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Title: Assessing the challenges faced by health systems in providing paediatric cotrimoxazole prophylaxis in resource limited countries
Author: Sibanda, E. L.
ISNI:       0000 0004 5363 2327
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2014
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Introduction: Cotrimoxazole prophylaxis (CTX-p) is a cost-effective intervention that saves lives of HIV positive individuals. It is recommended by WHO for all infants born to HIV positive women (HIV-exposed infants). Despite this it is poorly implemented in resource limited countries including Zimbabwe. This project aimed to explore health system and patient-level factors that affect implementation of CTX-p among HIV-exposed infants in Harare, Zimbabwe. Methods: In the first phase of the study, policy and implementation procedures for CTX-p were studied at national and health care centre level through document review and key informant interviews. In the second phase, a detailed study of implementation procedures was conducted at Mbare Clinic, Harare, to explore challenges to CTX-p at various points in the prevention of mother to child transmission (PMTCT) cascade. This involved 1) a survey among post-partum women, 2) qualitative interviews with women who delayed/did not seek antenatal care (ANC), 3) follow-up of HIV positive women at six-weeks postpartum to investigate initiation of CTX-p, and 3) follow-up of HIV-exposed infants until six months to explore adherence. In addition, a systematic review was conducted to investigate the magnitude of loss to follow-up (LTFU) of HIV exposed infants from real-life PMTCT programs. Results: CTX-p is recognised as important by the Zimbabwe Ministry of Health; it has been incorporated into guidelines and treatment procedures for HIV-exposed infants. Health systems face challenges implementing CTX-p due to lack of human resources and poor supply chain management. For women, the first hurdle is seeking ANC, where user fees, fear of HIV testing, unsupportive husbands/partners, nurses’ discourteousness and long queues are barriers. Lack of knowledge of the importance of a six-week visit is the main barrier to sixweek visit attendance. Adherence challenges include: unsupportive husbands/partners, drug stock-outs and fear of unwanted HIV disclosure and associated stigma. The systematic review revealed that there is unacceptable LTFU of HIV-exposed infants along various points of the PMTCT cascade. Conclusion: Health care systems need to put in place measures to ensure optimum implementation of life-saving interventions and retention of HIV-exposed infants in care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available