Background and methodology
Prevention of vertical transmission of HIV from mother to child is a priority for UNICEF in Latin America and the Caribbean. Evaluation of national programmes, thereby using evaluation as a powerful tool to influence national policies, is contributing significantly to achieving results in this area. The objective of the evaluation was to review the access to, and the quality of application of the Norms for Prevention of Vertical Transmission of HIV, elaborated in 2005 by the Chilean Ministry of Health. The study was carried out in the areas with the highest vertical transmission of HIV. Three components were examined: a) Diagnosis of HIV infection in pregnant woman; b) Application of the Prevention Protocol, and c) Perception of decision makers, civil society and service providers, with respect to the prevention of vertical transmission standards.
Methodologies used included a combination of quantitative and qualitative analysis. On the one hand, clinical records from the public institutions involved were used for quantitative analysis. On the other hand, focus group discussions and individual semi-structured interviews were conducted to gather the perception about access and quality of the protocol.
The Norms for Prevention of Vertical Transmission of HIV is adequate and beneficial particularly for newborns. The application of the protocol has resulted in major achievements in access to, and coverage in HIV-testing. In spite of such an acknowledgment, however, 45% of pregnant women still do not have access to HIV-testing and services. Application of the protocol for prevention of vertical transmission of HIV clearly focuses on preventing infection of the newborn child. Pre-test counselling contains no explicit message on the benefit of protecting the woman’s health.
The level of agreement with the requirement of explicit informed consent is very low. Both users and health-care professionals at all levels feel that the HIV test should be compulsory, at least for pregnant women. And when women are tested, delays in the delivery of test results occur frequently. Moreover, medical personnel are facing difficulties with regards to applying the prevention protocol to a child whose mother has refused the HIV test. Occasionally they must resort to the courts seeking protection measures for the newborn. However, good practices have also been identified such as counselling and HIV testing at first visit to pre-natal care, individualized follow up of each case from the maternity ward to ensure diagnosis and treatment for the newborn, development of initiatives with certain laboratories to improve timing on the delivery of results and avoid repetition of the tests.
The quality of attention received by the pregnant women varies among the public institutions assessed and within the region. These variations refer to the availability of human resources to cover the demand and particularly to the skills required to provide counselling to pregnant women. As an example, breastfeeding suppression is recommended to all HIV positive mothers but delivery of formula by the service is irregular.
The evaluation did not provide specific recommendations as it was considered more appropriate for decision makers and technical experts to interpret the findings presented.
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