Effectiveness of HIV counseling services on knowledge, attitude, behavior and practice (KABP) among pregnant women attending PPTCT program

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score = 15.3) and post test (mean score = 35.6) (P < 0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individuals with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p < 0.0001). The condom use among the study participants significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p < 0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.     

Knowledge and perception of HIV/AIDS among pregnant women attending antenatal clinics in Ogun State,Nigeria

Mother-to-child transmission of HIV (MTCT) is responsible for more than 90% of the cases of HIV infection in infants and children in sub-Saharan Africa. Accurate data on the knowledge and perceptions of HIV/AIDS among women attending antenatal clinics in Nigeria are scarce. A cross-sectional survey of 804 women attending antenatal clinics in Ogun State, South-West Nigeria was done using interviewer-administered questionnaires. Approximately 90% of the women respondents had heard of HIV/AIDS, but only about 27% knew HIV could be transmitted from mother to child; of those, almost 94% believed in the reality of HIV disease; in contrast, the majority (64%) believed they were not at risk of HIV infection, and a slightly greater proportion (70%) did not understand the benefits of voluntary HIV counselling and testing (VCT). Nonetheless, almost 90% of respondents were willing to know their status following health education about VCT. Those that were older, attending public hospitals, and with a higher level of education had more knowledge and better perceptions about HIV. The results suggest an urgent need for public health education on HIV/AIDS and the benefits of VCT to control MTCT, particularly targeting young women and those with little or no education.     

Testing for HIV in the antenatal clinic: the views of midwives.

Self administered questionnaires were given to 34 midwives, who regularly counsel parturient women about the HIV antibody test, to investigate their attitudes to the test being offered in the antenatal clinic. Most of the midwives felt that testing should not be compulsory and that the test should be offered to all pregnant women who ask for it, not only those in recognized risk groups. Most also felt that women should be told the results of the test and that it should not be the midwives aim to increase the number of women having the test. Most felt that all midwives should counsel about the test but would like health advisers, GPs and obstetricians to be involved also. They also felt that they did not have sufficient knowledge in some areas to counsel particularly with regard to the practical and psychological implications of being HIV positive. This has implications in terms of the provision of adequate pre-test counselling for all pregnant women as an improvement in counselling services requires an allocation of finances, e.g. for training of midwives, which may be seen as unnecessary in areas of low seroprevalence. Further discussion and debate of these issues is required.     

Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: first 18 months of experience

OBJECTIVE: To report on activities and lessons learned during the first 18 months of a rural programme of prevention of mother-to-child transmission of HIV (PMTCT) in Zimbabwe. METHODS: The PMTCT services were introduced in Murambinda Mission Hospital (120 beds), Buhera, in 2001. Programme strategies consisted in recruiting counselling staff, training health professionals, improving mother-child health (MCH) facilities and conducting information, education and communication activities within the community to address HIV/AIDS awareness and stigma. The following components were implemented within MCH services: voluntary counselling and testing of HIV using rapid testing, nevirapine short regimen proposed to all HIV-infected mothers identified and their newborns, support to exclusive breastfeeding for 6- and 18-month mother-child follow-up. Routine monitoring data collected from August 2001 to February 2003 were used to estimate programme uptake. RESULTS: Of 2471 pregnant women using antenatal services, 2298 were pre-test counselled, the acceptance of HIV testing reached 92.9%. Of the women who decided to take an HIV test, 1588 (74.3%) returned to collect their result. Overall HIV prevalence was 20.4% (n = 437); 326 of the HIV-positive women were counselled and 104 (24%) received complete mother-child antiretroviral prophylaxis. CONCLUSIONS: Acceptability of HIV testing after counselling has remained above 90% since the onset of the programme. Collection of test results and mother-child follow-up are among the most challenging activities of the programme. A district approach and community participation are critical to develop PMTCT programmes in rural settings, even with reasonably good MCH services.     

