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Pregnant and Postpartum Women's Experiences and Perspectives on the Acceptability and Feasibility of Copackaged Medicine for Antenatal Care and PMTCT in Lesotho.

Gill MM, Hoffman HJ, Tiam A, Mohai FM, Mokone M, Isavwa A, Mohale S, Makhohlisa M, Ankrah V, Luo C, Guay L - AIDS Res Treat (2015)

Bottom Line: Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested.Conclusions.Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Avenue NW, Suite 200, Washington, DC 20036, USA.

ABSTRACT
Objective. To improve PMTCT and antenatal care-related service delivery, a pack with centrally prepackaged medicine was rolled out to all pregnant women in Lesotho in 2011. This study assessed acceptability and feasibility of this copackaging mechanism for drug delivery among pregnant and postpartum women. Methods. Acceptability and feasibility were assessed in a mixed method, cross-sectional study through structured interviews (SI) and semistructured interviews (SSI) conducted in 2012 and 2013. Results. 290 HIV-negative women and 437 HIV-positive women (n = 727) participated. Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested. Positive experiences included that the pack helped women take pills as instructed and contents promoted healthy pregnancies. Negative experiences included inadvertent pregnancy disclosure and discomfort carrying the pack in communities. Implementation was also feasible; 85.2% of SI participants reported adequate counseling time, though 37.8% felt pack use caused clinic delays. SSI participants reported improvement in service quality following pack introduction, due to more comprehensive counseling. Conclusions. A prepackaged drug delivery mechanism for ANC/PMTCT medicines was acceptable and feasible. Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

No MeSH data available.


Related in: MedlinePlus

The pack and its inner boxes and instruction sheet. Counterclockwise from the left. (1) Outer pack identical for all women (size: 255 mm × 182 mm × 130 mm). (2) Instruction sheet written in Sesotho. (3) Blue inner box containing medicine to be taken during pregnancy: (i) ferrous sulphate, folic acid, and Vitamin B-complex for all women; (ii) Zidovudine (AZT) for HIV-positive women on ARV prophylaxis. (4) Yellow inner box containing medicine to be taken during delivery: (i) AZT/Lamivudine (3TC) in fixed dose combination and Nevirapine tablets for HIV-positive women on ARV prophylaxis. (5) Pink inner box containing medicine for the mother to be taken postpartum: (i) AZT/3TC 7-day “tail” in fixed dose combination for HIV-positive women on ARV prophylaxis; (ii) vitamin A for all women. (6) Pink inner box containing medicine for the infant through six weeks of age: (i) Nevirapine syrup and syringe for administration for HIV-positive women on prophylaxis and treatment.
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fig1: The pack and its inner boxes and instruction sheet. Counterclockwise from the left. (1) Outer pack identical for all women (size: 255 mm × 182 mm × 130 mm). (2) Instruction sheet written in Sesotho. (3) Blue inner box containing medicine to be taken during pregnancy: (i) ferrous sulphate, folic acid, and Vitamin B-complex for all women; (ii) Zidovudine (AZT) for HIV-positive women on ARV prophylaxis. (4) Yellow inner box containing medicine to be taken during delivery: (i) AZT/Lamivudine (3TC) in fixed dose combination and Nevirapine tablets for HIV-positive women on ARV prophylaxis. (5) Pink inner box containing medicine for the mother to be taken postpartum: (i) AZT/3TC 7-day “tail” in fixed dose combination for HIV-positive women on ARV prophylaxis; (ii) vitamin A for all women. (6) Pink inner box containing medicine for the infant through six weeks of age: (i) Nevirapine syrup and syringe for administration for HIV-positive women on prophylaxis and treatment.

