Cambodian Ministry of Health (MoH) is working towards the elimination of mother-to-child transmission (eMTCT) of HIV by 2025. According to national policy, following the antiretroviral therapy for HIV-positive pregnant women (PW), HIV-exposed infants (HEI) are given antiretroviral prophylaxis for six weeks (PMTCT Guideline 2011), followed by a first PCR test (PCR1) and cotrimoxazole (CTX) prophylaxis at six weeks of age, and later followed with an HIV-antibody test (AB-Test) at 18 months. Based on the Cambodia MOH national report in 2017, 75.0% of HEIs received ARV Prophylaxis, 35.0% received PCR1 and 41.3% obtained CTX within two months of age. Therefore, we aimed to assess the knowledge and practice of HIV-positive PW and providers' perception about low service uptake for HEIs.
We conducted a sequential mixed method study to quantitatively analyze national data on 1,118 HIV-positive PW and infants pairs registered between 2014 and 2016, supplemented by qualitative study through in-depth interviews with 38 HIV-positive PW and post-delivery women and 9 providers who worked at local antenatal and antiretroviral clinics in four referral hospital in Cambodia. Frequencies and factors associated with low uptake of HEI services were analyzed using STATA 14; qualitative conventional content was analyzed using NVivo 10. We excluded abortions and stillbirths and neonatal deaths from analysis.
We found that among 1,037 HEIs, 72.0% received NVP, 47.0% received PCR1, 50.3% received CTX within two months of age and 7.0% received AB-Test. Three supportive reasons discovered from qualitative study were: a lack of knowledge by women, a lack of clear education and misunderstanding by ART and ANC providers, and inadequate care seeking behavior by women driving to low use of HEI service.
We conclude that HIV-positive PW and providers in all four referral hospitals commonly misunderstand the service delivery needs of HEI. This report is the first describing gaps in knowledge and practices among HIV-positive PW and providers and has uncovered significant barriers to the use of HEI service that can be used to make the necessary changes needed to Cambodian MOH national eMTCT goal.