James Cook University health systems researcher, Associate Professor Stephanie Topp, is lending her skills to an international research effort to improve health outcomes for pregnant women battling HIV in Malawi, which has one of the world’s highest infection rates.
Led by the University of North Carolina (UNC), in collaboration with the Population Council, a global health-focussed non-government organisation, the study aims to identify the most effective models of community health worker care to help keep pregnant women and new mothers enrolled in Malawi’s extensive HIV treatment program.
In 2013, the country became the first in the world to announce that all pregnant women who tested HIV positive would be eligible to receive antiretroviral treatment, in an effort to prevent maternal transmission of the infection to their babies. The initiative was later extended to all HIV sufferers in Malawi.
“But Malawi is a poor country. As more people were coming in the front door to request treatment, there wasn't a commensurate increase in resources at the back end to cope with all these patients, who were now in need of ongoing support and monitoring to ensure they remained in treatment for the rest of their lives,” A/Professor Topp said.
“As a result, a series of non-government groups stepped up to provide community-based support, working alongside government health services that were delivering the actual treatment.”
A/Professor Topp, who spent eight years working as a public health practitioner and researcher in Zambia, prior to joining JCU and becoming a member of AITHM, was invited to develop the qualitative study component of the UNC project.
She is conducting case studies of 10 randomly-selected HIV treatment clinics across Malawi, interviewing some 235 community health workers, their clinical colleagues, practice managers, district health officials and pregnant women currently accessing care.
The country’s community health workers face a massive challenge to retain these women in the HIV treatment program and ensure their infants remain HIV-free. Travelling long distances and foregoing work to attend regular clinical appointments are major hurdles for many poor patients, and the stigma of HIV is high.
“Am I going to be able to work or stay in a loving relationship? How will people judge me? How am I going to handle lifelong medication? If I miss a pill will I die? When your understanding of HIV and HIV treatment only comes from what you've heard from family or village members, it’s easy to be scared and confused,” A/Professor Topp observed.
“Community health workers play a crucial role in explaining complex clinical information to patients; building trust in clinicians and the treatment program.”
She hopes her research findings will help to provide evidence of the skills, work conditions, and institutional support needed to accelerate the scale-up of community health worker models that best promote HIV maternal care retention.
“This research is designed to help policy makers and planners better understand what happens on the ground and the sorts of challenges that are encountered, when different strategies or interventions are put in place,” she said.
Associate Professor Stephanie Topp
Locations: Townsville, JCU