Mentions: The copackage is a color-coded rectangular box, measuring 255 mm × 182 mm × 130 mm (Figure 1). Each pack contained smaller packages inside representing the antenatal, intrapartum, and postpartum periods of pregnancy. The outer bag was also rectangle-shaped and made of dark blue cloth with no words or other markings. To minimize potential stigmatization associated with the pack, three package types were implemented: Pack 1 for HIV-negative women, Pack 2 for HIV-positive women eligible for PMTCT prophylaxis, and Pack 3 for HIV-positive women on antiretroviral treatment (ART). (All packs contained iron, folic acid, Vitamin A, and Vitamin B-complex. In addition, Pack 2 contained AZT tablets from 14 weeks of gestation to delivery and AZT/3TC (fixed dose combination) and Nevirapine tablets for delivery and 7 days postpartum. Providers administering the pack removed excess AZT from the pack based on the gestational age at which the woman received the pack. Pack 2 and Pack 3 also contained Nevirapine syrup with a syringe for administration to the infant until 6 weeks of age.) The packs were assembled and filled centrally and distributed to the health facilities through the existing system. The copackages were administered at the first ANC visit (≥14 weeks of gestation) and contained drugs through six weeks postpartum, including Nevirapine (NVP) for HIV-exposed infants. Pack 3 contained only one month of ART so women on treatment for their own health still had to return monthly to obtain refills. All packs contained ferrous sulphate, folic acid, and Vitamin A and Vitamin B-complex, which were not provided consistently and universally to pregnant women prior to the pack's implementation, and an instruction sheet. All women were advised to bring the pack to each visit in order to provide additional counseling and review of contents and to assess adherence to both the PMTCT drugs and other pack contents. The copackage differed from standard PMTCT care primarily in the drug delivery mechanism: dispensing a supply of maternal and infant drugs at the first ANC visit to last through six weeks postpartum, particularly to target HIV-positive women on prophylaxis in case they did not return for a subsequent ANC visit or deliver in a health facility. However, women were counseled on the importance of returning to the facility for HIV and pregnancy-related care. Women and their infants continued clinic follow-up after six weeks postpartum with collection of additional infant NVP for women on prophylaxis and additional ARV for women on ART. The pack was first piloted in three districts in January 2011 and then rolled out nationally to the remaining seven districts by August 2011.


Pregnant and Postpartum Women's Experiences and Perspectives on the Acceptability and Feasibility of Copackaged Medicine for Antenatal Care and PMTCT in Lesotho.

Gill MM, Hoffman HJ, Tiam A, Mohai FM, Mokone M, Isavwa A, Mohale S, Makhohlisa M, Ankrah V, Luo C, Guay L - AIDS Res Treat (2015)

The pack and its inner boxes and instruction sheet. Counterclockwise from the left. (1) Outer pack identical for all women (size: 255 mm × 182 mm × 130 mm). (2) Instruction sheet written in Sesotho. (3) Blue inner box containing medicine to be taken during pregnancy: (i) ferrous sulphate, folic acid, and Vitamin B-complex for all women; (ii) Zidovudine (AZT) for HIV-positive women on ARV prophylaxis. (4) Yellow inner box containing medicine to be taken during delivery: (i) AZT/Lamivudine (3TC) in fixed dose combination and Nevirapine tablets for HIV-positive women on ARV prophylaxis. (5) Pink inner box containing medicine for the mother to be taken postpartum: (i) AZT/3TC 7-day “tail” in fixed dose combination for HIV-positive women on ARV prophylaxis; (ii) vitamin A for all women. (6) Pink inner box containing medicine for the infant through six weeks of age: (i) Nevirapine syrup and syringe for administration for HIV-positive women on prophylaxis and treatment.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663282&req=5

