Knowledge, Attitudes and Practices on Prevention of Mother to Child transmission of HIV among Health Care Providers at the University Teaching Hospital and in Lusaka Urban Clinics

Abstract

In most developed countries HIV testing, use of antiretroviral drugs (ARVs) and modification of feeding practices have greatly reduced the rate of mother to child transmission (MTCT) of HIV-1 though this is not the case in many African countries. In Zambia, prevention of mother to child transmission (PMTCT) services has been introduced in nearly all public health institutions. Proper implementation of these services however, requires adequate knowledge and appropriate attitudes and practices (KAPs) on the part of the healthcare providers. The objective of this study was to assess the KAPs regarding PMTCT among healthcare providers at the University Teaching Hospital and in Lusaka Urban Clinic.This was an interviewer-administered questionnaire-based cross sectional study conducted at the University Teaching Hospital's Department of Obstetrics and Gynaecology as well as in Maternal and Child Health and maternity departments of four randomly selected clinics in the Lusaka Urban District, namely: Chilenje, Mtendere, Matero Reference, and George clinics. The participants were doctors, midwives, and general nurses in these facilities. Information was obtained on interventions for prevention of mother to child transmission (PMTCT) of HIV, negative and positive attitudes towards PMTCT, willingness to care for HIV infected pregnant women, practice of known interventions for PMTCT and perception of risk of acquiring occupational infection by the healthcare providers.Knowledge levels on PMTCT was variable (mean composite scores were in the 60-70% range, though only 45% knew of the risk during delivery and 19% through breastfeeding; almost 50% knew of an ARV prophylaxis regimen and 63% when to initiate ARVs). There was no statistically significant difference in mean scores by facility (UTH/Clinics), though younger, university trained providers (doctors) had better knowledge. Attitudes towards PMTCT were good (95%). Most providers (98%) were willing to care for HIV infected women and were not afraid of occupational infection. Ninety nine percent perceived the PMTCT programme to be very important. However they felt that there was not enough time to give to PMTCT (53.6%).This was possibly due to staff shortages. Most (80%) of the providers interviewed perceived the workload associated with PMTCT to be too much. The practice of PMTCT interventions was acceptable (89.3 percent offering voluntary counseling and testing; 93 percent offered ARVs for prophylaxis and 86.4 percent offering infant feeding counseling). Although caesarean section was not in the Zambian guidelines for PMTCT, 98.6 percent said they offered it as an option for delivery. However only 44.3 percent reported that they were offering safer obstetric practices and only 40.7 percent offered PCR testing.The study showed gaps in knowledge, attitudes, and practice on PMTCT amongst health care providers at UTH and in Lusaka urban clinics. Without further training and increase in staffing levels, the quality of and access to PMTCT services will likely be negatively impacted.