Exploring Factors Influencing the Continued Mother to Child Transmission of the HIV In Senanga, Zambia

Abbreviations

• AIDS – Acquired immune deficiency syndrome
• CIDRZ – Centre for infectious disease research in Zambia
• DHO – District Health Office
• FGD – Focus Group Discussion
• HIV – Human immune virus
• ICF – Informed Consent Form
• IDI – In Depth Interview
• KIs – Key informants
• M.O.H – Ministry of Heath
• PI – Principal investigator
• RA – Research Assistant
• RT – Research Team
• SP – Service provider
• SSI – Semi Structure Interview

Definition of terms

• Acquired immunodeficiency syndrome is a deadly disease caused by human immunodeficiency virus which destroys the immune system in the body (1)
• Mother to child transmission of HIV is the acquisition of the HIV by the baby from her mother who is HIV positive.(4)

Introduction

Background Information

Acquired immunodeficiency syndrome is a deadly disease caused by human immunodeficiency virus which destroys the immune system in the body (1). In 2018 about 37.9 million people were living with HIV globally. Out of these 3.8 million were children. It was estimated that worldwide 980 children got infected with HIV while 320 died from AIDS related conditions every day(2). In 2017, in Sub Saharan Africa of which Zambia is part of the region HIV positive mothers delivered 1.4 million infants and these were exposed to HIV(3). Mother to child transmission of HIV is the acquisition of the HIV by the baby from her mother who is HIV positive.(4) The possible ways of transmitting HIV from a mother who is HIV positive to her baby are during pregnancy, during child delivery and through breast milk when the woman is breastfeeding (5). There are factors that contributes to the transmission of HIV from mother to child: inappropriate feeding practices (mixed feeding), non-availability of ARV prophylaxis, deliveries conducted at home and no interventions done during antenatal visits(6). Zambia, which is still developing was ranked 143 out of 189 in the human development index in 2019(7).

Statement of the problem

Zambia is one of the countries largely affected with the HIV epidemic, with an estimate of about 630,000 adults being infected, with 5.7% of this number being women and 2.5 % being men.(8) Children from 0 to 14 years have been severely affected by the HIV epidemic in Zambia, where 72,000 children are estimated to be living with HIV, alongside 250,000 children orphaned by AIDS(9). In Zambia there was a significant decrease of HIV transmission in children by 51% between 2011 and 2012 after implementation programme of prevention of mother to child transmission of HIV(10).Despite all the developments Zambia has started experiencing problems faced by babies who are exposed at birth by HIV. Some infants have been reported to finding difficulties in getting along with treatment. In 2014, 40% of the babies were discovered that they had resistance to at least one ART medication in contrast to 21.5% in 2009. In 2017, there were 3,400 deaths recorded due to sicknesses related to AIDS. This was attributed to medication which was unreachable and unsuccessful (10). Western province in Zambia is the second highest region with HIV/AIDS with 16% while the capital city Lusaka first with 16.1% (11) Senanga district has a population of 126,506 (12) and poverty levels 82% (13) with hard to rich areas. Although no studies have been conducted statistical data collected at Senanga District Health records in 2018 shows that a total number 171 exposed babies who registered for under 5 clinic, 5 tested negative after prophylaxis, 2 babies were on ART and the rest have poor adherence to treatment. Therefore, there is rapidly a need to scale up the elimination of Mother to Child transmission program in Senanga so that it reaches every woman who needs it.(14) This can only be achieved through expansion and integration of antiretroviral therapy (ART) services into Maternal and child health (MCH) and related health care services (15).

Justification

The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS), is worldwide problem and affects all age groups regardless of the race or region(16) The figures are very high and will continue to rise unless the community and its members are sensitized and they in turn put this into practice, then we are assured that levels of HIV and AIDS in Senanga will reduce. This study needs to be conducted so that factors contributing to the problem can be addressed as quickly as possible to save the lives of the babies. There is significant evidence that the high HIV prevalence in western province is bothering supremacy(17). In western province no research has been conducted hence the need for this proposal.

Study Objectives

General Objective

1. To explore factors contributing to the continued MTCT of HIV in Senanga, Zambia in order to identify protective factors as well as potential risk factors of continued MTCT of HIV and consider recommendations.

Specific Objectives

1. To identify the socio economic and cultural factors that contribute to continued MTCT
2. To explore knowledge and perception of HIV positive pregnant women as well as HIV positive breast feeding mothers about MTCT
3. To make recommendations to the district health office by using the research findings

Methodology

Study type

This qualitative study will be carried out in a period of six months in order to achieve the set objectives in the study. This will give ample time for the researcher to gather in – depth information and to have a clear understanding of the study.

