Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda.
BACKGROUND
To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda.


METHODS
Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach.


RESULTS
The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families.


CONCLUSIONS
Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.
Nuwagaba-Biribonwoha
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International Center for AIDS Care and Treatment Programs (ICAP), Columbia University, Dar es Salaam, United Republic of Tanzania. hn2158@columbia.edu
Mayon-White
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RT
Okong
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Carpenter
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LM
D001364:Awareness; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007318:Inservice Training; D008297:Male; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D011295:Prenatal Care; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D013637:Tape Recording; D014454:Uganda