title: Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: the PEARL study.
abstract: BACKGROUND
  Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood.
  
  
  RESULTS
  We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant.
  
  
  CONCLUSIONS
  We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage.
authors.affiliation: Programme PAC-CI, Abidjan, Cote d'Ivoire, France. didier.ekouevi@gmail.com
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.forename: Pius
authors.initials: P
authors.lastname: Tih
authors.forename: Tracy
authors.initials: T
authors.lastname: Creek
authors.forename: Kathryn
authors.initials: K
authors.lastname: Stinson
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.forename: Thomas
authors.initials: T
authors.lastname: Welty
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Cathy
authors.initials: C
authors.lastname: Wilfert
authors.forename: Nathan
authors.initials: N
authors.lastname: Shaffer
authors.forename: Jeff
authors.initials: J
authors.lastname: Stringer
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000349:Africa; D002163:Cameroon; D007560:Cote d'Ivoire; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D013019:South Africa; D015024:Zambia