She knows that she will not come back: tracing patients and new thresholds of collective surveillance in PMTCT Option B.

Cataldo, Fabian ORCID: 0000-0001-8980-8951, Seeley, Janet, Nkhata, Misheck J, Mupambireyi, Zivai, Tumwesige, Edward, Gibb, Diana M and Lablite team, (2018) She knows that she will not come back: tracing patients and new thresholds of collective surveillance in PMTCT Option B. BMC health services research, 18 (1). 76-.

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Official URL: http://dx.doi.org/10.1186/s12913-017-2826-7

Abstract

<h4>Background</h4>Malawi, Uganda, and Zimbabwe have recently adopted a universal 'test-and-treat' approach to the prevention of mother-to-child transmission of HIV (Option B+). Amongst a largely asymptomatic population of women tested for HIV and immediately started on antiretroviral treatment (ART), a relatively high number are not retained in care; they are labelled 'defaulters' or 'lost-to-follow-up' patients.<h4>Methods</h4>We draw on data collected as part of a study looking at ART decentralization (Lablite) to reflect on the spaces created through the instrumentalization of community health workers (CHWs) for the purpose of bringing women who default from Option B+ back into care. Data were collected through semi-structured interviews with CHWs who are designated to trace Option B+ patients in Uganda, Malawi and Zimbabwe.<h4>Findings</h4>Lost to follow up women give a range of reasons for not coming back to health facilities and often implicitly choose not to be traced by providing a false address at enrolment. New strategies have sought to utilize CHWs' liminal positionality - situated between the experience of living with HIV, having established local social ties, and being a caretaker - in order to track 'defaulters'. CHWs are often deployed without adequate guidance or training to protect confidentiality and respect patients' choice.<h4>Conclusions</h4>CHWs provide essential linkages between health services and patients; they embody the role of 'extension workers', a bridge between a novel health policy and 'non-compliant patients'. Option B+ offers a powerful narrative of the construction of a unilateral 'moral economy', which requires the full compliance of patients newly initiated on treatment.

Item Type:	Article
Uncontrolled Keywords:	Lablite team, Humans, HIV Infections, Contact Tracing, Population Surveillance, Patient Compliance, Qualitative Research, Health Policy, Adult, Uganda, Malawi, Zimbabwe, Female, Male, Infectious Disease Transmission, Vertical, Lost to Follow-Up, Community Health Workers
Depositing User:	Symplectic Admin
Date Deposited:	22 May 2019 15:56
Last Modified:	19 Jan 2023 00:43
DOI:	10.1186/s12913-017-2826-7
Open Access URL:	https://doi.org/10.1186/s12913-017-2826-7
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3042503