Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Abstract
OBJECTIVES To explore the roles of community cadres
in improving access to and retention in care for PMTCT
(prevent mother-to-child transmission of HIV) services
in the context of PMTCT Option B+ treatment scale-up
in high burden low-income and lower-middle income
countries.
DESIGN/METHODS Qualitative rapid appraisal study
design using semistructured in-depth interviews and
focus group discussions (FGDs) between 8 June and 31
July 2015.
SETTING AND PARTICIPANTS Interviews were conducted
in the offices of Ministry of Health Staff, Implementing
partners, district offices and health facility sites across
four low-income and lower-middle income countries: Cote
D’Ivoire, Democratic Republic of Congo (DRC), Malawi and
Uganda. A range of individual interviews and FGDs with
key stakeholders including Ministry of Health employees,
Implementation partners, district management teams,
facility-based health workers and community cadres. A
total number of 18, 28, 31 and 83 individual interviews
were conducted in Malawi, Cote d’Ivoire, DRC and Uganda,
respectively. A total number of 15, 9, 10 and 16 mixed
gender FGDs were undertaken in Malawi, Cote d’Ivoire,
DRC and Uganda, respectively.
RESULTS Community cadres either operated solely
in the community, worked from health centres or in
combination and their mandates were PMTCT-specific
or included general HIV support and other health issues.
Community cadres included volunteers, those supported
by implementing partners or employed directly by the
Ministry of Health. Their complimentary roles along the
continuum of HIV care and treatment include demand
creation, household mapping of pregnant and lactating
women, linkage to care, infant follow-up and adherence
and retention support.
CONCLUSIONS Community cadres provide an integral link
between communities and health facilities, supporting
overstretched health workers in HIV client support and
follow-up. However, their role in health systems is neither
standardised nor systematic and there is an urgent need to
invest in the standardisation of and support to community
cadres to maximise potential health impacts.
Description
Keywords
Community cadres, Improving access, PMTCT (prevent mother-to-child transmission of HIV), Communities, Health facilitators
Citation
Besada, D. et al. (2018). Roles played by community cadres to support retention in PMTCT Option B+ in four African countries: a qualitative rapid appraisal. BMJ Open, 2018:8 e020754.