A mixed methods study on the barriers and facilitators of implementing HIV re-testing guidelines on pregnant women at a referral hospital in Kenya

Abstract

<title>Abstract</title> Background The Ministry of Health-Kenya developed guidelines on HIV testing for pregnant women at different points in time as a mitigative measure against mother-to child-transmission (MTCT) of HIV. However, the barriers and facilitators in the implementation of HIV re-testing guidelines among pregnant women in Kenya are not well understood. The aim of the present study was to evaluate the barriers and facilitators of HIV testing guidelines among pregnant women at the Pumwani Maternity Hospital. Methods This was a mixed methods study. Qualitative data on the barriers and facilitators of HIV re-testing among pregnant women was collected by interviewing key informants (healthcare workers). Quantitative data was collected from pregnant women who had been recruited into the study. Women with an initial HIV negative result at the antenatal clinic (ANC) were recruited at the labor/postnatal ward and at six weeks postnatal review. Quantitative data was analyzed using descriptive statistics while qualitative data was audio recorded, transcribed, and themes were identified. Results There were 242 women who participated in the interview 97 of whom were followed up at 6 weeks via a telephone interview. There were 170 women interviewed at labor ward. The retesting rate was 116 (69.5%). Majority of the women 114 (67.5%) lacked awareness on the need for HIV retesting. Of the 97 women followed up at 6 weeks postpartum, 72 (75%) were retested for HIV. Of the 15 HCWs who were interviewed, 14 (93.3%) had received HTS training. There was varied knowledge on repeat testing guidelines for HIV and the team relied on mentor mothers and prevention of mother to child transmission (PMTCT) nurses to implement the guideline. Conclusion These findings suggest that there were more missed opportunities for HIV re-testing at the labor ward relative to re-testing. There is a need to improve HIV screening at the labor ward to minimize lost opportunities for HIV screening.