fig1: The pack and its inner boxes and instruction sheet. Counterclockwise from the left. (1) Outer pack identical for all women (size: 255 mm × 182 mm × 130 mm). (2) Instruction sheet written in Sesotho. (3) Blue inner box containing medicine to be taken during pregnancy: (i) ferrous sulphate, folic acid, and Vitamin B-complex for all women; (ii) Zidovudine (AZT) for HIV-positive women on ARV prophylaxis. (4) Yellow inner box containing medicine to be taken during delivery: (i) AZT/Lamivudine (3TC) in fixed dose combination and Nevirapine tablets for HIV-positive women on ARV prophylaxis. (5) Pink inner box containing medicine for the mother to be taken postpartum: (i) AZT/3TC 7-day “tail” in fixed dose combination for HIV-positive women on ARV prophylaxis; (ii) vitamin A for all women. (6) Pink inner box containing medicine for the infant through six weeks of age: (i) Nevirapine syrup and syringe for administration for HIV-positive women on prophylaxis and treatment.
Mentions: The copackage is a color-coded rectangular box, measuring 255 mm × 182 mm × 130 mm (Figure 1). Each pack contained smaller packages inside representing the antenatal, intrapartum, and postpartum periods of pregnancy. The outer bag was also rectangle-shaped and made of dark blue cloth with no words or other markings. To minimize potential stigmatization associated with the pack, three package types were implemented: Pack 1 for HIV-negative women, Pack 2 for HIV-positive women eligible for PMTCT prophylaxis, and Pack 3 for HIV-positive women on antiretroviral treatment (ART). (All packs contained iron, folic acid, Vitamin A, and Vitamin B-complex. In addition, Pack 2 contained AZT tablets from 14 weeks of gestation to delivery and AZT/3TC (fixed dose combination) and Nevirapine tablets for delivery and 7 days postpartum. Providers administering the pack removed excess AZT from the pack based on the gestational age at which the woman received the pack. Pack 2 and Pack 3 also contained Nevirapine syrup with a syringe for administration to the infant until 6 weeks of age.) The packs were assembled and filled centrally and distributed to the health facilities through the existing system. The copackages were administered at the first ANC visit (≥14 weeks of gestation) and contained drugs through six weeks postpartum, including Nevirapine (NVP) for HIV-exposed infants. Pack 3 contained only one month of ART so women on treatment for their own health still had to return monthly to obtain refills. All packs contained ferrous sulphate, folic acid, and Vitamin A and Vitamin B-complex, which were not provided consistently and universally to pregnant women prior to the pack's implementation, and an instruction sheet. All women were advised to bring the pack to each visit in order to provide additional counseling and review of contents and to assess adherence to both the PMTCT drugs and other pack contents. The copackage differed from standard PMTCT care primarily in the drug delivery mechanism: dispensing a supply of maternal and infant drugs at the first ANC visit to last through six weeks postpartum, particularly to target HIV-positive women on prophylaxis in case they did not return for a subsequent ANC visit or deliver in a health facility. However, women were counseled on the importance of returning to the facility for HIV and pregnancy-related care. Women and their infants continued clinic follow-up after six weeks postpartum with collection of additional infant NVP for women on prophylaxis and additional ARV for women on ART. The pack was first piloted in three districts in January 2011 and then rolled out nationally to the remaining seven districts by August 2011.

Bottom Line: Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested.Conclusions.Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

View Article: PubMed Central - PubMed

Affiliation: Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Avenue NW, Suite 200, Washington, DC 20036, USA.

ABSTRACT
Objective. To improve PMTCT and antenatal care-related service delivery, a pack with centrally prepackaged medicine was rolled out to all pregnant women in Lesotho in 2011. This study assessed acceptability and feasibility of this copackaging mechanism for drug delivery among pregnant and postpartum women. Methods. Acceptability and feasibility were assessed in a mixed method, cross-sectional study through structured interviews (SI) and semistructured interviews (SSI) conducted in 2012 and 2013. Results. 290 HIV-negative women and 437 HIV-positive women (n = 727) participated. Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested. Positive experiences included that the pack helped women take pills as instructed and contents promoted healthy pregnancies. Negative experiences included inadvertent pregnancy disclosure and discomfort carrying the pack in communities. Implementation was also feasible; 85.2% of SI participants reported adequate counseling time, though 37.8% felt pack use caused clinic delays. SSI participants reported improvement in service quality following pack introduction, due to more comprehensive counseling. Conclusions. A prepackaged drug delivery mechanism for ANC/PMTCT medicines was acceptable and feasible. Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

No MeSH data available.


Related in: MedlinePlus