In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
In 2016, UNAIDS identified the Prevention of Mother-to-Child Transmission of HIV (PMTCT) as a significant challenge in the fight against HIV/AIDS in Guinea. This abstract presents the key findings of an evaluation conducted on the PMTCT component of MSF's HIV project in Guinea, implemented since the early 2000’s. The main objective of the evaluation was to assess its relevance, coherence, effectiveness, efficiency, impact, and sustainability.
METHODS
A mixed quantitative and qualitative methodology was applied, including a desk review of MSF project documents, field observations, and interviews with key stakeholders. The data were analysed by triangulation and benchmarking to ensure internal validity. Quantitative indicators provided information on the number of women receiving PMTCT treatment and the rate of HIV mother-to-child transmission (MTCT) in health facilities supported by MSF, allowing the measurement of the effectiveness of the intervention. The quality of data and the lack of primary data from 2011 to 2015 was the main limitation, hindering the calculation of statistical significance (p-value) for the observed change in the rate of MTCT of HIV.
RESULTS
MSF's PMTCT intervention was highly relevant and aligned with the country's needs. It demonstrated effectiveness through the significant number of women receiving PMTCT treatment, the establishment of a platform for viral load testing, drug supply support, and a reduction in the HIV MTCT rate. The rate of MTCT in health facilities supported by MSF decreased from 35.9% to 12% [7 – 12] between 2010 and 2021. The challenges relating to data accuracy, monitoring activities, the follow-up of babies born from HIV-infected mothers, and the readiness of the MoH to take over the programme were identified, highlighting the need for improvement to enhance the effectiveness and efficiency. Sustainability efforts remained low as the Guinean health system lacked enough funding to take over the programme.
CONCLUSIONS
The evaluation affirms the positive impact of the PMTCT intervention in reducing MTCT of HIV, even if project target (5%) was not achieved. Recommendations aim to strengthen investment in PMTCT and enhance the hand-over strategy to ensure sustainability after MSF exit.
CONTEXTE ET OBJECTIFS
Les épidémies de maladies évitables par la vaccination sont récurrentes en Guinée. En 2020, Matoto a enregistré 86% des cas de rougeole rapportés à Conakry. Cette étude avait pour objectif d’évaluer les occasions manquées de vaccination chez les enfants de 0-59 mois.
METHODES
Il s’agissait d’une étude transversale par entretien de sortie dans quatre établissements de santé (ES) de Matoto (Bernay Fotoba, Saint Gabriel, Tombolia, Dabompa) du 11-19 avril 2023. A été considéré comme OMV, tout enfant qui n'avait pas reçu les vaccins indiqués à l’issue de sa visite même s'il avait dépassé l'âge recommandé pour les recevoir selon la politique du pays.
Un échantillon de convenance par défaut a été utilisé avec au minimum, 100 enfants sélectionnés (50 âgés de 0-23 mois et 50 âgés de 24-59 mois) dans chaque ES. Les données ont été recueillies à l'aide d’un questionnaire anonyme standardisé MSF puis saisies dans une base de données Excel développé par MSF où les indicateurs ont été calculés automatiquement. Cette évaluation a reçu les approbations du comité national d’éthique et du comité d’éthique de MSF.
RESULTATS
Sur 357 enfants (0-23 mois=182 ; 24-59 mois=175) éligibles pour une vaccination, 300 ont présenté une OMV soit une prévalence des OMV de 84% (300/357). Parmi les enfants avec OMV, 53% (159/300) avait 24-59 mois. Ceux de 0-23 mois, cible du PEV, représentaient 47% (141/300). Le vaccin antirougeoleux (56%) et le vaccin antipoliomyélitique oral (50%) ont été les plus manqués. Nous notons que 41% (124/300) des enfants avec OMV étaient présents dans ces ES pour une vaccination. Le manque d’information (47%) et les ruptures de vaccins (38%) étaient les principales raisons invoquées par les participants pour justifier les OMV.
CONCLUSIONS
Nos résultats montrent la nécessité d’intégrer l’évaluation des OMV dans le système de santé en tant que processus de routine et d’assurer un approvisionnement constant et suffisant en vaccins et matériel de vaccination.
CONTEXTE ET OBJECTIFS
Les épidémies de maladies évitables par la vaccination sont récurrentes en Guinée. En 2020, Matoto a enregistré 86% des cas de rougeole rapportés à Conakry. Cette étude avait pour objectif d’évaluer les occasions manquées de vaccination chez les enfants de 0-59 mois.
