Evaluation of the quality of counselling for prevention of mother to child transmission of HIV offered to pregnant women in the copperbelt province of Zambia
Background: One study on estimating rates of mother to child transmission of HIV (MTCT) in program settings in Zambia showed significant reduction in the MTCT rate with some specific prevention of mother to child transmission of HIV (PMTCT) interventions. Prolonged breastfeeding and mixed feeding practices by HIV positive mothers increased the MTCT rate by more than double by the time the infant reached 6 to12 months of age. Although the study did not assess the quality of PMTCT counselling in antenatal care settings, literature shows that poor quality of counselling on PMTCT reduces the effectiveness of PMTCT interventions. Study aim: To evaluate the quality of PMTCT counselling offered to pregnant women attending antenatal care (ANC) services in four public health facilities in Kitwe, Copperbelt province of Zambia. Study design and data collection: This was a cross sectional descriptive study. Data was generated using qualitative research methods including document analysis and individual interviews with 22 participants using non-participant observations, client exit interviews and focus group discussions (FGDs) to collect data. The study participants were ANC attendees and PMTCT providers. Two FGDs were conducted with a total of 98 counselling observations done and 16 ANC client exit interviews. Client exit interviews were done immediately after the mothers had undergone PMTCT counselling. Results: Content for group health education (GHE) varied across the facilities. Individual pre-test, post-test and follow up counselling sessions were very short and lacked depth. A total of 41 (83.7%) pre-test observations took between 1 and 5 minutes to be conducted. In addition, several key topics including major modes of HIV transmission, MTCT and the "window period" were omitted. The counsellors' interpersonal skills were generally good but they did not consistently summarize the main issues. The 16 mothers interviewed had limited knowledge of PMTCT with only one client knowing all the MTCT modes correctly. Discussion: Quality of PMTCT counselling did not meet expectations. With a lot of key topics omitted, outcomes of PMTCT interventions may not be as good as expected. Facilities are faced with serious staff shortages and limitations with space. The few members of staff available are overworked and are not able to provide quality PMTCT counselling. Conclusion: While the PMTCT uptake was good and clients felt satisfied, the quality of PMTCT counselling is compromised. There is need to improve it and ensure optimal effectiveness of PMTCT services.