Optimal utilization of prevention of mother to child transmission of HIV services among adolescents under group versus focused antenatal care in Eastern Uganda

Abstract

Background: In the developed world, group antenatal care (G-ANC), an alternative to focused ANC has been associated with improved utilization of health care services like PMTCT of HIV services. Some low resource countries with poor utilization of health care services have piloted G-ANC. However, there is limited evidence of its efficiency. Objective: To compare group versus focused ANC; determine associated factors and explore barriers and facilitators under G-ANC for adolescent mothers with regards to optimal utilization of PMTCT of HIV services in Eastern Uganda. Methods: Following approval from the Makerere University School of Medicine Research Ethics Committee, a sequential explanatory mixed methods study among 528 adolescent mothers in 4 sites in Eastern Uganda was carried out. Data collected by interviewer administered questionnaires was analyzed in Stata version 16.0. Data was declared as a survey design dataset to adjust for clustering by study site. Stratified analysis at univariate basing on mode of ANC was used. The optimal utilization of PMTCT of HIV services under G-ANC versus F-ANC were compared using cluster adjusted T statistic after determining the mean proportion of optimal utilization in either ANC programme. To adjust for multilevel clustering i.e. by sampling by study site and HCW that offered PMTCT services under G-ANC, and because the prevalence was greater than 30%, a GLMM using poisson family and log link was used to determine the factors associated with optimal utilization of PMTCT of HIV services among adolescent mothers under G-ANC. Data from audio recordings were transcribed and analyzed using a deductive thematic analysis to explore barriers and facilitators. Results: There was a significant difference in mean proportion of adolescents that optimally utilized PMTCT of HIV services under G-ANC versus F-ANC (0.747 vs 0.412, p-0.0162). Associated factors among adolescent mothers under G-ANC were being married/cohabiting [PR=0.947, CI (0.903-0.994)], having higher education (secondary/ tertiary) [PR=1.075, CI (1.051-1.100)], attending greater than or equal to four ANC visits [PR=1.361, CI (1.216-1.524)], having had provider initiated testing and counselling [PR=1.049, CI (1.015-1.084)], being from Bugembe HCIV [PR=1.085, CI(1.070-1.100)] and trimester of first ANC visit: second trimester [PR=1.349, CI (1.286-1.414)] and first trimester [PR=1.361, (1.329-1.470)]. Limited space, few HCWs and financial constraints were major barriers for adolescents under G-ANC while encouragement from health care workers, effective ANC organization, low fear of discrimination and desire to protect child were reported as major facilitators. Conclusions and recommendations: Adolescent mothers under G-ANC had significantly higher optimal utilization of PMTCT of HIV services compared to those under F-ANC. Findings from this study support wider implementation of G-ANC by MoH especially among adolescents as it appears to be adolescent friendly in Uganda. Since the success of G-ANC depends on other health system factors, there is need for MoH and supporting partners to support G-ANC by providing bigger spaces, perhaps setting up separate facilities for G-ANC as well as supporting health care providers.