Workforce Patterns and the Prevention of Mother-to-Child Transmission of HIV Option B Cascade in Côte d'Ivoire

Thesis (Master's)--University of Washington, 2016-08

Background: Côte d’Ivoire continues to face regionally high rates of mother-to-child transmission of HIV despite implementation of a national program to prevent transmission (PMTCT). The aim of this study was to assess the impact of workforce density, distribution and training on PMTCT program success. Methods: Primary and secondary data were collected from a nationally representative sample of 50 PMTCT sites between June 2015 and February 2016. Assessment of the association between workforce factors and PMTCT outcomes (testing, treatment and retention) were assessed using multivariate logistic regression with generalized estimating equations. Results: Statistically significant positive associations were found between HIV testing and the following workforce densities (odds ratios presented are for a difference of 1 healthcare worker per 1000 new antenatal care patients): total density (OR = 1.01, 95% CI 1.01-1.01), physician density (OR = 1.03, 95% CI 1.01-1.05), density of trained staff (OR = 1.09, 95% CI 1.08-1.10) and midwife density (OR = 1.10, 95% CI 1.08-1.12). Negative associations were found between pharmacist density and testing and treatment (OR = 0.91 [0.86-0.96] and 0.83 [0.69-0.99] respectively) and between community health workers and testing (OR = 0.96, 95% CI 0.95-0.97). No associations were found between workforce indicators and retention. Discussion: While this study showed statistically significant associations between workforce patterns and PMTCT service delivery, the effect size of these associations was small. For an average site, the largest positive association (OR of 1.10) equates to increased testing for only 7.7 patients per year per additional healthcare worker trained. The study’s complex results (namely the relatively small positive odds ratios and the negative associations with pharmacist density and CHW density) more importantly highlight the need for additional research aimed at understanding how more complex workforce factors beyond density, as well as non-workforce factors, impact PMTCT success.