Increasing Prevention of Mother to Child Transmission (PMTCT) Uptake through Facility-Based Health Promotion: Intervention Development
2. Materials and Methods
2.1. Step 1: Need Assessment
2.2. Step 2: Program Outcomes and Objectives
2.3. Step 3: Program Design
2.4. Step 4: Developing Intervention Components and Program Production
2.5. Step 5: Implementation Plan
2.6. Step 6: Evaluation Plan
3.1. Step 1: Need Assessment
3.2. Steps 2 and 3: Program Outcomes, Objectives and Design
3.3. Steps 4 and 5: Developing Intervention Components and Implementation Plan
- Sensitization of hospital management to prioritize PMTCT. The technical advisory group that was formed from the Sudan National AIDS program (SNAP), the representative of obstetrics and genecology specialists, and the senior management in hospitals all supported this. It was agreed that the HIV test will be added to the lab prescription that has ANC routine tests. They ensured that at least twice a week a quick orientation on PMTCT is done to the doctors in the hospital. This was included as a discussion point in their monthly meetings.
- Ensuring HIV testing kits are available and no stock-out during the intervention period. This was done in collaboration with SNAP, who confirmed supplies will be provided and no stock out will happen during the intervention period. The research team followed up on a monthly basis with the PMTCT team to ensure supplies are pre-positioned.
- Orientation of doctors with reminders to offer HIV tests during ANC visits. The senior genecologists in maternity hospitals were asked to facilitate this at least twice a week. The technical advisory group was assigned to monitor this.
- Incentivizing counsellors to increase group and individual awareness and counselling for pregnant women during waiting time as well as individual counselling. The research team provided technical and supportive supervision to the counsellors in the hospitals. A limited financial incentive was also secured for the counsellors.
- Work with the lab technicians to expect an increase in HIV test requests. The research team followed up with the lab teams in the hospitals who also received orientation from the hospital management on the expected increase in the number of HIV tests.
- Mother-to-mother peer support group. We considered the educational level of pregnant women and their exposure to PMTCT and created effective awareness and counselling sessions. A group of pregnant women volunteered to support PMTCT awareness. They were trained on interpersonal communication skills and developed awareness schedules targeting their peers during the ANC visits.
- Supported aid materials. Print and audio-visual Information, Education, and Communication (IEC) materials are available and clearly visible in the waiting areas. A set of IEC materials that address the knowledge gap in relation to the individual level determinants was drafted and pre-tested among the pregnant women. These materials were then produced and placed in the waiting areas of the PMTCT sites and small leaflets were also handed to pregnant women who joins the group awareness and counselling sessions.
- Reporting: The research team worked with the PMTCT teams in the hospitals to ensure that the routine reporting systems are strengthened to capture the intervention components. For example, the number of counselling sessions conducted, the number of pregnant women that participated, and the number of pregnant women tested. As described in the evaluation section that follows, these were captured before, during, and after the intervention.
3.4. Step 6: Evaluation
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Name of Hospital||Sample Size (Number of Pregnant Women)||Type of Group|
|Omdurman Maternity Hospital||126||Experimental (intervention)|
|Al Suadi Maternity Hospital||115||Control (no intervention)|
|Bahri Teaching Hospital||77||Control (no intervention)|
|Al Turki Naternity Hospital||67||Experimental (intervention)|
|Existing Practices/Behaviours According to the Assessment||Determinants||Performance Objective||Proposed Interventions||Expected Effect|
|Strong coordination and advocacy with hospitals to support the intervention plan is needed||Willingness and support of the senior management in hospitals||Establish a technical advisory group to strengthen the coordination and ensure buy-in||Regular meetings, sensitization||Improved coordination and accountability to support the PMTCT intervention|
|Doctors are not offering the HIV test for the pregnant women||No clear policy directive. Very busy schedule and a lot of pregnant women coming, time-consuming |
Not a priority compared to other aspects of health care
|Doctors offer HIV tests to pregnant women during their ANC visits||1. Sensitization of doctors, including the issuance of a clear policy directive from the director of the hospital|
2. Key reminders and follow up with doctors
|Increase in percent of pregnant women tested for HIV|
|Lab technicians/staff are not prepared for an additional number of HIV tests||Perceived as an additional burden||Ensure that testing kits for HIV tests are available|
Lab technicians are aware and committed to the expected increase in HIV tests
|1. Provision of adequate testing kits|
2. Reminders for the lab technicians
|Quick and fast HIV tests are performed for pregnant women|
|Counsellors are not used to additional counselling sessions (pre and post-test sessions)||Perceived as an additional burden||Counsellors are prepared for additional counselling sessions following the expected increase of number of women who will be tested||1. Provision of supportive aid, e.g., IEC materials|
2. Reminders and financial incentives for counsellors
|Quality counselling sessions with more pregnant women involved|
|Existing Practices/Behaviours According to the Assessment||Determinants||Performance Objective||Proposed Interventions||Expected Effect|
|Pregnant women (PW) are not aware about the benefits of PMTCT||Limited knowledge about the PMTCT services and benefits |
Limited and poor public counselling sessions at PMTCT site
|Ensure that 85% of pregnant women attending the ANC are exposed to HIV awareness|
Refresher training of the counsellors to ensure quality sessions
|Awareness-raising sessions through counsellors and IEC materials (Print + TV screen) |
Mass-media short messages about importance of HIV test during pregnancy
Peer education groups from PW themselves
|Increase in knowledge among PW|
|Pregnant women are scared when they hear about HIV and AIDS||Scared of being positive and the consequences |
Believe that it is a chronic killing disease
Lack of in-depth discussion on PMTCT
|Ensure that 75% of pregnant women attending the ANC are exposed to quality HIV counselling||Counselling sessions targeting MTCT knowledge gaps|
Improved counselling by ensuring sessions are well-designed and tailored to the issues identified in our assessment
Stigma reduction through giving examples of successful delivery of HIV positive women and the fact that with the ARV people with HIV lives productive life
|Pregnant women are better prepared to accept HIV tests during pregnancy|
|Pregnant women are not convinced to undergo HIV test||Low self-efficacy |
Absence of high-quality counselling sessions
|Ensure that 65% of pregnant women attending the ANC are exposed to HIV peer education and high-quality individual counselling sessions||Establishment of pregnant women peer groups to do peer education sessions||Increase in percent of women who accept HIV test|
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Elsheikh, I.E.; Crutzen, R.; Adam, I.; Abdelraheem, S.I.; Van den Borne, H.W. Increasing Prevention of Mother to Child Transmission (PMTCT) Uptake through Facility-Based Health Promotion: Intervention Development. Behav. Sci. 2023, 13, 317. https://doi.org/10.3390/bs13040317
Elsheikh IE, Crutzen R, Adam I, Abdelraheem SI, Van den Borne HW. Increasing Prevention of Mother to Child Transmission (PMTCT) Uptake through Facility-Based Health Promotion: Intervention Development. Behavioral Sciences. 2023; 13(4):317. https://doi.org/10.3390/bs13040317Chicago/Turabian Style
Elsheikh, Ibrahim Elsiddig, Rik Crutzen, Ishag Adam, Salah Ibrahim Abdelraheem, and Hubertus W. Van den Borne. 2023. "Increasing Prevention of Mother to Child Transmission (PMTCT) Uptake through Facility-Based Health Promotion: Intervention Development" Behavioral Sciences 13, no. 4: 317. https://doi.org/10.3390/bs13040317