The impact and use of written leaflets as a counselling alternative in mass antenatal HIV screening

Pre-test counselling has been seen as a pre-requisite for HIV screening. As HIV moves into the heterosexual community, the role of HIV screening in ante-natal care has increased. As vertical transmission is the major contributor to perinatal infection HIV screening of pregnant women has become a reality. The pregnant population comprises large numbers, the practical difficulties of routine pre-test counselling and the informational demand from pregnant women themselves has necessitated the provision of ante-natal leaflets about HIV infection and AIDS. A survey of 24 London hospitals revealed only three leaflets in use, two from one hospital and one from an AIDS Charity. A content evaluation of the leaflets revealed varying readability, elements of bias and presentation factors which may all affect the usefulness of such leaflets. An in depth qualitative group on the leaflet with highest readability revealed particular concerns and highlighted the fact that the leaflets could be seen as additions and addendums to counselling but were not sufficient in themselves.     

Factors predicting uptake of voluntary counselling and testing in a real-life setting in a mother-and-child center in Ouagadougou, Burkina Faso

OBJECTIVE: To identify factors predicting uptake of voluntary HIV counselling and testing in pregnant women. METHODS: All pregnant women receiving ante-natal group health education at St Camille Medical Center, Ouagadougou, Burkina Faso from 1 May 2002 to 30 April 2004 were offered voluntary HIV counselling and testing. If they consented, the women were pre-test counselled, tested by two rapid tests giving immediate results and post-test counselled. RESULTS: Less than one-fifth of pregnant women [1,216/6,639 (18.3%, CI 17.4-19.3%)] accepted voluntary HIV counselling and testing, mainly at the first ante-natal visit (83.4%) and at early gestational age (73.4% before week 24). The HIV seroprevalence rate was 10.6% (8.8-12.5%). The uptake rate was independently associated with age, the number of previous pregnancies and the number of previous miscarriages. CONCLUSIONS: Our two-step approach of group education followed by voluntary HIV counselling and testing yielded a low uptake rate in this setting. However, the drop-out rate after enrolling in the programme was nearly zero. The timing of programme uptake would permit implementation of earlier prophylactic courses. Effective scaling-up of voluntary HIV counselling and testing outside the clinical trial requires a mass sensibilization campaign pointing out the programme's benefits and addressing the stigma of HIV. The independent value of age and previous obstetrical episodes show how important social factors are in influencing the voluntary HIV counselling and testing uptake rate.     

北京市孕妇人群AIDS认知程度与健康教育干预的研究

目的：了解北京市孕妇对艾滋病(AIDS)的预防知识、态度，以便为在该人群中采取切实可行的AIDS干预措施提供依据。方法：将孕妇分为干预组和对照组，两组均进行干预前问卷调查，然后对干预组采取讲课、发放AIDS预防宣传资料和小组咨询等干预措施，时间为6个月；对对照组不采取任何措施。6个月后，对两组分别进行问卷调查，与干预前调查内容相同。结果：干预组孕妇于干预前调查时，对AIDS有关知识的正确认识率与对照组差异无显著的统计学意义。但采取措施6个月后，干预组正确认识率由干预前的65．5％上升至80．5％，两者差异有非常显著的统计学意义(X^2＝31.678，P＜0．01)，但对照组干预前后差异无显著的统计学意义(X^2＝3．284，P＝0．063)。结论：孕妇在干预前，对AIDS已有一定程度的了解，但对其传播途径认识模糊。因此，有必要对该人群开展AIDS预防的健康教育。     

新疆伊宁市孕妇HIV流行情况及KABP调查

目的 了解伊宁市孕妇的HIV感染情况。方法2000年4月～2001年1月对在伊宁市妇幼保健院妇产科产前体检的孕妇进行问卷调查,同时进行HIV抗体检测。结果 共调查507名孕妇,查出HIV感染者1人,感染率为0.2％。随着文化程度的增高被调查孕妇对艾滋病的知晓率上升（趋势性检验x2=45.75,P<0.01）。文化程度越高对艾滋病知识的需求更高（趋势性检验x2=13.95,P<0.01）。孕妇认为产前应该进行艾滋病病毒检测的占 88.2％（447/507）。结论 伊宁市 HIV已从高危人群波及到一般人群,夫妻间性传播可能是新疆伊宁市孕妇感染HIV的主要途径。在HIV感染率高的地区对孕妇进行艾滋病知识宣传并开展产前HIV抗体检测势在必行。     

Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi – policy implications

In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to <100 beds; n = 42) and small nursing homes (10 to <25 beds; n = 29). A pre-tested questionnaire was designed to obtain basic information about hospital in context to PMTCT programme. Interviews of heads of obstetrics and gynaecology and paediatric departments were conducted by trained interviewers. It was observed that in private hospitals in year 2012, out of 38,186 antenatal women tested, 52 (0.14%) were detected HIV-positive. However, against National Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering PMTCT services in private health sector.     

Mother-to-child HIV transmission in resource poor settings: how to improve coverage?

OBJECTIVES: To review coverage of the current nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Mombasa, Kenya, and to reflect on alternative models to reduce mother-to-child transmission (MTCT) of HIV. METHODS: At the antenatal clinic, health information is provided, followed by pre-test HIV voluntary counselling and testing (VCT). Because many women deliver at home, HIV-infected women are provided with a tablet of 200 mg nevirapine for themselves, and with 0.6 ml (6 mg) nevirapine in a luer lock syringe for the baby. Data on coverage are provided from antenatal records and delivery registers. RESULTS: Out of 3564 first-visit pregnant women receiving health education, 2516 were counselled (71%) and 2483 were tested (97%); 348 were HIV positive (14%), and 106 women took nevirapine in labour, resulting in an overall coverage rate of 20%. In the same period, approximately 6000 women gave birth in CPGH, of whom 21% had attended a facility with VCT services. Assuming an overall HIV prevalence of 14%, 840 mother-infant pairs could have received a preventative intervention with a hospital policy of antepartum as well as intrapartum testing and treatment in place. CONCLUSION: The coverage of perinatal MTCT was low as a result of a variety of programme elements requiring urgent improvement at different levels. Alternative models, including intrapartum testing, should be considered as a safety net for women without access to VCT before delivery, and recommendations for nevirapine should be considered in the light of home deliveries.     

Effectiveness of antenatal group HIV voluntary counseling and testing services in rural India.

This study assessed HIV attitudes among pregnant women attending antenatal clinics in the Namakkal district of Tamilnadu, India, as well as HIV knowledge before and after group counseling sessions. Two hundred thirteen women (97%) attending five antenatal clinics in July 2004 accepted HIV counseling and testing and completed precounseling and postcounseling questionnaires. Although the majority of women had heard of HIV, precounseling knowledge was low (mean precounseling score; 6.9/18, SD: 4.53), with scores correlating with the women's educational level and the number of sources from which they had received information about HIV. Posttest scores increased by 21%, however, understanding of modalities to prevent HIV infection remained poor. Group counseling sessions achieve small gains in HIV knowledge, but there is a continued need for ongoing and multifaceted HIV education in rural India.     

HIV/AIDS knowledge and stigma among women of reproductive age in Ethiopia

HIV/AIDS stigma is one of the major public health challenges in Ethiopia. This study examined knowledge about HIV/AIDS and factors behind stigmatisation towards people living with the virus based on demographic and health survey data collected in 2011 from women in the age group 15–49 years. The result shows that 49.3% of rural women had adequate knowledge about HIV/AIDS compared with 74.7% of urban women. About three-fourths (72.1%) of the rural women had stigmatising attitudes towards PLWHA whilst the proportion in urban areas was only about a third (34.2%). The likelihood of having adequate knowledge about HIV/AIDS was significantly higher among educated women but lower among those living in Afar, Somali, and Gambella regions and Dire Dawa City. Women with higher levels of education and frequent access to media had a lower tendency to stigmatise people living with the virus. Adequate knowledge about HIV/AIDS was also significantly associated with lower likelihood of stigmatisation. The results generally indicate that HIV/AIDS stigma in Ethiopia is partly explained by people's knowledge about HIV/AIDS and by socio-cultural factors that shape their perception of the epidemic. Awareness-raising efforts should thus consider the socio-cultural contexts in which stigma occurs to tackle discrimination against people living with HIV/AIDS.     