Study area

The study area for this qualitative research will be Senanga district at Senanga urban clinic. The place is convenient because pregnant women access antenatal services from this place. Breastfeeding mothers also take their children for under-five clinic at the same healthy facility. The district has distinct cultures and people of the same socio economic status in the communities where they reside.

Sampling and Recruitment

Respondents will be selected using a purposeful sampling strategy because we want to reach out breastfeeding mothers and pregnant women who are HIV positive. The main respondents will be HIV positive pregnant women and breastfeeding mothers who are HIV positive. The respondents will be recruited through the HIV support groups in conjunction with Centre for infectious Disease Research in Zambia (CIDRZ) which is the existing NGO in Senanga. The NGO is working hand in hand with the district health office. It will be done this way since it is a very sensitive issue. The key informants will be recruited through the district health office.

Data collection methods

In-depth – interview

In depth – interview will be used because it allows individuals to contribute their opinions without influence from other participants. Using a topic guide which has been reworded properly (well) will be administered to HIV positive pregnant women and breastfeeding mothers who are HIV positive to explore decision making, traditional practice, cultural beliefs and knowledge regarding factors contributing to continued MTCT.This interview will be conducted in a suitable environment to ensure secrecy and confidentiality. The team will have an interviewer and a person taking notes to ensure that no information given out is missed. Each interview will take one hour. The interview will be recorded using a tape recorder and watching of the body language will be done in order to take note of any communication during the interview.

Focus Group Discussion (FGD)

During focus group discussion a number of open ended questions will be used in order to tackle issues related to the objectives. Topic guide will be reworded to lozi language which is a local language and pretested before it is administered in the field. The open ended questions will be used to explore knowledge, perception, social and cultural beliefs of HIV positive breastfeeding mothers and HIV positive pregnant women about MTCT. The group will have 8 respondents and the interview will take one hour. Focus group discussion will be administered to HIV positive pregnant women and breastfeeding mothers who are HIV positive. The moderator from the same sex will facilitate the focus group discussion. The discussion will be recorded using a tape recorder and a note taker will be present to take the notes so that no information is left out.

Semi-structured interview (SSI)

The research team will administer the semi structured interviews to the district health officers and service providers who are the key informants. This will done in order to explore factors with reference to the knowledge on continued MTCT, cultural and economic factors.

Data Processing and Analysis

Approval to conduct this research will be gotten from the authorities as well as individuals. The principal investigator will be responsible for getting permission since he will be part of the team. Pre testing data collection and analysis will commence two weeks before field work begins. This will grant the research team as well as the research assistants’ time for making corrections. Data collected will be reliable, valid and of good quality. It will also be checked for correctness and consistence. The collected data will be properly secured. Transcripts will be arranged according to their codes and will be entered using the same codes. A coding system will be developed and data will be computerized for analysis. Nvivo 11 will be used to summarize the all gathered information and explanation of the results will be done manually.

Ethical consideration

Permission will be granted by the ethical committee in Zambia in order to carry out this research. Consultations from the local informants will be done on the best way this study can be done since it is very sensitive. The researcher will have full responsibility over the use of data collected. The participants will be told the necessity of the study, objective, the way it will be done, potential benefits and risks of the study. The researcher will also ensure that the participants should have the first study results. Focused group discussion and interviews will be conducted in a conducive environment. Use of names and addresses will not be considered so that participants are guaranteed of secrecy and confidentiality. Coding of the records will be done for smooth entry of data. After a period of one year manuscripts and documents will be destroyed. A standardized Informed consent form World Health Organization (WHO) will be modified and reworded into lozi language which is their local language from English.

Quality assurance

Quality assurance is an important segment in this study and it will be considered at all levels of the study. The topic guide of the interviews and the focused group discussion will be formulated by the research team. This will be reworded from English into lozi language which is their local language. The research team will be trained so that they are well vested with the objectives as well as their part to play during the study. Before commencement of the study the tools and methods to be administered during the study will be pre tested at the clinic which has the similar setting. We will make alterations to the tools considering the feedback. The data collected from all methods will be arranged in pairs so that matching can be done easily. The research team will write the report after data collection which will be presented to the DHO and CIRZD for discussion.

Dissemination and use of data

A meeting will be organized for presentation of research findings. The findings will be presented to the district health office and the local NGO (CIRDZ) then it will be acknowledged for review in readiness for publication in the journal.

References

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