Increasing access to prevention of mother-to-child transmission of HIV services through the private sector in Uganda
- 1Ministry of Health, Department of Community Health, Kampala, Uganda
- 2London School of Hygiene and Tropical Medicine, Health Policy Unit, London, UK
- 3Makerere University, Institute of Statistics and Applied Economics, Kampala, Uganda
- 4Centre for Health Research and Development; Faculty of Life sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence to Dr A K Mbonye, Ministry of Health, Department of Community Health, Box 7272, Kampala, Uganda;
- Accepted 31 July 2009
- Published Online First 24 August 2009
Objectives: To explore whether private midwives can perform HIV counselling and testing, provide antiretroviral treatment and contraceptives, and how this affects access to services especially among young and HIV-positive women.
Methods: A formative study was conducted between January and April 2009 to assess care-seeking practices and perceptions on the prevention of mother-to-child transmission (PMTCT) and family planning services in Wakiso district, central Uganda. A household survey supplemented by 12 focus group discussions and 66 key informant interviews was carried out between January and April 2009.
Results: 10 706 women, mean age 25.8 years (14–49 years) were interviewed. The majority of women, 4786 (57%) were in the lowest wealth quintile; 62.0% were not using family planning (p<0.000); 56.2% did not access HIV counselling and testing because they feared knowing their HIV status (p<0.013), while 66.5% feared spouses knowing their HIV status (p<0.013). Access to these services among the young women and those with no education was also poor. Private midwives provide HIV testing to 7.8% of their clients; 5.9% received antiretroviral drugs and 8.6% received contraceptives. Client satisfaction with services at private midwifery practices was high. Private midwives are trusted and many clients confide in them. An intervention through private midwives was perceived to improve access because of short distances and no transport costs. Adolescents prioritised confidentiality, while subsidising costs, community sensitisation and focusing on male spouses were overwhelmingly recommended.
Conclusions: Private midwives clinics are potential delivery outlets for PMTCT in Uganda. A well-designed intervention linking them to the public sector and the community could increase access to services.
Funding This study was funded by a grant from The Bill & Melinda Gates Foundation through the Grand Challenges Exploration Initiative.
Competing interests None.
Ethics approval The study was approved by the Uganda National Council of Science and Technology (reference HS485).
Patient consent Obtained.
Provenance and Peer review Not commissioned; externally peer reviewed.