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Barriers and facilitators to implementing advanced HIV disease screening at a secondary referral hospital -Malawi: a
Brany Mithi1, Agatha Bula2, Lester Kapanda3
1Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), P/Bag 360, Chichiri, Blantyre 3, Malawi. branytitus@gmail.com.
Insights
Implementing advanced HIV disease screening in Malawi faces challenges like knowledge gaps and resource limitations. Addressing these barriers is crucial for reducing HIV/AIDS mortality and improving patient outcomes.
Area of Science:
- Public Health
- Implementation Science
- HIV/AIDS Research
Background:
- Malawi experiences significant HIV/AIDS mortality despite expanded Antiretroviral Therapy (ART) services.
- The 2020-2025 Malawi National HIV Strategic Plan (NSP) emphasizes advanced HIV screening.
- Implementation of advanced HIV disease (AHD) screening faces persistent challenges.
Purpose of the Study:
- To explore factors influencing the implementation of the AHD screening package.
- To identify barriers and enablers of AHD screening at Rumphi District Hospital, Malawi.
Main Methods:
- A mixed-method, convergent study design was employed at a secondary referral hospital.
- Semi-structured interviews with healthcare professionals guided by the Consolidated Framework for Implementation Research (CFIR).
- Analysis of 101 newly diagnosed HIV-positive client records from ART cards (July-December 2021).
Main Results:
- 60% of newly diagnosed HIV clients lacked documented CD4 cell count results.
- Key barriers included intervention complexity, poor communication, limited resources, and knowledge gaps.
- Enablers were external support from the Ministry of Health and committed focal leaders.
Conclusions:
- Contextual barriers such as knowledge gaps, poor communication, and inadequate resources hinder AHD screening.
- Overcoming these barriers requires a comprehensive, barrier-tailored strategy to improve AHD screening uptake.
- Effective implementation is vital for reducing HIV/AIDS mortality in Malawi.
Background:
Malawi continues to register HIV/AIDS mortality despite increased expansion of ART services and as well as advanced HIV screening as outlined in the 2020 -2025 Malawi National HIV Strategic Plan (NSP). This study aimed to explore factors influencing the implementation of the advanced HIV disease (AHD) screening package at Rumphi District Hospital, Malawi.
Methods:
We conducted a mixed method, convergent study at a secondary referral hospital with 8 659 clients on ART. Guided by a consolidated framework for implementation research (CFIR) we conducted semi-structured Interviews with healthcare professionals, purposively selected from various key departments that were actively involved in AHD screening. Transcripts were organized and coded using NVivo 12 software with thematically predefined CFIR constructs. Newly HIV-positive client records extracted from ART cards (July -Dec, 2021) were analyzed using STATA 14 software.
Results:
One hundred one ART records met inclusion criteria for review and analysis of which 60% (n = 61) of the newly diagnosed HIV clients had no documented results for CD4 Cell count. Barriers to AHD screening emerged from four major CFIR constructs: intervention complexity, communication, availability of resources and access to knowledge and information. The specific barriers included poor work coordination among implementers, limited resources to support the expansion of AHD screening, and knowledge gap among providers. External support from Ministry of Health implementing partners and the availability of committed focal leaders coordinating HIV programs emerged as major enablers of AHD screening package.
Conclusion:
The study has identified major contextual barriers to AHD screening including knowledge gap, poor communication systems and inadequate supporting resources. Improving uptake of AHD screening services would therefore require overcoming the existing barriers by adopting a comprehensive approach in developing barrier-tailored strategies.