Women's acceptability and husband's support of rapid HIV testing of pregnant women in India

This study examined acceptability among pregnant women and their husbands for HIV testing within the antenatal clinic (ANC) and delivery room (DR) of a government hospital in Pune, India from September 2000 to November 2001. Acceptance of HIV counselling and testing was high with 83% of eligible women in the antenatal clinic (851 of 1025) and 68% of eligible women in the delivery room (417 of 613) getting tested on the same day. Structured interviews were conducted on 94 pregnant women in the ANC 50 women in the DR, and 100 husbands who accompanied their wives in the ANC. These data indicated that the majority of women agreed to be tested independently without the need for further consultation with family members, a view that was strongly supported in this sub-sample of accompanying husbands. For delivering women who were not progressing in their labour, counselling in the DR allowed for individual attention to questions and concerns thereby making counselling in the DR feasible.     

HIV-related knowledge, attitudes, perceived benefits, and risks of HIV testing among pregnant women in rural Southern India

The rising prevalence of HIV among pregnant women in rural India is of great concern. Prenatal voluntary counseling and HIV testing (VCT) is critical to prevent mother-to-child transmission of HIV (PMTCT). We surveyed 202 pregnant women attending a rural antenatal clinic in Southern India to investigate HIV-related knowledge, attitudes toward infant feeding practices, and perceived benefits and risks of HIV testing. Of the total of 202 women surveyed, 189 women (94%) had heard of HIV/AIDS and 60% of them had relatively good knowledge regarding risk factors for HIV transmission. However, 48% did not know that there are "means to prevent mother-to-child HIV transmission." If women were not to breastfeed her baby, negative attitudes expected from the partner would include 84% thinking that that the mother is harming the baby, 78% thinking she is not a good mother, 74% thinking she has HIV, and 66% thinking she has been unfaithful. Ninety-seven percent of women did not perceive themselves at risk for HIV and only 57% had been tested for HIV. Although, 85% of women expressed their willingness to be tested, most were concerned about confidentiality and disclosing HIV serostatus because of fear of negative reactions from their husbands, parents, and community. Many social and cultural barriers confront pregnant women when they decide to opt for HIV testing. If VCT and PMTCT interventions are to be successful, urgent attention must be focused on education, development of innovative culturally appropriate interventions that empower women to make decisions about HIV testing, involvement of men, and addressing stigma and discriminatory attitudes toward people living with HIV/AIDS.     

Risk perception and counselling among HIV-positive women in São Paulo, Brazil

This study of HIV-positive women at a clinic for HIV/AIDS in S?o Paulo examined their risk perception for HIV before they had learned of their diagnosis and their experiences with pre- and post-test counselling. A sample of 148 women was interviewed regarding demographics, HIV risk factors and risk perception, pre- and post-test counselling, and sexual and reproductive conduct. The majority (77%) had been infected by their partners--37% by an injecting drug user partner. More than half (53%) did not perceive themselves at risk before learning of their HIV status and, of 68 who had perceived themselves at risk, 29% did so only after their partners became ill. The majority (64%) did not receive any kind of pre-test counselling. Post-test counselling was reported by 83% but 14% reported being mishandled by a physician in the process. Findings suggest the importance of prevention efforts to reduce women's barriers to learning about HIV status and the necessity of improving the quality of pre- and post-test counselling.     

