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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.


Percentage of structured interview participants that agree with the copackage acceptability statements by HIV status group. (Possible responses to statements included agree, disagree, and no opinion. “No opinion” responses ranged from 0.4 to 2.0% of the three groups combined for each statement, except the instruction sheet statement, in which 13.7%, 24.8%, and 22.0% of HIV-negative, HIV-positive on prophylaxis, and HIV-positive on ART women responded with “no opinion,” because they did not have or did not use the sheet.)
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fig2: Percentage of structured interview participants that agree with the copackage acceptability statements by HIV status group. (Possible responses to statements included agree, disagree, and no opinion. “No opinion” responses ranged from 0.4 to 2.0% of the three groups combined for each statement, except the instruction sheet statement, in which 13.7%, 24.8%, and 22.0% of HIV-negative, HIV-positive on prophylaxis, and HIV-positive on ART women responded with “no opinion,” because they did not have or did not use the sheet.)

Mentions: Data from close-ended questions in SI and SSI were entered into a Microsoft Access database (2007) using a double data entry and verification system. Descriptive statistics were calculated and reported for key characteristics of the study participants and agreement with acceptability and feasibility statements and reported experiences. Means and standard deviations were reported for all continuous variables (Table 1) and frequencies and percentages were reported for all categorical variables (Tables 1 and 2 and Figures 2 and 3). Differences in (1) the level of agreement with acceptability and feasibility statements and (2) the experience of either positive or negative consequences as a result of pack receipt among HIV-negative women, HIV-positive women on prophylaxis, and HIV-positive women on ART were examined with generalized estimating equations (GEE) using the binomial distribution with the logit link for dichotomous outcomes or the multinomial distribution with the cumulative logit link for ordinal outcomes. Select significant findings are highlighted in the text. Compound symmetry and independent working correlation structures were considered to account for the clustering of women in multiple facilities. Score tests were used to test the proportional odds assumption, and the Tukey-Kramer method for P value adjustment was used to account for multiple comparisons. All statistical tests were two-sided and the level of statistical significance was set at 0.05. All data were analyzed in Washington, DC, USA, using SAS/STAT software version 9.3 (Cary, North Carolina).


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)

Percentage of structured interview participants that agree with the copackage acceptability statements by HIV status group. (Possible responses to statements included agree, disagree, and no opinion. “No opinion” responses ranged from 0.4 to 2.0% of the three groups combined for each statement, except the instruction sheet statement, in which 13.7%, 24.8%, and 22.0% of HIV-negative, HIV-positive on prophylaxis, and HIV-positive on ART women responded with “no opinion,” because they did not have or did not use the sheet.)
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Percentage of structured interview participants that agree with the copackage acceptability statements by HIV status group. (Possible responses to statements included agree, disagree, and no opinion. “No opinion” responses ranged from 0.4 to 2.0% of the three groups combined for each statement, except the instruction sheet statement, in which 13.7%, 24.8%, and 22.0% of HIV-negative, HIV-positive on prophylaxis, and HIV-positive on ART women responded with “no opinion,” because they did not have or did not use the sheet.)
Mentions: Data from close-ended questions in SI and SSI were entered into a Microsoft Access database (2007) using a double data entry and verification system. Descriptive statistics were calculated and reported for key characteristics of the study participants and agreement with acceptability and feasibility statements and reported experiences. Means and standard deviations were reported for all continuous variables (Table 1) and frequencies and percentages were reported for all categorical variables (Tables 1 and 2 and Figures 2 and 3). Differences in (1) the level of agreement with acceptability and feasibility statements and (2) the experience of either positive or negative consequences as a result of pack receipt among HIV-negative women, HIV-positive women on prophylaxis, and HIV-positive women on ART were examined with generalized estimating equations (GEE) using the binomial distribution with the logit link for dichotomous outcomes or the multinomial distribution with the cumulative logit link for ordinal outcomes. Select significant findings are highlighted in the text. Compound symmetry and independent working correlation structures were considered to account for the clustering of women in multiple facilities. Score tests were used to test the proportional odds assumption, and the Tukey-Kramer method for P value adjustment was used to account for multiple comparisons. All statistical tests were two-sided and the level of statistical significance was set at 0.05. All data were analyzed in Washington, DC, USA, using SAS/STAT software version 9.3 (Cary, North Carolina).

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.