METHODES
Il s’agissait d’une étude transversale par entretien de sortie dans quatre établissements de santé (ES) de Matoto (Bernay Fotoba, Saint Gabriel, Tombolia, Dabompa) du 11-19 avril 2023. A été considéré comme OMV, tout enfant qui n'avait pas reçu les vaccins indiqués à l’issue de sa visite même s'il avait dépassé l'âge recommandé pour les recevoir selon la politique du pays.
Un échantillon de convenance par défaut a été utilisé avec au minimum, 100 enfants sélectionnés (50 âgés de 0-23 mois et 50 âgés de 24-59 mois) dans chaque ES. Les données ont été recueillies à l'aide d’un questionnaire anonyme standardisé MSF puis saisies dans une base de données Excel développé par MSF où les indicateurs ont été calculés automatiquement. Cette évaluation a reçu les approbations du comité national d’éthique et du comité d’éthique de MSF.
RESULTATS
Sur 357 enfants (0-23 mois=182 ; 24-59 mois=175) éligibles pour une vaccination, 300 ont présenté une OMV soit une prévalence des OMV de 84% (300/357). Parmi les enfants avec OMV, 53% (159/300) avait 24-59 mois. Ceux de 0-23 mois, cible du PEV, représentaient 47% (141/300). Le vaccin antirougeoleux (56%) et le vaccin antipoliomyélitique oral (50%) ont été les plus manqués. Nous notons que 41% (124/300) des enfants avec OMV étaient présents dans ces ES pour une vaccination. Le manque d’information (47%) et les ruptures de vaccins (38%) étaient les principales raisons invoquées par les participants pour justifier les OMV.
CONCLUSIONS
Nos résultats montrent la nécessité d’intégrer l’évaluation des OMV dans le système de santé en tant que processus de routine et d’assurer un approvisionnement constant et suffisant en vaccins et matériel de vaccination.
INTRODUCTION
Guinea’s Ministry of Health has proposed a standardized national community health program, including health promotion, case management, and referral; historically however the system has been implemented piecemeal by various actors. MSF has been present in Kouroussa, northern Guinea, since 2017. MSF activities there have been focused on community healthcare, through training and support for community health workers, or “recos”. Before exiting, MSF conducted a mixed-methods study to understand differences in the models and effects of MSF community health program, as compared to those implemented by other actors.
METHODS
We implemented an explanatory, sequential, mixed-methods study in Kouroussa and in three other zones, Mandiana, Télimélé, and Boussou; sites were selected to represent a diversity of situations, and those outside Kouroussa are supported by non-MSF actors. During the quantitative phase, 137 recos and 13 supervisory community health agents were interviewed about their demographic and professional details, availability of tools, the package of activities, activity levels, and practical knowledge. A qualitative phase, including 24 focus group discussions and 65 individual interviews followed, aiming to better understand the community and local health professional perceptions of community health programmes in each of the four zones. Quantitative data were analyzed using R (Vienna, Austria) to calculate descriptive measures; differences were compared between zones using chi-square and t-tests. Qualitative data audio recordings were translated and transcribed, read, and re-read to identify codes and themes.
ETHICS
This study was approved by the MSF Ethics Review Board and by the Comité National de la Recherche, Guinea.
RESULTS
Overall, recos in Mandiana and Télimélé were primarily involved in health promotion and referral, while recos in Kouroussa (supported by MSF), and some in Boussou, additionally conducted case management. In Kouroussa, recos conducted a median of 16.5 malaria consultations per month, compared to 8.0 in Boussou, 2.1 in Télimélé, and 0 in Mandiana (p<0.0005). The zones where recos conducted case management were those where medicines were more available, with 92% of recos in Kouroussa possessing anti-malarials at the time of visit, compared to 38% in Boussou, 3% in Télimélé, and 7% in Mandiana (p<0.0005). Qualitative data revealed that for recos to expand from health promotion into case management, medicines must be available, and in Kouroussa the community emphasized the importance of free care. Moreover, qualitative data showed the primary motivation for recos was their loyalty to their community, and that recos were better accepted and more effective when they came from the same community they served, or were a “child” of the village.
CONCLUSION
To consistently achieve stated national ambitions of having recos that conduct case management, including in Kouroussa after MSF exits, medicine availability must be assured through appropriate resourcing. Additionally, our data suggest that each community should continue to have the power to choose their own reco.
CONFLICTS OF INTEREST
None declared.