认知和行为因素对孕妇接受HIV检测意愿的影响

目的了解孕妇接受艾滋病检测意愿,以及认知、行为因素对其的影响。方法采用随机抽样方法,应用基于健康信念模式自行设计的问卷,采用面对面的方式,对符合纳入标准的研究对象进行问卷调查。结果共调查500名孕妇,58.6%的孕妇表达了愿意在怀孕期间接受艾滋病免费检测。艾滋病知识知晓率低(完全正确仅11.6%)。27.6%的孕妇认为自己容易感染艾滋病,怕被人误解等是影响孕妇接受艾滋病检测意愿的因素。结论加强对孕妇的艾滋病健康教育,提高其艾滋病知识知晓率,增加孕妇艾滋病检测意愿,从而改变其行为,有效阻止艾滋病母婴传播。     

Factors affecting attitudes towards mother-to-child transmission of HIV among pregnant women in a maternal and child hospital in Thailand

This study determines the factors which correlate with attitudes towards mother-to-child transmission of HIV in pregnant women. Using a structured questionnaire, 527 pregnant women who visited a hospital to have prenatal checkups were interviewed. The survey items were: sociodemographic characteristics, experiences of pre-test counselling, knowledge of mother-to-child transmission, and attitude towards termination of pregnancy. Results showed that many pregnant women (80%) did not have proper knowledge of the possibility of mother-to-child transmission. Logistic regression analysis also indicates that age and knowledge of the possibility of mother-to-child transmission were the significant determinants of attitudes towards termination of pregnancy. Older women who believe that all the babies of pregnant women with HIV will be infected are most likely to terminate their pregnancy when they are diagnosed as HIV positive. Considering the importance of informed decisions regarding pregnancy, this study must have important implications for future support programmes for HIV-positive pregnant women.     

Awareness of HIV/AIDS and household environment of pregnant women in Pune, India

Our objective was to determine the level of HIV/AIDS knowledge of pregnant women in India. In a sub-sample of these women, we documented the extent to which they experienced adverse social and physical difficulties within their home. The study was performed at an urban antenatal hospital clinic in Maharastra, India. From April to September 2001, structured interviews were conducted on 707 randomly selected antenatal clinic patients related to HIV/AIDS knowledge. Of these, 283 were further interviewed to document any social or physical difficulties they experienced. Over 75% of women displayed knowledge of primary transmission routes. Nearly 70% of women demonstrated knowledge of maternal to child transmission, however, only 8% knew of any methods of prevention. TV and written material were more strongly related to knowledge than access to radio messages or conversations with individuals. Thirty per cent of the women experienced physical or mental abuse or their spouse's alcohol and/or drug problems. Women reporting such abuse were more than twice as likely to have adequate HIV/AIDS knowledge compared with women reporting no such abuse. We found no relationship between reported household abuse and educational level of woman, husband, occupation of either partner, language or religion. We found no relationship between HIV status and knowledge of HIV and no relationship between HIV status and risk of abuse in the household. However, the total number of HIV patients in our sample was very small.     

深圳市宝安区预防与控制HIV/AIDS母婴传播的研究

目的　了解深圳市孕产妇艾滋病病毒 (HIV)感染情况 ,探索阻断艾滋病 (AIDS)母婴传播的方法。方法　采取政府行为 ,建立监测网络 ,对全部首次做孕期检查的孕产妇免费进行HIV检测及规范化的干预措施。结果　 2 0 0 2年、2 0 0 3年的监测率分别为 95 .0 9%、95 .12 % ;孕产妇HIV感染率分别为 0 .0 0 2 %、0 .0 0 9%。通过健康教育干预 ,孕产妇AIDS预防知识知晓率从项目实施前的 2 8.5 %～ 5 8.6 %上升到实施后的 85 .6 %～ 10 0 .0 % (P <0 .0 0 1% )。结论　深圳市孕产妇的HIV感染率远低于云南等省 ,但有逐年升高的趋势 ;建立监测网络 ,免费对首次孕期检查的孕产妇做HIV检测并实施预防性干预 ,以阻断HIV垂直传播的方法是成功可行的。