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

Cataldo, Fabian; Seeley, Janet; Nkhata, Misheck J.; Mupambireyi, Zivai; Tumwesige, Edward; Gibb, Diana M.

Abstract

Background: 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. Methods: 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. Findings: 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. Conclusions: 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.

Citation

Cataldo, F., Seeley, J., Nkhata, M. J., Mupambireyi, Z., Tumwesige, E., & Gibb, D. M. (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), Article 76. https://doi.org/10.1186/s12913-017-2826-7

• Journal Article Type: Article
• Acceptance Date: Dec 9, 2017
• Online Publication Date: Feb 1, 2018
• Publication Date: Feb 1, 2018
• Deposit Date: Mar 20, 2018
• Publicly Available Date: Mar 23, 2018
• Journal: BMC Health Services Research
• Electronic ISSN: 1472-6963
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 1
• Article Number: 76
• DOI: https://doi.org/10.1186/s12913-017-2826-7
• Public URL: https://durham-repository.worktribe.com/output/1332540