sectional study was conducted among healthcare workers attending to women in delivery wards of Kawempe National Referral Hospital. A total of 181 health care workers were recruited and blindly observed for practice of PMTCT and factors associated with adherence were assessed using a self-administered questionnaire. STATA version 13 was used to analyze the adherence practices with adherence considered if a health workers practiced 90% of the practices assessed. Associations between dependent variables and adherence to PMTCT guidelines was assessed by logistic regression analysis including bivariate and multivariate analysis with a p-values<0.05 considered to be statistically significant at multivariate analysis. Ethical approval was obtained, written informed consent was obtained and participation was voluntary. Results: More than half of the respondents (52.49%) had been in clinical practice for 5 years and had had training on PMTCT guidelines (62.98%). Over three quarters (75.14%) were found to have good knowledge on intrapartum PMTCT guidelines although 70.17% reported lack of access to the protocols. The level of level of adherence to MOH recommended intrapartum guidelines for PMTCT of HIV was 50.28% and this was significantly associated with female sex (aOR=1.03, P-Value 0.04), being a midwife (aOR=9.15, P-Value 0.079), increased duration since qualification (aOR=1.56, P-Value 0.010) and duration spent on maternity wards (aOR=8.60, P-Value 0.028). Conclusion: Adherence to PMTCT guidelines among health workers was poor with a large proportion of health care workers not adherent to the complete package of PMTCT. All health workers involved in child delivery should be provided with comprehensive education and training sessions on PMTCT guidelines to ensure that they understand the rationale behind the guidelines and how to implement them effectively in clinical practice.