Tuberculosis Screening for Pregnant Women Living with HIV in UThungulu District, in 2011/2012.

Abstract

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection in pregnancy are risk factors that affect both maternal and perinatal outcomes. TB is preventable in pregnant women living with HIV by initiating Isoniazid (INH) prophylactic therapy (IPT) if there are no TB symptoms upon screening. This study analysed health system factors associated with TB screening of pregnant women living with HIV, in 2011/2012, in antenatal care services in UThungulu District, in the Province of KwaZulu-Natal. Purpose To analyze health system factors associated with TB screening of pregnant women living with HIV in Basic Antenatal Care (BANC) services in UThungulu District. Objectives To determine the proportion of pregnant women living with HIV screened for TB at initiation of BANC in health facilities in UThungulu District and to analyze health system factors associated with the TB screening. Methods An observational cross-sectional study design, with descriptive and analytic components was carried out in health facilities in UThungulu District. Multi-stage sampling was used to select health facilities and then to select pregnant women living with HIV initiating BANC. An interviewer-administered structured questionnaire and data extraction tools were used to collect data. Data was analysed using descriptive and analytic statistics using mixed effect logistic regression with cluster vii effect, and doer and non-doer analysis, with Fischer’s exact analysis. The level of statistical significance was set at p=0.05. Results The results of the study showed that pregnant women living with HIV were 3 times more likely to be screened for TB in clinics where personnel had been trained on TB management, on Antiretroviral Therapy (ART) for pregnant women, and on the Prevention of Mother to Child Transmission (PMTCT) of HIV; and in clinics with a full-time enrolled nurse. Furthermore, clinics where ALL pregnant women living with HIV were screened for TB were more likely to have: a full-time midwife; personnel at all levels trained on TB management, on ART for pregnant women, and on PMTCT; and a policy to trace pregnant women who do not adhere to their scheduled subsequent visit. Conclusion Clinics with appropriate, and trained personnel, with a policy to follow-up pregnant women who do not adhere to scheduled appointments, are health system factors associated with the implementation of the National Department of Health Guideline and World Health Organisation recommendation for the screening of TB in pregnancy for women living with HIV