LSTM Home > LSTM Research > LSTM Online Archive

Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study

Downloads

Downloads per month over past year

Young, Nicole, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Aol, George, Bigogo, Godfrey M., Phillips-Howard, Penelope ORCID: https://orcid.org/0000-0003-1018-116X, Hill, Jenny, Laserson, Kayla F., terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 and Desai, Meghna (2018) 'Integrated point-of-care testing (POCT) of HIV, syphilis, malaria and anaemia in antenatal clinics in western Kenya: A longitudinal implementation study'. PLoS ONE, Vol 13, Issue 7, e0198784.

[img]
Preview
Text
plos_one_integrated point of care testing.pdf - Published Version
Available under License Creative Commons Public Domain Dedication.

Download (3MB) | Preview

Abstract

Background
In sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women.

Methods
A longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence.

Findings
For first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin–piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses.

Conclusions
Integrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Sexually Transmitted Diseases > WC 142 Public health control measures
WC Communicable Diseases > Sexually Transmitted Diseases > WC 160 Syphilis
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0198784
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 24 Jul 2018 14:11
Last Modified: 26 Jul 2018 09:16
URI: https://archive.lstmed.ac.uk/id/eprint/8948

Statistics

View details

Actions (login required)

Edit Item Edit Item